COVIDMENT Study Analysis
Of the 403,794 individuals included in the participating COVIDMENT cohort studies, 325,298 individuals met the eligibility criteria for the present study (Supplementary Fig. 1). Over half of the overall study population (65.1%), and of each participating cohort, were female (Supplementary Table 7). The mean age in the participating cohorts ranged from 36.9 years (MAP-19) to 59.4 years (CovidLife), with a mean of 48 years in the overall study population.
Individuals with a diagnosis of any mental illness were more likely to be female, compared to those without a mental illness (Table 1). The proportion of individuals with chronic physical conditions was higher among those with any mental illness diagnosis. Low levels of missing data were observed for the majority of covariates.
Table 1
Distribution of sociodemographic variables in the included COVIDMENT study population, overall and by diagnosis of any mental illness diagnosis, presented as N (%) or mean [SD].
| Diagnosis of any mental illness |
Yes (n = 122,976) | No (n = 201,273) | Missing (n = 1,049) | Total (N = 325,298) |
Cohort | | | | |
EstBB-C19 (Estonia) | 3,107 (2.5%) | 2,526 (1.3%) | 0 (0.0%) | 5,633 (1.7%) |
EstBB-EHR (Estonia) | 95,208 (77.4%) | 88,124 (43.8%) | 0 (0.0%) | 183,332 (56.4%) |
C-19 Resilience (Iceland) | 2,895 (2.4%) | 7,283 (3.6%) | 239 (22.8%) | 10,417 (3.2%) |
MAP-19 (Norway) | 698 (0.6%) | 2,722 (1.3%) | 474 (45.2%) | 3,894 (1.2%) |
MoBa (Norway) | 15,496 (12.6%) | 87,315 (43.4%) | 0 (0.0%) | 102,811 (31.6%) |
CovidLife (Scotland) | 1,230 (1.0%) | 3,499 (1.7%) | 31 (2.9%) | 4,760 (1.5%) |
Omtanke2020 (Sweden) | 4,342 (3.5%) | 9,804 (4.9%) | 305 (29.1%) | 14,451 (4.4%) |
Sex | | | | |
Female | 88,515 (72.0%) | 122,544 (60.9%) | 753 (71.8%) | 211,812 (65.1%) |
Male | 34,446 (28.0%) | 78,713 (39.1%) | 205 (19.5%) | 113,364 (34.9%) |
Other | 8 (0.0%) | 6 (0.0%) | 1 (0.1%) | 15 (0.0%) |
Missing | 7 (0.0%) | 10 (0.0%) | 90 (8.6%) | 107 (0.0%) |
Age group, years | | | | |
18–29 | 12,826 (10.5%) | 14,670 (7.3%) | 265 (25.3%) | 27,761 (8.5%) |
30–39 | 24,119 (19.6%) | 30,486 (15.1%) | 197 (18.8%) | 54,802 (16.9%) |
40–49 | 31,864 (25.9%) | 78,311 (38.9%) | 177 (16.9%) | 110,352 (33.9%) |
50–59 | 24,359 (19.8%) | 44,785 (22.2%) | 184 (17.5%) | 69,328 (21.3%) |
60–69 | 17,228 (14.0%) | 19,053 (9.5%) | 147 (14.0%) | 36,428 (11.2%) |
70+ | 12,558 (10.2%) | 13,845 (6.9%) | 76 (7.2%) | 26,479 (8.1%) |
Missing | 22 (0.0%) | 123 (0.1%) | 3 (0.3%) | 148 (0.1%) |
Mean [SD] age, years | 48.5 [1.8] | 47.8 [3.6] | 44.1 [9.4] | 48.0 [2.9] |
COVID-19 infection | | | | |
Yes | 3,094 (2.5%) | 4,629 (2.3%) | 17 (1.6%) | 7,740 (2.4%) |
No | 64,035 (52.1%) | 140,877 (70.0%) | 1032 (98.4%) | 205,944 (63.3%) |
Missing* | 55,847 (45.4%) | 55,767 (27.7%) | 0 (0.0%) | 111,614 (34.3%) |
Smoking status | | | | |
Yes | 26,465 (21.5%) | 34,253 (17.0%) | 62 (5.9%) | 60,780 (18.7%) |
No | 86,737 (70.5%) | 155,181 (77.1%) | 493 (47.0%) | 242,411 (74.5%) |
Missing | 9,774 (8.0%) | 11,839 (5.9%) | 494 (47.1%) | 22,107 (6.8%) |
Chronic physical conditions | | | | |
0 | 47,606 (38.7%) | 123,948 (61.6%) | 160 (15.2%) | 171,714 (52.8%) |
1 | 34,723 (28.2%) | 46,836 (23.3%) | 68 (6.5%) | 81,627 (25.1%) |
2+ | 39,497 (32.1%) | 27,288 (13.5%) | 46 (4.4%) | 66,831 (20.5%) |
Missing | 1,150 (0.9%) | 3,201 (1.6%) | 775 (73.9%) | 5,126 (1.6%) |
*Mainly due to COVID-19 testing data only being available for some EstBB-EHR individuals |
First dose of a COVID-19 vaccine by 30th September 2021
314,827 individuals were included in the analysis of uptake of the first dose of a COVID-19 vaccine by 30th September 2021 (Table 2). Overall vaccination uptake was high (85.1%; n = 267,981/314,827). However, a small difference in uptake was observed between individuals with (82.4%; n = 99,041/120,212) v.s. without (86.8%; n = 168,174/193,706) any mental illness. Vaccination uptake in each included cohort is displayed in Supplementary Table 8.
