History of suicide attempts and COVID-19 infection in Veterans with schizophrenia or schizoaffective disorder: effect modification by age and obesity

Okusaga, O. O.; Kember, R. L.; Peloso, G. M.; Peterson, R. E.; Vujkovic, M.; Mitchell, B. G.; Bernard, J.; Walder, A.; Bigdeli, T. B.

Introduction: Patients with schizophrenia or schizoaffective disorder have a high risk of suicide, and a history of suicide attempt is a strong predictor of suicide; therefore, determining whether a history of suicide attempt is associated with COVID-19 in patients with schizophrenia or schizoaffective disorder has implications for suicide prevention in this patient population. Methods: We carried out cross-sectional analyses of electronic health records (EHR) of Veterans with a diagnosis of schizophrenia or schizoaffective disorder that received treatment at any United States Veterans Affairs Medical Center from January 1, 2020 to January 31, 2021. Logistic regression was applied to estimate unadjusted and adjusted (including age, sex, race, marital status, BMI, and a medical comorbidity score) odds ratios (ORs) for COVID-19 positivity in suicide attempters relative to non-attempters. Results: A total of 101,032 Veterans [mean age 56.67 SD 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. There was effect modification by age and BMI in the association of history of suicide attempt with COVID-19 positivity such that the association was only significant in patients younger than 59 years and in obese (BMI [≥] 30) patients respectively (adjusted OR 3.42, 95% CI 2.02 - 5.79 and OR 2.85, 95% CI 1.65 - 4.94 respectively). Conclusions: Young or obese suicide attempters with a diagnosis of schizophrenia or schizoaffective disorder have higher rates of COVID-19 diagnosis; due to possible long-term neuropsychiatric sequelae of infection with SARS-CoV-2, such patients should be monitored closely.