SARS-CoV-2 Infections Among Vaccinated Adults With Psychiatric Disorders

Individuals with psychiatric disorders are at increased risk of SARS-CoV-2 infection, emphasizing the importance of targeted preventive strategies and vaccination efforts in this vulnerable population.

June 2022
SARS-CoV-2 Infections Among Vaccinated Adults With Psychiatric Disorders

Key points

Are psychiatric disorders associated with an increased risk of SARS-CoV-2 infection after vaccination?

Findings

In this cohort study of 263,697 fully vaccinated US Department of Veterans Affairs patients, diagnoses of psychiatric disorders were associated with a higher incidence of SARS-CoV-2 infection following vaccination.

Meaning

This study suggests that people with psychiatric disorders should consider specific strategies to prevent SARS-CoV-2 infections.

 

Importance

Psychiatric disorders may be associated with an increased risk of SARS-CoV-2 infection after vaccination, but no studies have tested this hypothesis.

Aim

To assess whether previous diagnoses of psychiatric disorders are associated with a higher incidence of SARS-CoV-2 infection among fully vaccinated people.

Design, environment and participants

This retrospective cohort study included data from patients’ administrative and electronic health records of the US Department of Veterans Affairs (VA) from February 20, 2020 to November 16, 2021 during the study period. study, had at least 1 SARS-CoV-2 test recorded in the electronic medical record, had no record of SARS-CoV-2 infection before vaccination, and had completed a complete vaccination schedule against SARS-CoV-2 14 days or more before.

Exhibitions

Diagnoses of psychiatric disorders in the past 5 years, including depression, post-traumatic stress disorder, anxiety, adjustment, alcohol use, substance use, bipolar, psychotic, attention deficit/hyperactivity disorder, dissociative, and eating disorders.

Main results and measures

SARS-CoV-2 breakthrough infections, defined as positive SARS-CoV-2 tests, among fully vaccinated individuals.

Results

Of 263,697 fully vaccinated VA patients (239,539 men [90.8%]; mean [SD] age, 66.2 [13.8] years), 135,481 (51.4%) had at least 1 psychiatric disorder diagnosis and 39,109 (14.8%) developed an advanced infection.

A diagnosis of any psychiatric disorder was associated with a higher incidence of breakthrough infection, both in models adjusted for potential confounders (adjusted relative risk [aRR], 1.07; 95% CI, 1.05-1.09). as additionally adjusted for medical comorbidities and smoking (aRR, 1.03; 95% CI, 1.01-1.05).

Most diagnoses of specific psychiatric disorders were associated with a higher incidence of breakthrough infection, with the highest relative risk for adjustment disorder (aRR, 1.13; 95% CI, 1.10-1.16) and for substance use (aRR, 1.16; 95% CI, 1.12-1.21) in fully adjusted models.

Stratification of the sample at age 65 years revealed that associations between psychiatric diagnoses and progression of incident infection were present in both age groups, but were stronger and more robust when adjusting for medical comorbidities and smoking among patients. greater.

SARS-CoV-2 Infections Among Vaccinated Adults With
The reference group for each model is without psychiatric disorders; each individual psychiatric disorder was estimated in a separate model as the main factor and adjusted for age, age squared, sex, race, ethnicity, vaccine type, time since vaccination, vaccine type × time since vaccination, obesity status, diabetes, cardiovascular disease including hypertension, obstructive sleep apnea, chronic obstructive pulmonary disease, cancer, chronic kidney disease, liver disease, HIV and smoking.

Conclusions and relevance

This cohort study suggests that diagnoses of psychiatric disorders were associated with a higher incidence of SARS-CoV-2 infection among VA patients, with the strongest associations observed in older people.

People with psychiatric disorders may be at increased risk of contracting COVID-19 even after vaccination, suggesting the need for targeted prevention efforts.

