Suicidal ideation following self-reported COVID-19-like symptoms or serology-confirmed SARS-CoV-2 infection in France: A propensity score weighted analysis from a cohort study

• Published in: PLoS medicine 2023-02, Vol.20 (2), p.e1004171-e1004171
• Main Authors: Davisse-Paturet, Camille, Orri, Massimiliano, Legleye, Stéphane, Florence, Aline-Marie, Hazo, Jean-Baptiste, Warszawski, Josiane, Falissard, Bruno, Geoffroy, Marie-Claude, Melchior, Maria, Rouquette, Alexandra
• Format: Article
• Language: English
• Subjects: Analysis; Anxiety; Biology and life sciences; Cohort analysis; Cohort Studies; Coronaviruses; Cough; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 vaccines; Cross-Sectional Studies; Enzyme-linked immunosorbent assay; Epidemics; Female; France; Health aspects; Humans; Immunization; Infections; Life Sciences; Longitudinal studies; Male; Medical research; Medicine and health sciences; Medicine, Experimental; Mental disorders; Mental health; Middle Aged; Olfaction; Pandemics; Propensity Score; Psychological aspects; Public health; Regression analysis; Risk factors; Santé publique et épidémiologie; SARS-CoV-2; Self destructive behavior; Self Report; Serology; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Sociodemographics; Spike protein; Statistics; Suicidal behavior; Suicidal Ideation; Suicide; Suicides & suicide attempts; Systematic review
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1004171

A higher risk of suicidal ideation associated with self-report of Coronavirus Disease 2019 (COVID-19)-like symptoms or COVID-19 infection has been observed in cross-sectional studies, but evidence from longitudinal studies remains limited. The aims of this study were 2-fold: (1) to explore if self-reported COVID-19-like symptoms in 2020 were associated with suicidal ideation in 2021; (2) to explore if the association also existed when using a biological marker of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in 2020. A total of 52,050 participants from the French EpiCov cohort were included (median follow-up time = 13.7 months). In terms of demographics, 53.84% were women, 60.92% were over 45 years old, 82.01% were born in mainland France from parents born in mainland France, and 59.38% completed high school. COVID-19-like symptoms were defined as participant report of a sudden loss of taste/smell or fever alongside cough, shortness of breath, or chest oppression, between February and November 2020. Symptoms were self-reported at baseline in May 2020 and at the first follow-up in Autumn 2020. Serology-confirmed SARS-CoV-2 infection in 2020 was derived from Spike protein ELISA test screening in dried-blood-spot samples. Samples were collected from October 2020 to March 2021, with 94.4% collected in 2020. Suicidal ideation since December 2020 was self-reported at the second follow-up in Summer 2021. Associations of self-reported COVID-19-like symptoms and serology-confirmed SARS-CoV-2 infection in 2020 with suicidal ideation in 2021 were ascertained using modified Poisson regression models, weighted by inverse probability weights computed from propensity scores. Among the 52,050 participants, 1.68% [1.54% to 1.82%] reported suicidal ideation in 2021, 9.57% [9.24% to 9.90%] had a serology-confirmed SARS-CoV-2 infection in 2020, and 13.23% [12.86% to 13.61%] reported COVID-19-like symptoms in 2020. Self-reported COVID-19-like symptoms in 2020 were associated with higher risks of later suicidal ideation in 2021 (Relative Riskipw [95% CI] = 1.43 [1.20 to 1.69]), while serology-confirmed SARS-CoV-2 infection in 2020 was not (RRipw = 0.89 [0.70 to 1.13]). Limitations of this study include the use of a single question to assess suicidal ideation, the use of self-reported history of mental health disorders, and limited generalizability due to attrition bias. Self-reported COVID-19-like symptoms in 2020, but not serology-confirmed SARS-CoV-2