COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People

Venexia M. Walker; Praveetha Patalay; Jose Ignacio Cuitun Coronado; 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. Sterne; Longitudinal Health and Wellbeing COVID-19 National Core Study; 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 Suseeladevi; Bang Zheng; Betty Raman; Bo Hou; Bozena Wielgoszewska; Brain Mackenna; Callum Stewart; Chao Fang; Charis Bridger-Staatz; 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 Tunnicliffe; Ellena Badrick; Emily Herrett; Emma L Turner; Eoin McElroy; Fatima Almaghrabi; Felix Greaves; Fintan McArdle; Fiona Glen; Francisco Perez-Reche; 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 Mahalingasivam; Wels Jacques; William Hulme; Yatharth Ranjan; Zeena-Britt Sanders

doi:10.1001/jamapsychiatry.2024.2339

COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People

Venexia M. Walker, Praveetha Patalay, Jose Ignacio Cuitun Coronado, 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 MehrkarSeb Bacon, Ben Goldacre, Angela Wood, Nishi Chaturvedi, John Macleod, Ann John, Jonathan A. C. Sterne, Longitudinal Health and Wellbeing COVID-19 National Core Study, 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 Suseeladevi, Bang Zheng, Betty Raman, Bo Hou, Bozena Wielgoszewska, Brain Mackenna, Callum Stewart, Chao Fang, Charis Bridger-Staatz, 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 Tunnicliffe, Ellena Badrick, Emily Herrett, Emma L Turner, Eoin McElroy, Fatima Almaghrabi, Felix Greaves, Fintan McArdle, Fiona Glen, Francisco Perez-Reche, 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 Mahalingasivam, Wels Jacques, William Hulme, Yatharth Ranjan, Zeena-Britt Sanders

Cardiff School of Sport and Health Sciences

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Journal	JAMA Psychiatry
Early online date	21 Aug 2024
DOIs	https://doi.org/10.1001/jamapsychiatry.2024.2339
Publication status	Published - 21 Aug 2024

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1001/jamapsychiatry.2024.2339Licence: CC BY

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2822342

Cite this

Walker, V. M., Patalay, P., Cuitun 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. F., Wei, Y., Al Arab, M., Knight, R., Fisher, L., Massey, J., Davy, S., ... Sanders, Z.-B. (2024). COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2024.2339

