Psych disorders linked to COVID-19 breakthrough infection in vaccinated VA patients

Diagnoses of psychiatric disorders were associated with increased incidence of COVID-19 breakthrough infection in VA patients, with the strongest associations found in older patients, according to a study published in JAMA Network Open.

“Prior to the widespread availability of vaccinations, individuals with psychiatric disorders were at heightened risk for contracting COVID-19 and for experiencing severe sequelae, including hospitalization and death,” Kristen Nishimi, PhD, of the department of psychiatry and Weill Institute for Neurosciences at the University of California, San Francisco, and colleagues wrote.

“There is a need to identify whether psychiatric disorders increase the risk for SARS-CoV-2 breakthrough infections after vaccination so that targeted preventive interventions can be used in this population if warranted.”

Nishimi and colleagues wanted to evaluate if past diagnoses of psychiatric disorders carry any association with increased incidence of COVID-19 breakthrough infection among those who are fully vaccinated.

The retrospective cohort study included data from health records of 263,697 Veterans Affairs patients (90.8% male; mean age, 66.2 years) from Feb. 20, 2020, to Nov. 16, 2021. All participants registered at least one COVID-19 test in their electronic health records, had no prior infection before vaccination, and had completed a full vaccination at least 2 weeks or more prior.

Data were analyzed to include psychiatric disorder diagnoses in the past 5 years including depressive, posttraumatic stress, anxiety, adjustment, alcohol/substance use, bipolar, psychotic, ADHD, dissociative, and eating disorders.

Results revealed that 135,481 (51.4%) of participants presented with at least one psychiatric disorder diagnosis, with39,109 (14.8%) developing a breakthrough infection.

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

Data additionally showed, when classifying the above for those less than or more than 65 years of age, associations between psychiatric diagnoses and breakthrough infection were present in both groups but were stronger when adjusting for medical comorbidities and smoking among older patients.

“Psychiatric disorders remained significantly associated with incident breakthrough infections above and beyond sociodemographic and medical factors, suggesting that mental health is important to consider in conjunction with other risk factors,” Nishimi said.