History of Suicide Attempts and COVID-19 Infection in Veterans with Schizophrenia or Schizoaffective Disorder: Moderating Effects of Age and Body Mass Index

  1. Olaoluwa O. Okusaga
  2. Rachel L. Kember
  3. Gina M. Peloso
  4. Roseann E. Peterson
  5. Mariana Vujkovic
  6. Brian G. Mitchell
  7. Jared Bernard
  8. Annette Walder
  9. Tim B. Bigdeli

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Abstract

<b><i>Introduction:</i></b> Relative to the general population, patients with schizophrenia or schizoaffective disorder have higher rates of suicide attempts and mortality from COVID-19 infection. Therefore, determining whether a history of suicide attempt is associated with COVID-19 in patients with schizophrenia or schizoaffective disorder has implications for COVID-19 vulnerability stratification in this patient population. <b><i>Methods:</i></b> We carried out cross-sectional analyses of electronic health records of veterans with a diagnosis of schizophrenia or schizoaffective disorder that received treatment at any United States Veterans Affairs Medical Center between January 1, 2020, and January 31, 2021. We used logistic regression to estimate unadjusted and adjusted (including age, sex, race, marital status, body mass index (BMI), and a medical comorbidity score) odds ratios (ORs) for COVID-19 positivity in suicide attempters relative to nonattempters. <b><i>Results:</i></b> A total of 101,032 veterans (mean age 56.67 ± 13.13 years; males 91,715 [90.8%]) were included in the analyses. There were 2,703 (2.7%) suicide attempters and 719 (0.7%) patients were positive for COVID-19. The association between history of suicide attempt and COVID-19 positivity was modified by age and BMI, such that the relationship was only significant in patients younger than 59 years, and in obese (BMI ≥30) patients (adjusted OR 3.42, 95% CI 2.02–5.79 and OR 2.85, 95% CI 1.65–4.94, respectively). <b><i>Conclusions:</i></b> Higher rates of COVID-19 in young or obese suicide attempters with a diagnosis of schizophrenia or schizoaffective disorder might be due to the elevated risk for the infection in this subgroup of patients.

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  1. Version published to 10.1159/000521230
  2. ScreenIT

    SciScore for 10.1101/2021.08.25.21262627: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Approval for the study was granted by the Institutional Review Board (IRB) of Baylor College of Medicine and the Michael E.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed with IBM SPSS, Version 27 (IBM Corp., Armonk, NY, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study is subject to several limitations. First, the cross-sectional design makes it impossible to infer a causal association between suicide attempt and COVID-19. Second, we do not have data on the specific nature and severity of suicide attempts. Third, the sample was predominantly male which limits the generalizability of our results. Fourth, we were unable to adjust for psychotropic medications, especially clozapine which has been associated with increased likelihood of testing positive for COVID-19.27 Finally, we did not have information on illness severity and so did not adjust for it. Related to the last limitation is our inability to control for inpatient vs. outpatient status since inpatients are more likely to get tested for COVID. In summary, our findings provide preliminary evidence of an association between history of suicide attempt and COVID-19 in a subgroup of patients with schizophrenia or schizoaffective disorder and therefore support the expansion of strategies to ensure vaccination of patients with schizophrenia or schizoaffective disorder, especially given the fact that patients with schizophrenia are under vaccinated against COVID-19.28 Future well-powered, prospective studies are needed to confirm our observed association between history of suicidal behavior and COVID-19 in patients with schizophrenia or schizoaffective disorder and also to elucidate the underlying mechanisms of the association.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.08.25.21262627 on medRxiv