@article{fcdd183cad9448f7a9cdba9ec31e4469,

title = "COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People",

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.",

author = "Walker, {Venexia M.} and Praveetha Patalay and {Cuitun Coronado}, {Jose Ignacio} and Rachel Denholm and Harriet Forbes and Jean Stafford and Bettina Moltrecht and Tom Palmer and Alex Walker and Thompson, {Ellen J.} and Kurt Taylor and Genevieve Cezard and Horne, {Elsie M. F.} and Yinghui Wei and {Al Arab}, Marwa and Rochelle Knight and Louis Fisher and Jon Massey and Simon Davy and Amir Mehrkar and Seb Bacon and Ben Goldacre and Angela Wood and Nishi Chaturvedi and John Macleod and Ann John and Sterne, {Jonathan A. C.} and Study, {Longitudinal Health and Wellbeing COVID-19 National Core} and Agnieszka Lemanska and Alex Kwong and Alexia Sampri and Alicja Rapala and Alisia Carnemolla and Alun Hughes and Amelia Green and Amos Folarin and Amy Roberts and {Goncalves Soares}, Ana and Andrew Steptoe and Andrew Wong and Andy Boyd and Andy Gibson and Anika Knueppel and Anoop Shah and Archie Campbell and Arun Kanagaratnam and {Karthikeyan Suseeladevi}, Arun and Bang Zheng and Betty Raman and Bo Hou and Bozena Wielgoszewska and Brain Mackenna and Callum Stewart and Chao Fang and Charis Bridger-Staatz and Charlotte Booth and Chelsea Beckford and Chloe Park and Claire Steves and Colm Andrews and Daniel McCartney and Daniel Kopasker and Diane Foster and Dominik Piehlmaier and Dylan Williams and Edward Parker and Elena Rafeti and Elena Lukaschuk and Elizabeth Tunnicliffe and Ellena Badrick and Emily Herrett and Turner, {Emma L} and Eoin McElroy and Fatima Almaghrabi and Felix Greaves and Fintan McArdle and Fiona Glen and Francisco Perez-Reche and Gareth Griffith and George Ploubidis and Gillian Santorelli and {Di Gessa}, Giorgio and Hannah Woodward and Helen Curtis and Annie Herbert and Ian Douglas and Jacqui Oakley and Wild, {James M} and Jane Maddock and Jd Carpentieri and Jess Morley and Jingmin Zhu and John Tazare and John Wright and John Kellas and Jonathan Kennedy and Kate Northstone and Kate Tilling and Kate Mansfield and Evans, {Katharine M} and Kathryn Mansfield and Kathryn Willan and Kevin Wang and Campbell, {Kirsteen C} and Kishan Patel and Laura Fox and Laura Sheard and Saunders, {Laura C} and Laurie Tomlinson and {Hamill Howes}, Lee and Liam Smeeth and Lidia Nigrelli and Linda Nab and Lisa Hopcroft and Lizzie Huntley and Louise Jones and Lucy Finnigan and Lucy Teece and Mark Green and Matthew Crane and Maxim Freydin and Michael Parker and Michael Green and Milla Kibble and Nathan Cheetham and Nicholas Timpson and Olivia Hamilton and Paola Zaninotto and Paz Garcia and Peter Jezzard and Rebecca Whitehorn and Rebecca Rhead and Renin Toms and Richard Thomas and Richard Silverwood and Richard Dobson and Robert Willans and Robin Flaig and Rosie McEachan and Ruth Mitchell and Ruth Bowyer and Ruth Costello and Sam Parsons and Samantha Berman and Samantha Ip and Sarah Baz and Scott Walker and {Syed Ahmar}, Shah and Richard Shaw and Sheikh Aziz and Sinead Langan and Sinead Brophy and Spiros Denaxas and Stefan Neubauer and Stefan Piechnik and Stela McLachlan and Stephen Smith and Steve Sharp and Teri North and Theocharis Kromydas and Thomas Cowling and Tiffany Yang and Tom Bolton and Vanessa Ferreira and Vittal Katikireddi and Viyaasan Mahalingasivam and Wels Jacques and William Hulme and Yatharth Ranjan and Zeena-Britt Sanders",

