Has COVID-19 vaccination had a positive impact on mental health?

Even if the advantages of vaccination reduction in severity and mortality of COVID-19 is well established, its impact on mental health is a less explored area. As a result of COVID-19, ongoing mental health issues, including anxiety and depression, have been reported. In a recent ICMR study, 9% of people who survived COVID-19 hospitalization suffered from mental health problems lasting at least a year. These conditions overlap with Long COVID, a spectrum of persistent symptoms affecting approximately 5% of people recovering from COVID-19, regardless of severity. Any intervention that could reduce this burden would therefore be valuable.

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A recent British study by Walker et al. revealed an increased incidence of mental health problems following COVID-19. However, this was less common in vaccinated people than in unvaccinated people. The additional risk of depression 6 months after COVID-19 was 449 per 100,000 among vaccinated people, while it was 1,009 per 100,000 among unvaccinated people.

Researchers studied the medical records of 17 million people in the UK, comparing the incidence of eight types of mental illness over a period from the pre-vaccine era to several months after the vaccine rollout. This made it possible to detect various types of mental illnesses associated with COVID, not only before vaccines were available, but also after.

Clear difference

In the period after the vaccine rollout, researchers saw a clear difference in mental health outcomes among vaccinated people. They suffered less depression, anxiety and serious mental illness following COVID-19 than their unvaccinated peers. The effect was independent of whether they had a history of mental illness. This is hypothesized to be due to decreased severity of COVID-19 among vaccinated individuals, which could have indirectly impacted mental health outcomes.

An additional explanation is that vaccination reduces anxiety, thereby creating a sense of security, as an article from the University of New Hampshire points out. Various studies confirm this, indicating a reduction in anxiety and depression according to age, gender and profession among vaccinated people. However, mental health is not a binary topic and further examination is needed to shed light on this topic.

Unlike physical health and its commonly used markers such as hospitalization and death rates, mental health is more difficult to measure and is often understudied. There is no laboratory test or analysis that can diagnose mental illness. Depression, anxiety, suicidal ideation, substance abuse, schizophrenia and personality disorders are part of the spectrum whose diagnosis requires expert assessment. In countries such as the United Kingdom, electronic health records provide a reliable source of data on the burden of mental illness in the population. This is mainly due to the GP system which caters to the general public and in which all medical conditions are recorded electronically.

Quality of life

Poor mental health negatively affects the quality of life, not only of the individual but also of those in their care. It contributes directly and indirectly to productivity and, therefore, to the economy. A person with undiagnosed mental health might not be as productive as a healthy person, regardless of their role, be it a housewife or a civil servant. Mental illness can affect the quality of decisions made in daily life, from personal matters to government policies. This leads to inefficiency, absenteeism and retirements, with employees frequently leaving their jobs. A Deloitte UK report estimates that there has been a 25% increase in costs for UK employers, directly attributable to poor mental health during the pandemic.

A paper from the US National Bureau of Economic Research found that vaccination reduced the burden of anxiety and depression among the population by 30%, leading to an estimated monetary saving of $346 billion. No “ripple effects” were observed, ruling out benefits to the unvaccinated. The reduction in anxiety and depression was therefore exclusive to vaccinated individuals.

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On an individual level, better mental health could mean the difference between committing suicide and being alive, being happy or sad, being unemployed or otherwise. Unfortunately, the stigma associated with mental illness has prevented many people from seeking the help they need. Unlike illnesses such as chickenpox or conjunctivitis, whose overt clinical features allow rapid identification, mental illnesses can remain undiagnosed for years, until a critical event reveals them.

In any research, it is important to examine the basic characteristics of the groups being studied. It is possible that there are fundamental differences between people who chose to be vaccinated and those who refused.

Marginalized groups

Studies reveal that unvaccinated individuals tend to have relatively lower levels of education and belong to socioeconomically and ethnically disadvantaged groups. Within these subgroups, the physical consequences of COVID-19 are compounded by job uncertainty, income declines, job loss, bereavement, domestic stress and access difficulties. to health care. Having an indirect impact on mental health, some of these factors may have contributed to the apparent difference between the two groups after experiencing COVID-19.

The UK study looked at data from 2021, a period during which several mandates were in place in developed countries. Vaccination granted people certain privileges, beyond the reach of the unvaccinated. This discrimination may have contributed to their delayed recovery from a mental health problem.

Another possible explanation is that early vaccination prioritized older adults and healthcare workers who initially felt greater anxiety about the outcome of COVID-19. Therefore, these people may have felt a sense of relief when vaccines were introduced.

In fact, a 2022 study published in the European Economic Review from the University of Leeds found that the mental health benefits of vaccination were mainly seen in the elderly and clinically vulnerable. They found no significant differences in mental health outcomes attributable to vaccination among younger groups. This could be because younger people are less worried about the outcome of COVID and may not have felt the need to get vaccinated. Additionally, vaccination may have had a greater impact among older adults, as they were prone to severe forms of COVID.

It is estimated that 50% of all disability benefits in Britain are related to mental health, up from just 25% twenty years ago. Mental health issues, when left unaddressed, can worsen unemployment. The longer a person remains unemployed, the more difficult it will be to find a job in the future.

Children affected too

Mental health has been affected during the pandemic in many ways besides COVID-19 infection. The Hindu released a report in October 2020 claiming the pandemic had triggered mood disorders among older adults in India. At the start of the pandemic, factors such as social isolation, limited access to communication devices and domestic violence by caregivers created problems among the elderly in India. The untimely deaths of friends and loved ones from COVID-19 have exacerbated their sadness and anxiety.

Adults aren’t the only ones who suffer from mental health problems. The children were affected by the closure of schools. Schools provide essential non-academic services and support systems, including personal safety and child nutrition, all of which have been disrupted during closures. Increased screen time along with an increased attraction to video games, decreased quality of education and lack of social interaction further impacted their mental health.

Among young adults, working from home early in the pandemic led to family conflict, excessive drinking, and social isolation. An entity called Zoom dysmorphia has been described, which is essentially a distorted perception of self-image. As a result of prolonged Zoom meetings, some people develop increased self-consciousness and dissatisfaction with their body image.

A study from Cambridge in the United Kingdom showed an interesting paradox. Although depression and anxiety were lower among vaccinated people in general, the opposite was observed among vaccinated people with lower education levels. The authors note that initial vaccine hesitancy and susceptibility to misinformation in this subgroup contributed to a paradoxical increase in anxiety and depression.

A 2023 meta-analysis by Lee et al. found that although vaccination reduced depression and anxiety overall, people with a history of COVID-19 had more severe symptoms of depression and anxiety after being vaccinated. The British study, however, found no such difference.

In summary, poor mental health in the time of COVID-19 has rightly been called the second pandemic. Difficult to detect, but having a profound impact on the individual, the family, society as well as economic productivity, it deserves greater attention. Overwhelming evidence suggests that vaccination has reduced the negative impact of COVID-19 on mental health.

(Dr. Rajeev Jayadevan is co-chair of the IMA COVID National Task Force.)