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

BackgroundA 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. Methods and findingsA 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 Risk(ipw) [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. ConclusionsSelf-reported COVID-19-like symptoms in 2020, but not serology-confirmed SARS-CoV-2 infection in 2020, were associated with a higher risk of subsequent suicidal ideation in 2021. The exact role of SARS-CoV-2 infection with respect to suicide risk has yet to be clarified. Including mental health resources in COVID-19-related settings could encourage symptomatic individuals to care for their mental health and limit suicidal ideation to emerge or worsen. Author summary Why was this study done? There is a need to investigate suicide-related outcomes in individuals exposed to virus responsible for epidemics.Coronavirus Disease 2019 (COVID-19) infection seems associated with a higher risk of suicidal ideation, but studies exploring the association over time are limited. What did the researchers do and find? We explored if COVID-19-like symptoms in 2020, as reported by participants, and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in 2020, as confirmed by serological tests, were associated with a higher risk of suicidal ideation in 2021 in 52,050 participants from a French longitudinal study from the general population, followed three times from May 2020 to July 2021 in France.Among these participants, reporting COVID-19-like symptoms in 2020 was associated with a higher risk of reporting suicidal ideation in 2021 (relative risk [95% confidence interval] 1.43 [1.20 to 1.69), while having a serologically confirmed SARS-CoV-2 infection in 2020 was not associated with a higher risk of reporting suicidal ideation in 2021 (0.89 [0.70 to 1.13]). These results account for sociodemographic and health-related factors. What do these findings mean? Individuals experiencing COVID-19-like symptoms in the first year of the pandemic were at higher risk of later suicidal ideation, but this association was not observed for serologically confirmed SARS-CoV-2 infection. Thus, further study is needed to confirm the role of the virus in relation to suicide risk.From a public health perspective, short communication on what to do when someone is experiencing poor mental health, whether directly after the onset of symptoms or a few months later, may be beneficial to address increase in suicidal ideation.