year = "2024",

month = aug,

day = "21",

doi = "10.1001/jamapsychiatry.2024.2339",

language = "English",

journal = "JAMA Psychiatry",

issn = "2168-622X",

}

Walker, VM, Patalay, P, Cuitun Coronado, JI, Denholm, R, Forbes, H, Stafford, J, Moltrecht, B, Palmer, T, Walker, A, Thompson, EJ, Taylor, K, Cezard, G, Horne, EMF, 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, JAC, Study, LHAWCOVIDNC, Lemanska, A, Kwong, A, Sampri, A, Rapala, A, Carnemolla, A, Hughes, A, Green, A, Folarin, A, Roberts, A, Goncalves Soares, A, Steptoe, A, Wong, A, Boyd, A, Gibson, A, Knueppel, A, Shah, A, Campbell, A, Kanagaratnam, A, Karthikeyan Suseeladevi, A, Zheng, B, Raman, B, Hou, B, Wielgoszewska, B, Mackenna, B, Stewart, C, Fang, C, Bridger-Staatz, C, Booth, C, Beckford, C, Park, C, Steves, C, Andrews, C, McCartney, D, Kopasker, D, Foster, D, Piehlmaier, D, Williams, D, Parker, E, Rafeti, E, Lukaschuk, E, Tunnicliffe, E, Badrick, E, Herrett, E, Turner, EL, McElroy, E, Almaghrabi, F, Greaves, F, McArdle, F, Glen, F, Perez-Reche, F, Griffith, G, Ploubidis, G, Santorelli, G, Di Gessa, G, Woodward, H, Curtis, H, Herbert, A, Douglas, I, Oakley, J, Wild, JM, Maddock, J, Carpentieri, J, Morley, J, Zhu, J, Tazare, J, Wright, J, Kellas, J, Kennedy, J, Northstone, K, Tilling, K, Mansfield, K, Evans, KM, Mansfield, K, Willan, K, Wang, K, Campbell, KC, Patel, K, Fox, L, Sheard, L, Saunders, LC, Tomlinson, L, Hamill Howes, L, Smeeth, L, Nigrelli, L, Nab, L, Hopcroft, L, Huntley, L, Jones, L, Finnigan, L, Teece, L, Green, M, Crane, M, Freydin, M, Parker, M, Green, M, Kibble, M, Cheetham, N, Timpson, N, Hamilton, O, Zaninotto, P, Garcia, P, Jezzard, P, Whitehorn, R, Rhead, R, Toms, R, Thomas, R, Silverwood, R, Dobson, R, Willans, R, Flaig, R, McEachan, R, Mitchell, R, Bowyer, R, Costello, R, Parsons, S, Berman, S, Ip, S, Baz, S, Walker, S, Syed Ahmar, S, Shaw, R, Aziz, S, Langan, S, Brophy, S, Denaxas, S, Neubauer, S, Piechnik, S, McLachlan, S, Smith, S, Sharp, S, North, T, Kromydas, T, Cowling, T, Yang, T, Bolton, T, Ferreira, V, Katikireddi, V, Mahalingasivam, V, Jacques, W, Hulme, W, Ranjan, Y & Sanders, Z-B 2024, 'COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People', JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2024.2339

TY - JOUR

T1 - COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People

AU - Walker, Venexia M.

AU - Patalay, Praveetha

AU - Cuitun Coronado, Jose Ignacio

AU - Denholm, Rachel

AU - Forbes, Harriet

AU - Stafford, Jean

AU - Moltrecht, Bettina

AU - Palmer, Tom

AU - Walker, Alex

AU - Thompson, Ellen J.

AU - Taylor, Kurt

AU - Cezard, Genevieve

AU - Horne, Elsie M. F.

AU - Wei, Yinghui

AU - Al Arab, Marwa

AU - Knight, Rochelle

AU - Fisher, Louis

AU - Massey, Jon

AU - Davy, Simon

AU - Mehrkar, Amir

AU - Bacon, Seb

AU - Goldacre, Ben

AU - Wood, Angela

AU - Chaturvedi, Nishi

AU - Macleod, John

AU - John, Ann

AU - Sterne, Jonathan A. C.

