COVID-19 与接种疫苗和未接种疫苗者的精神疾病。

IF 22.5 1区 医学 Q1 PSYCHIATRY
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
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引用次数: 0

摘要

重要性:在基于医院和人群的研究中发现,COVID-19 与随后的精神疾病之间存在关联。然而,在这些人群中,根据疫苗接种情况确定哪些精神疾病与 COVID-19 相关的证据却很有限:目的:根据住院患者和普通人群的疫苗接种情况,确定哪些精神疾病与确诊的 COVID-19 相关:本研究在 3 个队列中进行,1 个队列在疫苗上市前,在野生型/阿尔法变异时代(2020 年 1 月至 2021 年 6 月)进行跟踪,2 个队列(已接种疫苗和未接种疫苗)在德尔塔变异时代(2021 年 6 月至 12 月)进行跟踪。经英格兰国家卫生服务局批准,OpenSAFELY-TPP 用于访问使用 TPP SystmOne 在英格兰全科诊所登记的 2400 万人的链接数据。研究对象包括在英格兰全科医生处登记至少 6 个月,且已知年龄在 18 至 110 岁之间、性别、贫困指数信息和基线地区的在世者。如果在基线前已感染 COVID-19,则排除在外。数据分析时间为 2022 年 7 月至 2024 年 6 月:主要结果和测量指标:在抑郁症、严重精神疾病、一般焦虑症、创伤后应激障碍、进食障碍、成瘾、自残和自杀方面,比较确诊COVID-19后与确诊前或未确诊COVID-19前的精神疾病发病率的调整危险比(aHRs):最大的队列(疫苗接种前队列)包括 18 648 606 人(女性 9 363 710 [50.2%] ,男性 9 284 896 [49.8%]),中位数(IQR)年龄为 49(34-64)岁。接种疫苗的人群包括 14 035 286 人(女性 7 308 556 [52.1%] 人,男性 6 726 730 [47.9%]人),年龄中位数(IQR)为 53(38-67)岁。未接种疫苗的人群包括 3 242 215 人(女性 1 363 401 人 [42.1%] ,男性 1 878 814 人 [57.9%]),年龄中位数(IQR)为 35(27-46)岁。与确诊 COVID-19 之前或未确诊 COVID-19 之前相比,在确诊 COVID-19 后的第 1 至 4 周,每个队列中大多数结果的发生率都有所升高。与接种疫苗前和未接种疫苗的队列相比,接种疫苗队列的精神疾病发病率较低:在接种 COVID-19 后的第 1 至 4 周,抑郁症和严重精神疾病的 aHR 分别为 1.93(95% CI,1.88-1.98)和 1.49(95% CI,1.49-1.98)。98)和 1.49(95% CI,1.41-1.57),未接种疫苗队列为 1.79(95% CI,1.68-1.90)和 1.45(95% CI,1.27-1.65),而接种疫苗队列为 1.16(95% CI,1.12-1.20)和 0.91(95% CI,0.85-0.98)。COVID-19的发病率升高幅度更大,且在住院后持续时间更长:在这项研究中,未接种疫苗的人在接种严重的 COVID-19 后,精神疾病的发病率会升高长达一年。这些发现表明,接种疫苗可减轻 COVID-19 对精神健康的不良影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People.

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.

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来源期刊
JAMA Psychiatry
JAMA Psychiatry PSYCHIATRY-
CiteScore
30.60
自引率
1.90%
发文量
233
期刊介绍: JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.
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