The association between schizophrenia and increased Covid-19 mortality in a cohort of over 2 million people in Brazil

Objective: To determine clinical outcomes and mortality risk factors related to mental disorders in a cohort of hospitalized patients with Covid-19 in Brazil. Methods: This retrospective cohort study used a Brazilian database called the Sistema de Vigilância Epidemiológica da Gripe (Influenza Epidemiological Surveillance System) to analyze patients aged ≥ 18 years who were hospitalized with Covid-19 between 2020 and 2022. The exposure of interest was mental disorders (anxiety, depression, schizophrenia, and bipolar disorder) identified through self-report. The primary outcome was in-hospital mortality. Covariates included demographic and clinical characteristics. Descriptive statistics, t-tests, chi-square tests, and binary logistic regression were used to analyze the data. Results: A cohort of 2,124,285 patients was included in the analysis, with 23,246 individuals (1.1%) self-reporting mental disorders, of which depression was the most prevalent (52.3%). The mortality rate of patients with mental disorders was 30.8%. Age, sex, region, dyspnea, low oxygen saturation, and comorbidities were associated with a higher mortality risk, as was schizophrenia (adjusted OR: 1.68; 95%CI 1.54-1.81). Conclusions: Individuals with schizophrenia had a greater likelihood of Covid-19-related death than those without mental health conditions. These findings underscore the significant effect of serious mental disorders on Covid-19 mortality.