Psychiatric Adverse Events Following COVID-19 Vaccination: A Population-based Cohort Study in Seoul, South Korea

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Abstract

Evidence has suggested an increased risk of psychiatric manifestations following viral infections including coronavirus disease-2019 (COVID-19). However, psychiatric adverse events (AEs) after COVID-19 vaccination, which were documented in case reports and case series, remain unclear.

This study is aimed to investigate the psychiatric AEs after COVID-19 vaccination from a large population-based cohort in Seoul, South Korea.

We recruited 50% of the Seoul-resident population randomly selected from the Korean National Health Insurance Service (KNHIS) claims database on 1, January, 2021. The included participants (n = 2,027,353) from the Korean National Health Insurance Service claims database were divided into two groups according to COVID-19 vaccination.

The cumulative incidences per 10,000 of psychiatric AEs were assessed on one week, two weeks, one month, and three months after COVID-19 vaccination. Hazard ratios (HRs) and 95% Confidence interval (CIs) of psychiatric AEs were measured for the vaccinated population. The cumulative incidence of depression, anxiety, dissociative, stress-related, and somatoform disorders, sleep disorders, and sexual disorders at three months following COVID-19 vaccination were higher in the vaccination group than no vaccination group. However, schizophrenia and bipolar disorders showed lower cumulative incidence in the vaccination group than in the non-vaccinated group. Depression (HR [95% CI] = 1.683 [1.520–1.863]), anxiety, dissociative, stress-related, and somatoform disorders (HR [95% CI] = 1.439 [1.322–1.568]), and sleep disorders (HR [95% CI] = 1.934 [1.738–2.152]) showed increased risks after COVID-19 vaccination, whereas the risks of schizophrenia (HR [95% CI] = 0.231 [0.164–0.326]) and bipolar disorder (HR [95% CI] = 0.672 [0.470–0.962]). COVID-19 vaccination increased the risks of depression, anxiety, dissociative, stress-related, and somatoform disorders, and sleep disorders while reducing the risk of schizophrenia and bipolar disorder.

Therefore, special cautions are necessary for administering additional COVID-19 vaccinations to populations vulnerable to psychiatric AEs.

Introduction

In the unprecedented era of coronavirus disease-2019 (COVID-19), the global outbreak of COVID-19 has had an unpredictable and heterogeneous impact on the healthcare system worldwide [1, 2]. Especially in mental illness, COVID-19 showed an increased risk of mental health problems together with lockdown, social distancing, and uncertain causes [3, 4]. There have been growing concerns that the COVID-19 pandemic has increasingly had a detrimental effect on long-term mental health at an early stage in the development of vaccines [5, 6].

The rapid development of COVID-19 vaccines, ranging from mRNA-based vaccines (BNT162b2, mRNA-1273) to viral vector vaccines (cDNA-based vaccines; AZD1222, JNJ-78436735), has contributed [?] to overcoming the COVID-19 pandemic in the view of severity and mortality [1, 7]. However, it has also given rise to new issues such as post-COVID-19 sequelae and vaccine-related adverse events (AEs) [2, 5,6,7,8,9,10]. With their issues, mental health is still an unsolved concern in the post-COVID-19 era [4, 6]. Many studies have focused on the correlation between mental health and COVID-19 breakthrough [11]. However, mental illness as a result of the COVID-19 vaccine itself, specifically post-vaccination psychiatric AEs was not well-studied, with scant evidence in the literature, which was documented primarily in the form of case reports and case series [12,13,14,15].

In this study, we investigated the psychiatric AEs including schizophrenia, depression, bipolar disorder, anxiety, dissociative, stress-related, and somatoform disorders, sleep disorders, and sexual disorders after COVID-19 vaccination from a population-based cohort using the Korean National Health Insurance Service (KNHIS) claims database in Seoul, South Korea.

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