Table 2
Uptake of COVID-19 vaccination overall and by diagnosis of any mental illness diagnosis, in the included COVIDMENT study population, presented as N (%).
| Uptake of first dose of a COVID-19 vaccine by 30th September 2021 | Uptake of first dose of a COVID-19 vaccine by 18th February 2022 | Uptake of second dose of a COVID-19 vaccine by 18th February 2022 |
Yes | No | Total | Yes | No | Total | Yes | No | Total |
Total study population | 267,981 (85.1%) | 46,846 (14.9%) | 314,827 (100.0) | 278,887 (88.9%) | 34,697 (11.1%) | 313,584 (100.0%) | 252,439 (95.5%) | 11,965 (4.5%) | 264,404 (100.0%) |
Mental illness | 99,041 (82.4%) | 21,171 (17.6%) | 120,212 (100.0%) | 103,955 (86.7%) | 15,953 (13.3%) | 119,908 (100.0%) | 93,420 (94.7%) | 5,251 (5.3%) | 98,671 (100.0%) |
No mental illness | 168,174 (86.8%) | 25,532 (13.2%) | 193,706 (100.0%) | 174,612 (90.3%) | 18,728 (9.7%) | 193,340 (100.0%) | 158,830 (95.9%) | 6,712 (4.1%) | 165,542 (100.0%) |
Missing | 766 (84.3%) | 143 (15.7%) | 909 (100.0%) | 320 (95.2%) | 16 (4.8%) | 336 (100.0%) | 189 (99.0%) | 2 (1.0%) | 191 (100.0%) |
Results from the meta-analysis showed no significant association, after adjustment for covariates, between the diagnosis of any mental illness and vaccination uptake (pooled PR: 0.99, 95% CI: 0.97- 1.00]; I2: 91.7%, p < 0.001) (Fig. 1A, Supplementary Table 9). Although the level of heterogeneity was high, a statistically significant association between the diagnosis of any mental illness and lower vaccination uptake was only found in the EstBB-EHR and MAP-19 cohorts. No associations were observed between anxiety or depressive symptoms and vaccination uptake.
First dose of a COVID-19 vaccine by 18th February 2022
Uptake of the first dose of a COVID-19 vaccine by 18th February 2022 was analysed in 313,584 individuals. Vaccination uptake was high (88.9%; n = 278,887/313,584); however, a small difference in uptake remained between individuals with (86.7%; n = 103,955/119,908) v.s. without (90.3%; n = 174,612/193,340) mental illness (Table 2).
Results from the meta-analysis revealed a small association, after adjustment for covariates, between the diagnosis of any mental illness and vaccination uptake (PR: 0.99, 95% CI: 0.98–0.99; I2: 79.98, p < 0.001) (Fig. 1B, Supplementary Table 9). No associations were observed between anxiety or depressive symptoms and vaccination uptake.
Second dose of a COVID-19 vaccine by 18th February 2022
264,404 individuals were eligible for the analysis of uptake of the second dose of a COVID-19 vaccine by 18th February 2022 (Table 2). Among these individuals, vaccination uptake wasvery high (95.5%; n = 252,439/264,404) and the difference in uptake between those with (94.7%; n = 93,420/98,671) v.s. without (95.9%; n = 158,830/165,542) mental illness was very small. Due to low numbers of participants, models could not be run in the MAP-19 and CovidLife cohorts.
The meta-analysis of the remaining eligible cohorts showed no significant differences in vaccination uptake by the diagnosis of any mental illness or the presence of anxiety or depressive symptoms, after adjustment for covariates (Fig. 1C, Supplementary Table 9).
For all outcomes, no substantial differences were observed in any of the sensitivity analyses (Supplementary Table 10).
