COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People

• DOI: 10.1001/jamapsychiatry.2024.2339
• Publication Date: 2024-08-21T22:41:59Z
• Authors: Venexia M. Walker; Praveetha Patalay; Jose Ignacio Cuit...; Rachel Denholm; Harriet Forbes; Jean Stafford; Bettina Moltrecht; Tom Palmer; Alex Walker; Ellen J. Thompson; Kurt Taylor; Genevieve Cezard; Elsie M. F. Horne; Yinghui Wei; Marwa Al Arab; Rochelle Knight; Louis Fisher; Jon Massey; Simon Davy; Amir Mehrkar; Seb Bacon; Ben Goldacre; Angela Wood; Nishi Chaturvedi; John Macleod; Ann John; Jonathan A. C. St...; ; Agnieszka Lemanska; Alex Kwong; Alexia Sampri; Alicja Rapala; Alisia Carnemolla; Alun Hughes; Amelia Green; Amos Folarin; Amy Roberts; Ana Goncalves Soares; Andrew Steptoe; Andrew Wong; Andy Boyd; Andy Gibson; Anika Knueppel; Anoop Shah; Archie Campbell; Arun Kanagaratnam; Arun Karthikeyan ...; Bang Zheng; Betty Raman; Bo Hou; Bozena Wielgoszewska; Brain Mackenna; Callum Stewart; Chao Fang; Charis Bridger-St...; Charlotte Booth; Chelsea Beckford; Chloe Park; Claire Steves; Colm Andrews; Daniel McCartney; Daniel Kopasker; Diane Foster; Dominik Piehlmaier; Dylan Williams; Edward Parker; Elena Rafeti; Elena Lukaschuk; Elizabeth Tunnicl...; Ellena Badrick; Emily Herrett; Emma L Turner; Eoin McElroy; Fatima Almaghrabi; Felix Greaves; Fintan McArdle; Fiona Glen; Francisco Perez-R...; Gareth Griffith; George Ploubidis; Gillian Santorelli; Giorgio Di Gessa; Hannah Woodward; Helen Curtis; Annie Herbert; Ian Douglas; Jacqui Oakley; James M Wild; Jane Maddock; JD Carpentieri; Jess Morley; Jingmin Zhu; John Tazare; John Wright; John Kellas; Jonathan Kennedy; Kate Northstone; Kate Tilling; Kate Mansfield; Katharine M Evans; Kathryn Mansfield; Kathryn Willan; Kevin Wang; Kirsteen C Campbell; Kishan Patel; Laura Fox; Laura Sheard; Laura C Saunders; Laurie Tomlinson; Lee Hamill Howes; Liam Smeeth; Lidia Nigrelli; Linda Nab; Lisa Hopcroft; Lizzie Huntley; Louise Jones; Lucy Finnigan; Lucy Teece; Mark Green; Matthew Crane; Maxim Freydin; Michael Parker; Michael Green; Milla Kibble; Nathan Cheetham; Nicholas Timpson; Olivia Hamilton; Paola Zaninotto; Paz Garcia; Peter Jezzard; Rebecca Whitehorn; Rebecca Rhead; Renin Toms; Richard Thomas; Richard Silverwood; Richard Dobson; Robert Willans; Robin Flaig; Rosie McEachan; Ruth Mitchell; Ruth Bowyer; Ruth Costello; Sam Parsons; Samantha Berman; Samantha Ip; Sarah Baz; Scott Walker; Shah Syed Ahmar; Richard Shaw; Sheikh Aziz; Sinead Langan; Sinead Brophy; Spiros Denaxas; Stefan Neubauer; Stefan Piechnik; Stela McLachlan; Stephen Smith; Steve Sharp; Teri North; Theocharis Kromydas; Thomas Cowling; Tiffany Yang; Tom Bolton; Vanessa Ferreira; Vittal Katikireddi; Viyaasan Mahaling...; Wels Jacques; William Hulme; Yatharth Ranjan; Zeena-Britt Sanders
