COVID-19 illness, SARS-CoV2 infection, and subsequent suicidal ideation in the French nationwide population-based EpiCov cohort : a propensity score analysis of more than 50,000 individuals

Abstract

Symptomatic COVID-19 appears to be associated with suicidal ideation but longitudinal evidence is still scarce. SARS-CoV2-induced neurological damages might underline this association, but findings are inconsistent. We therefore investigated the association between COVID-19 disease and subsequent suicidal ideation in the general population, using both self-reported symptoms and serology as well as inverse probability weighting to draw as near as possible to the direct association. Using data from the nationwide French EpiCov cohort, COVID-19 disease was assessed through 1) COVID-19 illness (self-reported symptoms of sudden loss of taste/smell or fever alongside cough, shortness of breath or chest oppression, between February and November 2020), and 2) SARS-CoV2 infection (Spike protein ELISA test screening in dried-blood-spot samples). Suicidal ideation was self-reported between December 2020 and July 2021. Inverse probability weighting with propensity scores was used as an adjustment strategy, leading to balanced sociodemographic and health-related factors between the exposed and non-exposed groups of both COVID-19 disease measures. Then, modified Poisson regression models were used to investigate the association of COVID-19 illness and SARS-CoV2 infection with subsequent suicidal ideation. Among 52,050 participants from the EpiCov cohort, 1.68% [1.54%-1.82%] reported suicidal ideation in the first half of 2021, 9.57% [9.24%-9.90%] had a SARS-CoV2 infection in 2020 and 13.23% [12.86%-13.61%] reported COVID-19 symptoms in 2020. COVID-19 illness in 2020 was associated with higher risks of subsequent suicidal ideation in the first half of 2021 (Relative Riskipw [CI95%]= 1.43 [1.20-1.69]) while SARS-CoV2 infection in 2020 was not (RRipw = 0.88 [0.69-1.12]). If COVID-19 illness was associated with subsequent suicidal ideation, the exact role of SARS-CoV2 infection with respect to suicide risk has yet to be clarified. Psychological support should be offered to persons recovering from symptomatic COVID-19 in order to minimize suicidal ideation risk. Moreover, if such psychological support is to be implemented, serology status alone does not seem a relevant criterion to define persons who suffered from COVID-19 to prioritize.