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

Abstract

Introduction: 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. 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 between January 1, 2020 to 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 non-attempters. Results: 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). Conclusions: Higher rates of COVID-19 in young or obese suicide attempters with a diagnosis of schizophrenia or schizoaffective disorder might be due to elevated risk for the infection in this sub-group of patients.

Visuospatial ability and attention as risk factors for suicidal ideation in middle-aged and elderly schizophrenia patients: a cross-sectional study

“…In this study, we found that 23.5% of SZ patients had suicidal ideation, which is consistent with the results of previous studies [ 25 , 36 – 38 ].Moreover, we found that young SZ patients had higher risk of suicidality than middle-aged and elderly SZ patients, which is consistent with the previous studies [ 2 , 39 ].Meanwhile, young age was a risk factor for suicidal ideation in middle-aged and elderly SZ patients. A positive effect of age on mental health-related quality of life (HRQOL) has been found in the previous study [ 40 ].…”

The effect of the COVID-19 pandemic on health behavior and psychopathology in patients with psychotic disorders

“…Nevertheless, none of the studies reviewed within the scope of this meta-analysis addressed the suicidal behavior in psychotic disorders. In a study in which the relationship between suicide attempts and being infected with COVID-19 in veterans with schizophrenia and schizoaffective disorder was investigated, the rate of suicide attempts during the pandemic was reported as 2.7% ( Okusaga et al, 2021 ). In comparison, in this study, the rates of patients with suicidal ideation during the pandemic period was found as 40.7%, and patients who attempted suicide during the pandemic period were found as 11.3%, and the rates were higher than those reported in the literature.…”

Machine Learning Algorithm-Based Prediction Model for the Augmented Use of Clozapine with Electroconvulsive Therapy in Patients with Schizophrenia

“…In addition, a differential association between BMI and fronto-limbic white matter microstructure was found among patients with first-episode schizophrenia spectrum disorders [ 24 ]. Furthermore, BMI and age had the moderating effects of an association between a history of suicidal attempts and COVID-19 infection among patients with schizophrenia or schizoaffective disorder [ 25 ]. Therefore, BMI and other sociodemographic and clinical data were included as one of the variable profiles for the substantial prediction model.…”