Psychiatric Disorders Do Not Decrease COVID-19 Vaccine Effectiveness

Keypoint: The COVID-19 mRNA vaccines are effective for individuals with psychiatric disorders.

Although psychiatric disorders increase COVID-19 hospitalization risk, mRNA COVID-19 vaccine effectiveness is not affected by psychiatric disorder status, according to study results published in Influenza and Other Respiratory Viruses.

Previous research indicates that psychiatric disorders may be risk factors for severe manifestations of COVID-19 that result in hospitalizations and mortality. Additionally, psychiatric symptoms have been associated with a reduced immune response to influenza, measles, and hepatitis B vaccines. However, relatively little is known about whether psychiatric disorders affected COVID-19 vaccine effectiveness. To close this knowledge gap, researchers conducted a retrospective cohort analysis of 4 health systems across 4 states in the United States from December 2021 to August 2022.

The researchers analyzed electronic health records to explore the association between psychiatric disorders and COVID-19 vaccination status, age group, and type of psychiatric disorder. The primary outcomes of interest were COVID-19 vaccine effectiveness and COVID-19-associated hospitalization among persons with and without psychiatric disorders. The researchers also evaluated whether the outcomes varied by number of mRNA vaccine doses.

The study included 2,436,999 participants (median age=47 years), of whom 58.3% were women and 66.1% were White. At each patient’s start date with their health care system, 41.6% of participants were unvaccinated, 35.7% had received 2 vaccine doses and 22.7% had received 3 doses. Additionally, 22% of participants had a psychiatric disorder. The most common disorder was anxiety (13.6%), followed by mood disorders (12.9%), trauma- and stressor-related disorders (3.1%), attention-deficit/hyperactivity disorder (1.9%), and psychotic disorders (1.0%).

The researchers found that patients with psychiatric disorders displayed a markedly higher incidence of COVID-19-associated hospitalization (hazard ratio [HR], 2.53; 95% CI, 2.36-2.70) at 394 per 100,000 person-years, relative to156 per 100,000 person-years for those without psychiatric conditions. This elevated risk remained robust even after controlling for demographics, vaccination status, and number of vaccination doses (adjusted hazard ratio [aHR], 1.27; 95% CI, 1.18-1.37).

When stratified by psychiatric disorder type, the highest risk for COVID-19-associated hospitalization was observed for mood disorders (aHR, 1.25; 95% CI, 1.15-1.36), anxiety disorders (aHR, 1.33; 95% CI, 1.22-1.45), and psychotic disorders (aHR, 1.41; 95% CI, 1.14-1.74). However, the researchers did not observe a significant interaction between psychiatric disorder status and either age groups (P =.55) or COVID-19 vaccination status (P =.34). These findings indicate that the increased risk associated with psychiatric disorders was consistent regardless of age or vaccination status.

Although hospitalization risk was higher among patients with psychiatric disorders, COVID-19 vaccination effectiveness did not significantly vary between groups. Among individuals with any psychiatric disorder, aHRs for the association between vaccination and hospitalization were 0.35 (95% CI, 0.25–0.49) with 2 vaccination doses and 0.08 (95% CI, 0.06–0.11) for 3 doses, relative to unvaccinated patients. These patterns of COVID-19 vaccine effectiveness were consistent across age, affirming that vaccination significantly lowers hospitalization risk irrespective of psychiatric status.

In a press release, study co-author and vice president for data and analytics at Regenstrief Institute, Shaun Grannis, MD, MS, stated, “For patients with a diagnosis of depression, anxiety, or mood disorders who are wondering if the COVID vaccine would be valuable, this paper gives us evidence that the vaccine maintains its effectiveness even in the face of mental illness. So, I would encourage vaccination because it reduces the risk of hospitalization significantly.”

Study limitations include the lack of information on the severity or trajectory of specific symptoms, the possibility of misclassification, and the lack of data on pharmacologic and behavioral treatments for psychiatric disorders.

Disclosure: Multiple study authors reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Note: This article originally appeared on Psychiatry Advisor