Impact of COVID-19 on mental illness in vaccinated and unvaccinated people

This study examined associations of COVID-19 with subsequent mental illness in the pre-vaccination period of the pandemic and for unvaccinated and vaccinated people after vaccination became available.

Paper information

  • Venexia Walker,
  • Praveetha Patalay,
  • Jose Ignacio Cuitun Coronado,
  • Rachel Denholm,
  • Harriet Forbes,
  • Jean Stafford,
  • Bettina Moltrecht,
  • Tom Palmer,
  • Alex Walker,
  • Ellen Thompson,
  • Kurt Taylor,
  • Genevieve Cezard,
  • Elsie 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 Sterne
Walker V, Patalay P, Cuitin Coronado J, et al. Impact of COVID-19 on mental illness in vaccinated and unvaccinated people: a population-based cohort study in OpenSAFELY. medRxiv 2023.12.06.23299602v1



COVID-19 is associated with subsequent mental illness in both hospital- and population-based studies. Evidence regarding effects of COVID-19 vaccination on mental health consequences of COVID-19 is limited.


With the approval of NHS England, we used linked electronic health records (OpenSAFELY-TPP) to conduct analyses in a ‘pre-vaccination’ cohort (17,619,987 people) followed during the wild-type/Alpha variant eras (January 2020-June 2021), and ‘vaccinated’ and ‘unvaccinated’ cohorts (13,716,225 and 3,130,581 people respectively) during the Delta variant era (June-December 2021). We estimated adjusted hazard ratios (aHRs) comparing the incidence of mental illness after diagnosis of COVID-19 with the incidence before or without COVID-19.


We considered eight outcomes: depression, serious mental illness, general anxiety, post-traumatic stress disorder, eating disorders, addiction, self-harm, and suicide. Incidence of most outcomes was elevated during weeks 1-4 after COVID-19 diagnosis, compared with before or without COVID-19, in each cohort. Vaccination mitigated the adverse effects of COVID-19 on mental health: aHRs (95% CIs) for depression and for serious mental illness during weeks 1-4 after COVID-19 were 1.93 (1.88-1.98) and 1.42 (1.24-1.61) respectively in the pre-vaccination cohort and 1.79 (1.68-1.91) and 2.21 (1.99-2.45) respectively in the unvaccinated cohort, compared with 1.16 (1.12-1.20) and 0.91 (0.84-0.98) respectively in the vaccinated cohort. Elevation in incidence was higher, and persisted for longer, after hospitalised than non-hospitalised COVID-19.


Incidence of mental illness is elevated for up to a year following severe COVID-19 in unvaccinated people. Vaccination mitigates the adverse effect of COVID-19 on mental health. Funding: Medical Research Council (MC_PC_20059) and NIHR (COV-LT-0009).