• Keywords: Adult; Male; Supplementary Information; Adolescent; 330; https://cdn.jamanetwork.com/ama/content_public/journal/psych/0/yoi240050supp2_prod_1723059057.8842.pdf?Expires=1728984774&Signature=zKNTzmA-xusbyA6-FtD1lyTHlcQBdZgJPo2oM3RMCAvjcdWFnJso2AjfXR-IPyUjMWtN1cqwB9A9J8mz-wyxiyQF5ey65XlA5u-TtGQZ6He72F~RKZ3M2tHnF6YAodlZTvEy1KXhPnCkAtjGKeXZJ3VPkZW0dWTuM3RTO0ZVT0wqkjf5wecWecq2cp8oc50uLyxqX0GNziA4AlsbCz0pth6xbT3GnU1i5ittzkiwN5XB-2Ttwjo9Q0eQFjNpF0Ibd53H1ATqUuMvOi~0EracVrHUC-UL1sBxgZmnD1OjLw4KbWGUzdjyzlAHuFJE7vbDfq67zRkk3c7xK63QQj3f8Q__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA; 610; R Medicine (General); 613; Cohort Studies; Young Adult; 03 medical and health sciences; 0302 clinical medicine; SDG 3 - Good Health and Well-being; 80 and over; https://cdn.jamanetwork.com/ama/content_public/journal/psych/0/yoi240050supp3_prod_1723059057.8903.pdf?Expires=1728984774&Signature=KNsAamjYX5LYVlJ~Y4nSR8Srham04bXYAVVVD2jFjaVA5QDO0eAePonRKMiNXk-UqZ2TqpINnWcJ1DtsKKzSNeMkq9ganJRRWNeupApQu6mGZkGodO5sglGyMW8POw~XWWfbxaQQEfiG3FZ0dXk8evha2E4NfLmVemmvQR6OlS5zHygvGFZynHh80OifehVeB-DZSrS4kiOk75tLIjmw6y7vtcs6r4hKORQMV7~mUmZrCjXYX-7kSKZbOUJ3xY2UgcbeA9Qqys4x~y19g7P4jN-Xn2O3UH06nZv7QHv-rB8dFWGAavxbqgBIaN-qbdY6I9reIlIwm7tc67k23k2YAA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA; Humans; England/epidemiology; Aged; COVID-19 Vaccines/administration & dosage; COVID-19/epidemiology; Original Investigation; SARS-CoV-2; Middle Aged; https://cdn.jamanetwork.com/ama/content_public/journal/psych/0/yoi240050supp1_prod_1723059057.74559.pdf?Expires=1728984774&Signature=3wu-yX9C8MUyZJa0vgmBiQUzH3MER8tbLEZokx6Af1EmA9U2Ju4~i30ABlkz3fpcWFMLf1psjHU54CTQTDz74yAqPZoXCDnU7sxbf2d~muasM1EpTao-lXTLgrHQVl6AQzqoQVgha3Vpf5X2Nqi7boFutI6kxxNIVNdj1de7wAfWxa-5P43EE87wIQRcD3FKafukPG8CBuIBXJ8kqcJHMpebeYfPwk4NHehFiG2nRVMJxeOKyDcbkvPkxa2G2nD9NQfhbRL97k621nXrDFHsCuiH-~ViTkq87SgkrVt9ZFnmwbai6CLYlNb5HG6vsUGzcyg1AAR3T5K9a3IUF4fVfw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA; R1; Psychiatry and Mental health; Vaccination/statistics & numerical data; Female; Mental Disorders/epidemiology

ImportanceAssociations 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.ObjectiveTo determine which mental illnesses are associated with diagnosed COVID-19 by vaccination status in both hospitalized patients and the general population.Design, Setting, and ParticipantsThis 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.ExposureConfirmed COVID-19 diagnosis recorded in primary care secondary care, testing data, or the death registry.Main Outcomes and MeasuresAdjusted 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.ResultsThe 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 RelevanceIn 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.