SARS-CoV-2 seroprevalence among patients with severe mental illness: A cross-sectional study

Marie Reeberg Sass, Tobias Søgaard Juul, Robert Skov, Kasper Iversen, Lene Holm Harritshøj, Erik Sørensen, Sisse Rye Ostrowski, Ove Andersen, Claus Thorn Ekstrøm, Henrik Ullum, Jimmi Nielsen, Ida Hageman, Anders Fink-Jensen, Marie Reeberg Sass, Tobias Søgaard Juul, Robert Skov, Kasper Iversen, Lene Holm Harritshøj, Erik Sørensen, Sisse Rye Ostrowski, Ove Andersen, Claus Thorn Ekstrøm, Henrik Ullum, Jimmi Nielsen, Ida Hageman, Anders Fink-Jensen

Abstract

Patients with severe mental illness (SMI) i.e. schizophrenia, schizoaffective disorder, and bipolar disorder are at increased risk of severe outcomes if infected with coronavirus disease 2019 (COVID-19). Whether patients with SMI are at increased risk of COVID-19 is, however, sparsely investigated. This important issue must be addressed as the current pandemic could have the potential to increase the existing gap in lifetime mortality between this group of patients and the background population. The objective of this study was to determine whether a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder is associated with an increased risk of COVID-19. A cross-sectional study was performed between January 18th and February 25th, 2021. Of 7071 eligible patients with schizophrenia, schizoaffective disorder, or bipolar disorder, 1355 patients from seven psychiatric centres in the Capital Region of Denmark were screened for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. A total of 1258 unvaccinated patients were included in the analysis. The mean age was 40.5 years (SD 14.6), 54.3% were female. Fifty-nine of the 1258 participants had a positive SARS-CoV-2 antibody test, corresponding to a adjusted seroprevalence of 4.96% (95% CI 3.87-6.35). No significant difference in SARS-CoV-2-risk was found between female and male participants (RR = 1.32; 95% CI 0.79-2.20; p = .290). No significant differences in seroprevalences between schizophrenia and bipolar disease were found (RR = 1.12; 95% CI 0.67-1.87; p = .667). Seroprevalence among 6088 unvaccinated blood donors from the same region and period was 12.24% (95% CI 11.41-13.11). SARS-CoV-2 seroprevalence among included patients with SMI was significantly lower than among blood donors (RR = 0.41; 95% CI 0.31-0.52; p < .001). Differences in seroprevalences remained significant when adjusting for gender and age, except for those aged 60 years or above. The study is registered at ClinicalTrails.gov (NCT04775407). https://ichgcp.net/clinical-trials-registry/NCT04775407?term=NCT04775407&draw=2&rank=1.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flowchart of patients with severe…
Fig 1. Flowchart of patients with severe mental illness.
All unvaccinated patients with severe mental illness who fulfilled all criteria to be enrolled in the study, and with a positive or negative SARS-CoV-2 antibody test result, were included in the statistical analysis.
Fig 2. Seroprevalences for included patients with…
Fig 2. Seroprevalences for included patients with severe mental illness compared with blood donors of the Capital Region of Denmark.
Seroprevalences adjusted for test sensitivity and specificity with 95% confidence intervals among all included patients with severe mental illness (n = 1258), according to ICD-10 diagnosis (schizophrenia n = 725, bipolar disorder n = 484) and blood donors (n = 6088).

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