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Impact of COVID-19 on mental illness in vaccinated and unvaccinated people: a population-based cohort study in OpenSAFELY

Walker, V.; Patalay, P.; Cuitin Coronado, J. I.; Denholm, R.; Forbes, H.; Stafford, J.; Moltrecht, B.; Palmer, T.; Walker, A.; Thompson, E. J.; Taylor, K.; Cezard, G.; Horne, E. M.; Wei, Y.; Al Arab, M.; Knight, R.; Fisher, L.; Massey, J.; Davy, S.; Mehrkar, A.; Bacon, S.; Goldacre, B.; Wood, A.; Chaturvedi, N.; Macleod, J.; John, A.; Sterne, J. A.

2023-12-07 epidemiology
10.1101/2023.12.06.23299602 medRxiv
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BackgroundCOVID-19 is associated with subsequent mental illness in both hospital- and population-based studies. Evidence regarding effects of COVID-19 vaccination on mental health consequences of COVID-19 is limited. MethodsWith the approval of NHS England, we used linked electronic health records (OpenSAFELY-TPP) to conduct analyses in a pre-vaccination cohort (17,619,987 people) followed during the wild-type/Alpha variant eras (January 2020-June 2021), and vaccinated and unvaccinated cohorts (13,716,225 and 3,130,581 people respectively) during the Delta variant era (June-December 2021). We estimated adjusted hazard ratios (aHRs) comparing the incidence of mental illness after diagnosis of COVID-19 with the incidence before or without COVID-19. OutcomesWe considered eight outcomes: depression, serious mental illness, general anxiety, post-traumatic stress disorder, eating disorders, addiction, self-harm, and suicide. Incidence of most outcomes was elevated during weeks 1-4 after COVID-19 diagnosis, compared with before or without COVID-19, in each cohort. Vaccination mitigated the adverse effects of COVID-19 on mental health: aHRs (95% CIs) for depression and for serious mental illness during weeks 1-4 after COVID-19 were 1.93 (1.88-1.98) and 1.42 (1.24-1.61) respectively in the pre-vaccination cohort and 1.79 (1.68-1.91) and 2.21 (1.99-2.45) respectively in the unvaccinated cohort, compared with 1.16 (1.12-1.20) and 0.91 (0.84-0.98) respectively in the vaccinated cohort. Elevation in incidence was higher, and persisted for longer, after hospitalised than non-hospitalised COVID-19. InterpretationIncidence of mental illness is elevated for up to a year following severe COVID-19 in unvaccinated people. Vaccination mitigates the adverse effect of COVID-19 on mental health. FundingMedical Research Council (MC_PC_20059) and NIHR (COV-LT-0009).

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