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. 2024 Nov 1;81(11):1071-1080.
doi: 10.1001/jamapsychiatry.2024.2339.

COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People

Venexia M Walker  1   2   3 , Praveetha Patalay  4   5 , Jose Ignacio Cuitun Coronado  1 , Rachel Denholm  1   6   7 , Harriet Forbes  8 , Jean Stafford  4 , Bettina Moltrecht  5 , Tom Palmer  1   2 , Alex Walker  9 , Ellen J Thompson  10   11 , Kurt Taylor  1 , Genevieve Cezard  12   13 , Elsie M F Horne  1   4 , Yinghui Wei  14 , Marwa Al Arab  1 , Rochelle Knight  1   3   6   15 , Louis Fisher  9 , Jon Massey  9 , Simon Davy  9 , Amir Mehrkar  9 , Seb Bacon  9 , Ben Goldacre  9 , Angela Wood  12   13   16   17   18   19 , Nishi Chaturvedi  4 , John Macleod  15 , Ann John  20 , Jonathan A C Sterne  1   6   7 ; Longitudinal Health and Wellbeing COVID-19 National Core Study
Collaborators, Affiliations

COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People

Venexia M Walker et al. JAMA Psychiatry. .

Abstract

Importance: Associations have been found between COVID-19 and subsequent mental illness in both hospital- and population-based studies. However, evidence regarding which mental illnesses are associated with COVID-19 by vaccination status in these populations is limited.

Objective: To determine which mental illnesses are associated with diagnosed COVID-19 by vaccination status in both hospitalized patients and the general population.

Design, setting, and participants: This study was conducted in 3 cohorts, 1 before vaccine availability followed during the wild-type/Alpha variant eras (January 2020-June 2021) and 2 (vaccinated and unvaccinated) during the Delta variant era (June-December 2021). With National Health Service England approval, OpenSAFELY-TPP was used to access linked data from 24 million people registered with general practices in England using TPP SystmOne. People registered with a GP in England for at least 6 months and alive with known age between 18 and 110 years, sex, deprivation index information, and region at baseline were included. People were excluded if they had COVID-19 before baseline. Data were analyzed from July 2022 to June 2024.

Exposure: Confirmed COVID-19 diagnosis recorded in primary care secondary care, testing data, or the death registry.

Main outcomes and measures: Adjusted hazard ratios (aHRs) comparing the incidence of mental illnesses after diagnosis of COVID-19 with the incidence before or without COVID-19 for depression, serious mental illness, general anxiety, posttraumatic stress disorder, eating disorders, addiction, self-harm, and suicide.

Results: The largest cohort, the pre-vaccine availability cohort, included 18 648 606 people (9 363 710 [50.2%] female and 9 284 896 [49.8%] male) with a median (IQR) age of 49 (34-64) years. The vaccinated cohort included 14 035 286 individuals (7 308 556 [52.1%] female and 6 726 730 [47.9%] male) with a median (IQR) age of 53 (38-67) years. The unvaccinated cohort included 3 242 215 individuals (1 363 401 [42.1%] female and 1 878 814 [57.9%] male) with a median (IQR) age of 35 (27-46) years. Incidence of most outcomes was elevated during weeks 1 through 4 after COVID-19 diagnosis, compared with before or without COVID-19, in each cohort. Incidence of mental illnesses was lower in the vaccinated cohort compared with the pre-vaccine availability and unvaccinated cohorts: aHRs for depression and serious mental illness during weeks 1 through 4 after COVID-19 were 1.93 (95% CI, 1.88-1.98) and 1.49 (95% CI, 1.41-1.57) in the pre-vaccine availability cohort and 1.79 (95% CI, 1.68-1.90) and 1.45 (95% CI, 1.27-1.65) in the unvaccinated cohort compared with 1.16 (95% CI, 1.12-1.20) and 0.91 (95% CI, 0.85-0.98) in the vaccinated cohort. Elevation in incidence was higher and persisted longer after hospitalization for COVID-19.

Conclusions and relevance: In this study, incidence of mental illnesses was elevated for up to a year following severe COVID-19 in unvaccinated people. These findings suggest that vaccination may mitigate the adverse effects of COVID-19 on mental health.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr A. Walker reported grants from the National Institute for Health and Care Research (NIHR) during the conduct of the study. Dr Mehrkar reported grants obtained from the Bennett Foundation, Wellcome Trust, NIHR Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, Mohn-Westlake Foundation, and National Health Service (NHS) England during the conduct of the study and consultancy fees from Induction Healthcare and is a senior clinical researcher at the University of Oxford in the Bennett Institute and from the Royal College of General Practitioners (RCGP)/British Medical Association (member of the RCGP health informatics group) and the NHS Digital General Practice Extraction Service (advisory group that advises on access to general practice data for pandemic planning and research outside the submitted work. Dr Chaturvedi reported grants from UK Research and Innovation (UKRI) during the conduct of the study and personal fees from AstraZeneca (data monitoring and safety committee member) outside the submitted work. Dr Sterne reported grants from the UK National Institute for Health and Care Research, UKRI Medical Research Council, and Health Data Research UK during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Maximally Adjusted Hazard Ratios and 95% CIs for Depression and Serious Mental Illness Following Diagnosis of COVID-19, Overall, and by COVID-19 Severity
Figure 2.
Figure 2.. Maximally Adjusted Hazard Ratios and 95% CIs for Depression and Serious Mental Illness Following Diagnosis of COVID-19 by History of the Outcome
Figure 3.
Figure 3.. Maximally Adjusted Hazard Ratios and 95% Confidence Intervals for Other Mental Illness Events Following Diagnosis of COVID-19
See this image and copyright information in PMC

Comment in

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