Comments

A new study led by UC San Francisco has shown that people who are vaccinated against SARS-CoV-2 and have a history of certain psychiatric conditions have an increased risk of COVID-19, a finding that may be related to an impaired immune system , as well as risk behaviors associated with some disorders.

Researchers at UCSF and the San Francisco VA Healthcare System found that patients over age 65 with substance abuse, psychotic disorders, bipolar disorder, adjustment disorder and anxiety faced an increased risk of up to 24% of advance of COVID. For those under 65, risks were up to 11% higher than for those without a psychiatric history.

For both age groups, data were adjusted for age, sex, race, ethnicity and vaccine type, as well as smoking and underlying conditions such as obesity, diabetes, sleep apnea, cardiovascular, lung, kidney and liver diseases, HIV and cancer.

In the study, published April 14, 2022, in JAMA Network Open, researchers tracked data from more than a quarter of a million U.S. Department of Veterans Affairs patients who had completed their vaccine regimen. and had at least one SARS-CoV-2 test. Just over half (51.4%) of patients had received at least one psychiatric diagnosis in the past five years and 14.8% developed a COVID flare, confirmed by a positive test.

Declining immunity and less protection from new variants may explain higher rates

"Our research suggests that the increase in breakthrough infections in people with psychiatric disorders cannot be fully explained by sociodemographic factors or pre-existing conditions," said lead author Aoife O’Donovan, PhD, of the UCSF Weill Institute for Neurosciences and the University of San Francisco. Veterans Health Care System. "Immunity after vaccination may wane more rapidly or more strongly for people with psychiatric disorders and/or they may have less protection against newer variants."

A study earlier this year, led by the same UCSF researchers, found that people with high anxiety and probable post-traumatic stress disorder, conditions associated with impulsivity, were more likely to engage in behaviors that put them at greater risk. of COVID.

The average age of the 263,697 participants was 66 years and 90.8% were men. Overall, participants with psychiatric disorders had a 3% higher risk of COVID infections in 2021, when adjusted for demographic factors and pre-existing conditions, compared to participants without a psychiatric history.

But the risk was 24% higher for those over 65 with substance abuse, 23% higher for those with psychotic disorders, 16% higher for bipolar disorder, 14% for adjustment disorder and 12% for anxiety.

Surprisingly, given the higher incidence of breakthrough infections among younger people, this study showed significantly smaller effects in the under-65 group.

Additionally, the risks were 10% lower in participants with psychotic disorders compared to those without a psychiatric diagnosis, a decrease that O’Donovan attributes to possible lower socialization among younger people with psychotic disorders compared with older people who "may be less socially isolated because of their greater burden of poor health and contacts with caregivers."

However, the risks of breakthrough infections associated with substance abuse, adjustment disorder, anxiety, and post-traumatic stress disorder were higher in the younger cohort than in their peers without a psychiatric diagnosis: 11%, 9%, and 9%. 4% and 3%, respectively.

Greater need for in-person care may mean higher risk

First author Kristen Nishimi, PhD, also of the UCSF Weill Institute for Neurosciences and the San Francisco VA Healthcare System, believes that the higher incidence of breakthrough infections among older participants may be due to "a lower response immunological to the vaccine that has been associated with some psychiatric disorders, which may be more important in older adults.

It’s also possible that older adults with psychiatric disorders "may require more frequent in-person care, which could increase their interactions with the health care system," he noted.

Progression risks for other non-psychiatric conditions were also calculated and adjusted for factors such as obesity and smoking, as well as other underlying conditions. The researchers found that patients with chronic kidney disease had a 23% increased risk, compared with 20% for HIV, 19% for cardiovascular disease, 18% for COPD, and 13% for sleep apnea.

This shows that certain psychiatric conditions, particularly in the over-65 age group , face risks that are on par with other conditions, O’Donovan said. “It is important to consider mental health along with other risk factors,” he said, “and some patients should be prioritized for boosters and other critical preventative efforts.”