AU - Study, Longitudinal Health and Wellbeing COVID-19 National Core

AU - Lemanska, Agnieszka

AU - Kwong, Alex

AU - Sampri, Alexia

AU - Rapala, Alicja

AU - Carnemolla, Alisia

AU - Hughes, Alun

AU - Green, Amelia

AU - Folarin, Amos

AU - Roberts, Amy

AU - Goncalves Soares, Ana

AU - Steptoe, Andrew

AU - Wong, Andrew

AU - Boyd, Andy

AU - Gibson, Andy

AU - Knueppel, Anika

AU - Shah, Anoop

AU - Campbell, Archie

AU - Kanagaratnam, Arun

AU - Karthikeyan Suseeladevi, Arun

AU - Zheng, Bang

AU - Raman, Betty

AU - Hou, Bo

AU - Wielgoszewska, Bozena

AU - Mackenna, Brain

AU - Stewart, Callum

AU - Fang, Chao

AU - Bridger-Staatz, Charis

AU - Booth, Charlotte

AU - Beckford, Chelsea

AU - Park, Chloe

AU - Steves, Claire

AU - Andrews, Colm

AU - McCartney, Daniel

AU - Kopasker, Daniel

AU - Foster, Diane

AU - Piehlmaier, Dominik

AU - Williams, Dylan

AU - Parker, Edward

AU - Rafeti, Elena

AU - Lukaschuk, Elena

AU - Tunnicliffe, Elizabeth

AU - Badrick, Ellena

AU - Herrett, Emily

AU - Turner, Emma L

AU - McElroy, Eoin

AU - Almaghrabi, Fatima

AU - Greaves, Felix

AU - McArdle, Fintan

AU - Glen, Fiona

AU - Perez-Reche, Francisco

AU - Griffith, Gareth

AU - Ploubidis, George

AU - Santorelli, Gillian

AU - Di Gessa, Giorgio

AU - Woodward, Hannah

AU - Curtis, Helen

AU - Herbert, Annie

AU - Douglas, Ian

AU - Oakley, Jacqui

AU - Wild, James M

AU - Maddock, Jane

AU - Carpentieri, Jd

AU - Morley, Jess

AU - Zhu, Jingmin

AU - Tazare, John

AU - Wright, John

AU - Kellas, John

AU - Kennedy, Jonathan

AU - Northstone, Kate

AU - Tilling, Kate

AU - Mansfield, Kate

AU - Evans, Katharine M

AU - Mansfield, Kathryn

AU - Willan, Kathryn

AU - Wang, Kevin

AU - Campbell, Kirsteen C

AU - Patel, Kishan

AU - Fox, Laura

AU - Sheard, Laura

AU - Saunders, Laura C

AU - Tomlinson, Laurie

AU - Hamill Howes, Lee

AU - Smeeth, Liam

AU - Nigrelli, Lidia

AU - Nab, Linda

AU - Hopcroft, Lisa

AU - Huntley, Lizzie

AU - Jones, Louise

AU - Finnigan, Lucy

AU - Teece, Lucy

AU - Green, Mark

AU - Crane, Matthew

AU - Freydin, Maxim

AU - Parker, Michael

AU - Green, Michael

AU - Kibble, Milla

AU - Cheetham, Nathan

AU - Timpson, Nicholas

AU - Hamilton, Olivia

AU - Zaninotto, Paola

AU - Garcia, Paz

AU - Jezzard, Peter

AU - Whitehorn, Rebecca

AU - Rhead, Rebecca

AU - Toms, Renin

AU - Thomas, Richard

AU - Silverwood, Richard

AU - Dobson, Richard

AU - Willans, Robert

AU - Flaig, Robin

AU - McEachan, Rosie

AU - Mitchell, Ruth

AU - Bowyer, Ruth

AU - Costello, Ruth

AU - Parsons, Sam

AU - Berman, Samantha

AU - Ip, Samantha

AU - Baz, Sarah

AU - Walker, Scott

AU - Syed Ahmar, Shah

AU - Shaw, Richard

AU - Aziz, Sheikh

AU - Langan, Sinead

AU - Brophy, Sinead

AU - Denaxas, Spiros

AU - Neubauer, Stefan

AU - Piechnik, Stefan

AU - McLachlan, Stela

AU - Smith, Stephen

AU - Sharp, Steve

AU - North, Teri

AU - Kromydas, Theocharis

AU - Cowling, Thomas

AU - Yang, Tiffany

AU - Bolton, Tom

AU - Ferreira, Vanessa

AU - Katikireddi, Vittal

AU - Mahalingasivam, Viyaasan

AU - Jacques, Wels

AU - Hulme, William

AU - Ranjan, Yatharth

AU - Sanders, Zeena-Britt

PY - 2024/8/21

Y1 - 2024/8/21

N2 - 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.

AB - 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.

U2 - 10.1001/jamapsychiatry.2024.2339

DO - 10.1001/jamapsychiatry.2024.2339

M3 - Article

C2 - 39167370

SN - 2168-622X

JO - JAMA Psychiatry

JF - JAMA Psychiatry

ER -