Unvaccinated survivors of severe COVID saw rise in mental illness in year after, study suggests

COVID-19
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A study of nearly 19 million adults in England reveals a higher rate of mental illness among survivors of COVID-19 hospitalization—particularly among the unvaccinated—for up to a year.

A team led by University of Bristol investigators evaluated the incidence of mental illness in patients before and after COVID-19 diagnosis within the past year in three groups: (1) patients before vaccine was available and followed up during the wild-type and Alpha variant–dominant waves (January 2020 to June 2021) and (2) vaccinated patients and (3) unvaccinated patients during the Delta-dominant era (June to December 2021). 

The research was published this week in JAMA Psychiatry.

Mental illness rates by vaccination status

In the pre-vaccine group, which was the largest, the average age was 49 years, 50.2% were female, and 5.4% had tested positive for COVID-19. The average age of the vaccinated cohort was 53 years, and 52.1% were female, compared with 35 years and 42.1% female in the unvaccinated participants.

The researchers used data on confirmed COVID-19 diagnoses in primary care or secondary care records, test results, or the national death registry. The conditions studied were depression, serious mental illness, general anxiety, posttraumatic stress disorder (PTSD), eating disorders, addiction, self-harm, and suicide.

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

Rise mostly seen after hospital admission

Rates of most outcomes peaked in the first 4 weeks after COVID-19 diagnosis, compared with before or without COVID-19 infection in each group. The incidence of mental illness was lower among vaccinated participants than those in the pre-vaccine and unvaccinated groups.

The benefit of vaccination was that it prevented people from getting severe COVID-19 and therefore prevented the adverse consequences of COVID-19 in the longer term.

Jonathan Sterne, PhD

In a JAMA author interview, study senior author Jonathan Sterne, PhD, of the University of Bristol, said, "The benefit of vaccination was that it prevented people from getting severe COVID-19 and therefore prevented the adverse consequences of COVID-19 in the longer term."

The adjusted hazard ratios [HRs] for depression and serious mental illness in the first 4 weeks after COVID-19 diagnosis were 1.93 and 1.49 in the pre-vaccine cohort and 1.79 and 1.45 in the unvaccinated cohort, compared with 1.16 and 0.91 in vaccinated participants. 

The most common mental illness diagnosis was depression. A history of mental illness was a risk factor for mental illness after COVID-19. The incidence of depression in the first 4 weeks post-diagnosis and week 5 through 28 for serious mental illness in all periods was higher in participants aged 60 than in their younger counterparts. 

Rates of depression and serious mental illness were slightly higher for men than women in the first 4 weeks. The incidences of other mental illnesses were similar to those of depression and serious mental illness.

"Between-cohort differences in the incidence of mental illnesses in the absence of COVID-19 likely reflect both demographic differences and changes in diagnostic practices and access to health care during the pandemic," the authors wrote.

The rise in mental illness was mainly seen after severe COVID-19 that led to hospitalization, with little elevation after milder illness. In the vaccinated group, the incidence of depression after mild or moderate COVID-19 was comparable to that before or without infection. Rates remained elevated after hospitalization.

Implications for public health, mental health services 

"The findings support recommendation of COVID-19 vaccination in the general population and particularly among those with mental illness, who may be at higher risk of both SARS-CoV-2 infection and adverse outcomes following COVID-19," the researchers concluded.

In a university press release, first author Venexia Walker, PhD, of the University of Bristol, said, "Our findings have important implications for public health and mental health service provision, as serious mental illnesses are associated with more intensive healthcare needs and longer-term health and other adverse effects."

Sterne said the research continues. "We have already identified associations of COVID-19 with cardiovascular disease, diabetes and now mental illnesses," he said in the release. "We are continuing to explore the consequences of COVID-19 with ongoing projects looking at associations of COVID-19 with renal, autoimmune and neurodegenerative conditions."

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