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.

中文翻译：

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接种疫苗和未接种疫苗的人的 COVID-19 和精神疾病。


重要性 在基于医院和人群的研究中，都发现了 COVID-19 与随后的精神疾病之间的关联。然而，关于这些人群的疫苗接种状况与哪些精神疾病相关的证据有限。目的 根据住院患者和普通人群的疫苗接种状况确定哪些精神疾病与确诊的 COVID-19 相关。设计、设置和参与者 这项研究在 3 个队列中进行，1 个在疫苗可用之前，随后在野生型/Alpha 变体时代（2020 年 1 月至 2021 年 6 月）和 2 个（接种疫苗和未接种疫苗）在 Delta 变体时代（2021 年 6 月至 12 月）。经英格兰国家卫生服务局批准，OpenSAFELY-TPP 被用于使用 TPP SystmOne 访问英格兰 2400 万注册全科诊所的人的链接数据。包括在英格兰的全科医生处注册至少 6 个月且已知年龄在 18 至 110 岁之间、性别、剥夺指数信息和基线地区的人。如果人们在基线之前患有 COVID-19，则被排除在外。数据分析时间为 2022 年 7 月至 2024 年 6 月。暴露 在初级保健、二级保健、检测数据或死亡登记中记录的确诊 COVID-19 诊断。主要结局和措施 调整后的风险比 （aHRs） 比较了 COVID-19 诊断后的精神疾病发病率与抑郁症、严重精神疾病、一般焦虑症、创伤后应激障碍、饮食失调、成瘾、自残和自杀的 COVID-19 之前或没有 COVID-19 的发病率。结果 最大的队列，即疫苗供应前队列，包括 18 648 606 人 （9 363 710 [50.2%] 女性和 9 284 896 [49.8%] 男性），中位 （IQR） 年龄为 49 （34-64） 岁。 接种疫苗的队列包括 14 035 286 人（7 308 556 [52.1%] 女性和 6 726 730 [47.9%] 男性），中位 （IQR） 年龄为 53 （38-67） 岁。未接种疫苗的队列包括 3 242 215 人（1 363 401 [42.1%] 女性和 1 878 814 [57.9%] 男性），中位 （IQR） 年龄为 35 （27-46） 岁。在每个队列中，与 COVID-19 诊断前或未确诊 COVID-19 相比，COVID-19 诊断后第 1 周至第 4 周大多数结局的发生率升高。与疫苗供应前和未接种疫苗的队列相比，接种疫苗的队列中的精神疾病发病率较低：COVID-19 后第 1 周至第 4 周抑郁症和严重精神疾病的 aHR 为 1.93（95% CI，1.88-1.98）和 1.49（95% CI，1.41-1.57）在疫苗供应前队列中为 1.79（95% CI，1.68-1.90）和 1.45（95% CI， 1.27-1.65），而未接种疫苗的队列为 1.16（95% CI，1.12-1.20）和 0.91（95% CI，0.85-0.98）。因 COVID-19 住院后发病率升高且持续时间更长。结论和相关性 在这项研究中，未接种疫苗的人在严重 COVID-19 后长达一年内，精神疾病的发病率升高。这些发现表明，接种疫苗可能会减轻 COVID-19 对心理健康的不利影响。