Despite evidence indicating increased risk of psychiatric issues among COVID-19 survivors, questions persist about long-term mental health outcomes and the protective effect of vaccination. Using UK Biobank data, three cohorts were constructed: SARS-CoV-2 infection (n = 26,101), contemporary control with no evidence of infection (n = 380,337) and historical control predating the pandemic (n = 390,621). Compared with contemporary controls, infected participants had higher subsequent risks of incident mental health at 1 year (hazard ratio (HR): 1.54, 95% CI 1.42–1.67; P = 1.70 × 10⁻²⁴; difference in incidence rate: 27.36, 95% CI 21.16–34.10 per 1,000 person-years), including psychotic, mood, anxiety, alcohol use and sleep disorders, and prescriptions for antipsychotics, antidepressants, benzodiazepines, mood stabilizers and opioids. Risks were higher for hospitalized individuals (2.17, 1.70–2.78; P = 5.80 × 10⁻¹⁰) than those not hospitalized (1.41, 1.30–1.53; P = 1.46 × 10⁻¹⁶), and were reduced in fully vaccinated people (0.97, 0.80–1.19; P = 0.799) compared with non-vaccinated or partially vaccinated individuals (1.64, 1.49–1.79; P = 4.95 × 10⁻²⁶). Breakthrough infections showed similar risk of psychiatric diagnosis (0.91, 0.78–1.07; P = 0.278) but increased prescription risk (1.42, 1.00–2.02; P = 0.053) compared with uninfected controls. Early identification and treatment of psychiatric disorders in COVID-19 survivors, especially those severely affected or unvaccinated, should be a priority in the management of long COVID. With the accumulation of breakthrough infections in the post-pandemic era, the findings highlight the need for continued optimization of strategies to foster resilience and prevent escalation of subclinical mental health symptoms to severe disorders.

尽管有证据表明 COVID-19 幸存者出现精神问题的风险增加，但关于长期心理健康结果和疫苗接种的保护作用的问题仍然存在。使用英国生物银行数据，构建了三个队列：SARS-CoV-2 感染 ( n  = 26,101)、无感染证据的当代对照 ( n  = 380,337) 和大流行之前的历史对照 ( n  = 390,621)。与当代对照组相比，感染参与者在 1 年时发生心理健康事件的后续风险更高（风险比 (HR)：1.54，95% CI 1.42–1.67；P  = 1.70 × 10 ⁻²⁴；发生率差异：27.36，95 % CI 21.16–34.10 每 1,000 人年），包括精神病、情绪、焦虑、饮酒和睡眠障碍，以及抗精神病药、抗抑郁药、苯二氮卓类药物、情绪稳定剂和阿片类药物的处方。住院个体 (2.17, 1.70–2.78; P  = 5.80 × 10 ⁻¹⁰ )的风险高于未住院个体 (1.41, 1.30–1.53; P  = 1.46 × 10 ⁻¹⁶ )，并且在完全接种疫苗的人群中降低 (0.97 , 0.80–1.19; P  = 0.799) 与未接种疫苗或部分接种疫苗的个体 (1.64, 1.49–1.79; P  = 4.95 × 10 ⁻²⁶ ) 相比。 与未感染对照相比，突破性感染显示出类似的精神病诊断风险（0.91，0.78-1.07；P  = 0.278），但处方风险增加（1.42，1.00-2.02；P = 0.053）。早期识别和治疗 COVID-19 幸存者的精神疾病，尤其是那些受到严重影响或未接种疫苗的幸存者，应成为长期 COVID 管理的首要任务。随着大流行后时代突破性感染的积累，研究结果强调需要继续优化策略，以增强复原力并防止亚临床心理健康症状升级为严重疾病。