Swedish Register Study Analysis
Among the 8,080,234 individuals included in the Swedish register study population, individuals with a specialist diagnosis of mental illness were more likely to be female (55.5% vs. 49.7%) and were, on average, younger (45.0 years vs. 50.2 years), compared to those without a mental illness (Table 3). Among those with a mental illness diagnosis, the proportions of individuals who had completed university education, were cohabiting, and were in the highest quartile of income were all lower, whilst the presence of chronic physical conditions was more common, compared to those without a mental illness diagnosis. The proportion of missing data for all covariates was low (≤ 2.5%).
Table 3
Distribution of sociodemographic variables in the included Swedish register study population, overall and by specialist diagnosis of a mental illness, presented as N (%) or mean [SD].
| Mental illness (n = 473,386) | No mental illness (n = 7,606,848) | Total (N = 8,080,234) |
Sex | | | |
Male | 210,601 (44.5%) | 3,829,720 (50.3%) | 4,040,321 (50.0%) |
Female | 262,785 (55.5%) | 3,777,128 (49.7%) | 4,039,913 (50.0%) |
Age group, years | | | |
18–29 | 123,576 (26.1%) | 1,389,202 (18.3%) | 1,512,778 (18.7%) |
30–39 | 93,549 (19.8%) | 1,295,735 (17.0%) | 1,389,284 (17.2%) |
40–49 | 75,419 (15.9%) | 1,220,404 (16.0%) | 1,295,823 (16.0%) |
50–59 | 74,689 (15.8%) | 1,229,745 (16.2%) | 1,304,434 (16.2%) |
60–69 | 53,272 (11.3%) | 1,042,587 (13.7%) | 1,095,859 (13.6%) |
70–79 | 36,203 (7.6%) | 949,670 (12.5%) | 985,873 (12.2%) |
80+ | 16,678 (3.5%) | 479,505 (6.3%) | 496,183 (6.1%) |
Mean [SD] age, years | 45.0 [18.1] | 50.2 [19.0] | 49.9 [19.0] |
Region of residence | | | |
East | 217,982 (46.0%) | 2,977,470 (39.1%) | 3,195,452 (39.5%) |
South | 180,150 (38.1%) | 3,308,918 (43.5%) | 3,489,068 (43.2%) |
North | 75,246 (15.9%) | 1,312,775 (17.3%) | 1,388,021 (17.2%) |
Missing | 8 (0.0%) | 7,685 (0.1%) | 7,693 (0.1%) |
Highest educational attainment | | | |
University (> 12 years) | 132,793 (28.0%) | 2,928,124 (38.5%) | 3,060,917 (37.9%) |
Secondary school (9–12 years) | 218,796 (46.2%) | 3,263,952 (42.9%) | 3,482,748 (43.1%) |
Primary school (< 9 years) | 114,887 (24.3%) | 1,224,746 (16.1%) | 1,339,633 (16.6%) |
Missing | 6,910 (1.5%) | 190,026 (2.5%) | 196,936 (2.4%) |
Cohabitation status | | | |
Cohabiting | 103,576 (21.9%) | 3,227,296 (42.4%) | 3,330,872 (41.2%) |
Non-cohabiting | 369,802 (78.1%) | 4,371,867 (57.5%) | 4,741,669 (58.7%) |
Missing | 8 (0.0%) | 7,685 (0.1%) | 7,693 (0.1%) |
Income | | | |
Q1 (lowest) | 212,484 (44.9%) | 1,805,939 (23.8%) | 2,018,423 (25.0%) |
Q2 | 116,302 (24.6%) | 1,903,106 (25.0%) | 2,019,408 (25.0%) |
Q3 | 83,798 (17.7%) | 1,933,705 (25.4%) | 2,017,503 (25.0%) |
Q4 (highest) | 60,794 (12.8%) | 1,956,408 (25.7%) | 2,017,202 (24.9%) |
Missing | 8 (0.0%) | 7,690 (0.1%) | 7,698 (0.1%) |
Severe COVID-19 infection | | | |
Yes | 3,769 (0.8%) | 24,773 (0.3%) | 28,542 (0.4%) |
No | 469,617 (99.2%) | 7,582,075 (99.7%) | 8,051,692 (99.6%) |
Charlson Comorbidity Index (CCI) | | | |
0 | 382,408 (80.8%) | 6,770,464 (89.0%) | 7,152,872 (88.5%) |
1 | 32,744 (6.9%) | 299,760 (3.9%) | 332,504 (4.1%) |
2+ | 58,234 (12.3%) | 536,624 (7.1%) | 594,858 (7.4%) |
First dose of a COVID-19 vaccine by 30th September 2021
In this study population, uptake of the first dose of a COVID-19 vaccine by 30th September 2021 was high (84.6%; n = 6,834,074/8,080,234) (Table 4). However vaccination uptake was slightly lower in individuals with (78.1%; n = 369,549/473,386) v.s. without (85.0%; 6,464,525/7,606,848) a specialist diagnosis of a mental illness. Vaccination uptake in relation to each type of mental illness diagnosis and type of psychiatric medication used is shown in Supplementary Table 11.
