People with mental illness are known to have poorer physical health outcomes. Among them, patients with schizophrenia spectrum disorders are disproportionately burdened. A number of recent studies have highlighted that patients with schizophrenia are particularly at risk from COVID-19. The aim of this systematic review is to clarify whether patients with schizophrenia spectrum disorders are at greater risk for poor COVID-19 outcomes. We conducted a systematic review of the literature following the PRISMA guidelines, using PubMed, PsycINFO (via Ovid) and Scopus as databases, to identify all studies which investigated infection and/or mortality rate from SARS-CoV-2 in patients with schizophrenia spectrum disorders. Following a formal screening process, seven studies met our inclusion criteria. The results of these seven studies were reported using odds ratios or adjusted odds ratios. The collective results indicated a moderate, but statistically significant effect for higher infection rates, and a strong statistically significant effect for higher mortality rates in patients with schizophrenia. Our findings indicate that people with schizophrenia have a high risk of being infected by the new coronavirus and have a significantly higher mortality rate than the general population. There are contradictory findings concerning other outcomes, including the frequency of intensive care unit admissions for this group. Collectively, these results indicate that people with schizophrenia spectrum disorders may be more vulnerable to being infected and more likely to die due to COVID-19, and yet their access to Intensive Care Units does not seem to be higher. We conclude that patients with schizophrenia constitute a vulnerable group for COVID-19 related infection and mortality, consequently there is a necessity for this vulnerable group of people to have better access to healthcare, including priority in nationwide COVID-19 vaccination programs and expedited intensive care treatment. Our conclusion adds to the ongoing debate arguing for equitable access to healthcare for people with schizophrenia spectrum disorders.

KEYWORDS: schizophrenia, COVID-19, mortality, infection, equity, access to care, vaccination

Sokratis E. Karaoulanis, Nikos G. Christodoulou


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