RESUMO
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.
RESUMO
Backgroundthe EpiCov study, initiated at the end of the first national lockdown in France, aimed to provide national and regional estimates of the seroprevalence of SARS-CoV-2 infection, and to analyze relations between living conditions and the dynamics of the epidemic. We present and discuss here the survey methodology, and describe the first-round fieldwork. Method371,000 individuals aged 15 years or more were randomly selected from the national tax register, stratified by departments, including three overseas departments, and by poverty level with over-representation of people living below the poverty line. Health, socio-economics, migration history, and living conditions were collected through self-computed-assisted web interviews or via computer-assisted telephone interviews. The first-round survey was conducted in May. A random subsample was eligible to receive material for home blood self-sample on dried blood spot (DBS), in order to detect IgG antibodies against the spike protein (Euroimmun ELISA-S), and neutralizing antibodies for non-negative ELISA-S. For the second-round conducted in November, all respondents were eligible for the antibodies detection from home DBS sample, as well as the other household members aged 6 years or more for 20% of them. Participation and adjustment for nonresponse134,391 respondents completed the first-round questionnaire from May 2 to June 1, 2020, including 16,970 (12.6%) respondents under the poverty line. Multimodal web/tel interviews was randomly assigned to 20% of the sample. The other were assigned to exclusive CAWI. Overall 17,441 respondents were eligible for home blood sample, among them 12,114 returned the DBS (interquartile date: May 25-June 5). The response probability was first estimated from logit models adjusted on a wide range of auxiliary demographic and socio-economic variables available from the sampling frame, and final weights calibrated to the margins of the population census permitted to correct for a large part of the non-response bias. ConclusionThe Epicov study is one of the largest national random population-based seroprevalence cohort, with both an epidemiological and sociological approaches to evaluate the spread of the COVID-19 epidemic, and the impact on health and living conditions. One of the major interests of this study is the broad coverage of the socio-economic and territorial diversity of the population.