Table 4
Uptake of COVID-19 vaccination overall, and by specialist diagnosis of any mental illness and prescribed use of any psychiatric medication, in the included Swedish register population, presented as N (%).
| First dose of a COVID-19 vaccine by 30th September 2021 | Second dose of a COVID-19 vaccine by 30th November 2021 |
| Yes | No | Total | Yes | No | Total |
Total study population | 6,834,074 (84.6%) | 1,246,160 (15.4%) | 8,080,234 (100.0%) | 6,704,293 (98.1%) | 129,761 (1.9%) | 6,834,054 (100.0%) |
Any mental illness |
Yes | 369,549 (78.1%) | 103,837 (21.9%) | 473,386 (100.0%) | 355,040 (96.1%) | 14,508 (3.9%) | 369,548 (100.0%) |
No | 6,464,525 (85.0%) | 1,142,323 (15.0%) | 7,606,848 (100.0%) | 6,349,253 (98.2%) | 115,253 (1.8%) | 6,464,506 (100.0%) |
Any psychiatric medication |
Yes | 1,801,401 (87.7%) | 253,406 (12.3%) | 2,054,807 (100.0%) | 1,766,489 (98.1%) | 34,909 (1.9%) | 1,801,398 (100.0%) |
No | 5,032,673 (83.5%) | 992,754 (16.5%) | 6,025,427 (100.0%) | 4,937,804 (98.1%) | 94,852 (1.9%) | 5,032,656 (100.0%) |
Taking into account all covariates, we found that the uptake of vaccination in individuals with any mental illness was 2% lower than that of individuals without a mental illness (PR: 0.98, 95% CI: 0.98–0.99, p < 0.001) (Fig. 2A). Similarly small differences in vaccination uptake were shown for most types of mental illness, except for substance use disorder which had the strongest association with lower vaccination uptake (PR: 0.95, 95% CI: 0.94–0.95, p < 0.001). A 3% higher uptake was observed among individuals using prescribed psychiatric medication, compared to individuals not using such medication (PR: 1.03, 95% CI: 1.03–1.03, p < 0.001). Similar associations were found for different types of psychiatric medication. Stratified analyses revealed no substantial differences in the associations by sex or the presence of chronic physical conditions (Supplementary Table 12).
Results from the multi-level exposure analysis showed that, compared to individuals with neither a specialist mental illness diagnosis nor prescribed use of psychiatric medication, vaccination uptake was 3% higher among those with prescribed use of psychiatric medication but no specialist diagnosis (PR: 1.03, 95% CI: 1.03–1.03, p < 0.001), and 1% higher among those with both a specialist diagnosis and prescribed use of any psychiatric (PR: 1.01, 95% CI: 1.01–1.01, p < 0.001) (Fig. 3A). However, those with a specialist diagnosis of any mental illness but no prescribed use of any psychiatric medication had a 9% reduction in vaccination uptake (PR: 0.91, 95% CI: 0.91–0.91, p < 0.001). This pattern was also observed for the multi-level exposure analysis carried out for anxiety, depression, and psychotic disorder.
Second dose of a COVID-19 vaccine by 30th November 2021
6,834,054 individuals were eligible for the analysis of the uptake of the second dose of a COVID-19 vaccine by 30th November 2021 (Table 4). Vaccination uptake had a very high coverage overall (98.1%; n = 6,704,293/6,834,054), and the difference between those with (96.1%; n = 355,040/369,548) v.s. without (98.2%; n = 6,349,253/6,464,506) a mental illness was very small.
A very small difference in vaccination uptake was noted among those with v.s. without a specialist diagnosis of a mental illness (PR: 0.99, 95% CI: 0.99–0.99, p < 0.001) or prescribed use of psychiatric medication (Fig. 2B). This was also observed for different types of mental illness diagnosis and all types of psychiatric medication. Results from the stratified analyses showed no differences in the associations by sex or the presence of chronic physical conditions (Supplementary Table 12). Simiarly, the multi-level exposure analysis showed statistically significant, but very small, differences in vaccination uptake according to specialist diagnosis and/or prescribed medication use (Fig. 3B).