COVID-19 Vaccine Uptake and Psychiatric Disorders

Grant Details

Funder: NIMH (MHRN III Feasibility Pilot Program)

Grant Number: U19MH121738

Project Period: 7/1/2021 – 6/30/2022


Background: Psychiatric disorders, and especially severe mental illness (SMI), are associated with an increased risk of COVID-19 infection and COVID-19-related morbidity and mortality. Several studies have found an association between an existing psychiatric disorder and increased risk for COVID-19 infection and COVID-19-related hospitalization, morbidity, and mortality. Factors that contribute to worse outcomes include concomitant medications, poorer premorbid general health, physical comorbidity, reduced access to medical care, and environmental and lifestyle factors such as lower socioeconomic status, smoking, or obesity. In light of these vulnerabilities, it is important that people with SMI receive a vaccination. However, people with SMI are less likely to receive preventive or guideline-appropriate health care for concerns such as cardiovascular disease and cancer. This reduced access to preventive care is reflected in the low uptake of immunizations recommended for adults among people with SMI. Of these, influenza may serve as a particularly useful model given the recommendation for an annual vaccination. In contrast with other vulnerable groups in the United States, influenza vaccination rates among people with SMI are as low as 25%. The purpose of this analysis is to examine COVID-19 vaccine uptake among individuals with diagnosed psychiatric disorders compared to individuals without any diagnosed psychiatric disorders and to examine whether there is variation by type of diagnosis, sociodemographic and/or clinical characteristics. There have been no known studies published to date that address this topic.

  • Research Questions:
    • Are individuals with diagnosed psychiatric disorders more or less likely to have received the COVID vaccine compared to those without any diagnosed psychiatric disorders? How does this pattern compare to uptake of the flu vaccine in this population?
    • Among those with diagnosed psychiatric disorders, is there variation in COVID vaccination status by type of psychiatric disorder? By other sociodemographic and clinical characteristics?

Methods: Using electronic medical record data across 2 Mental Health Research Network sites (KPGA and KPSC), individuals with diagnosed psychiatric disorders will be identified and matched on age and sex to controls with no diagnosed psychiatric disorders.

  • Analyses:
    • Compare sample characteristics of persons with and without any psychiatric disorder using χ2 tests for categorical variables and t tests for continuous variables.
    • Calculate the proportion of eligible patients who received the COVID-19 vaccine by psychiatric status (no diagnosis vs. psychiatric diagnosis).
    • Use multivariable methods to examine the relationship between psychiatric disorders status and vaccine uptake, controlling for demographic characteristics, medical comorbidities (Charlson score), and whether individual lives in rural or medically-underserved area.

Planned Product: The results of this study will be published and presented at a conference and will be used as preliminary data to guide (1) qualitative research to better understand any differences between patients with vs. without mental health conditions and/or (2) intervention research to improve vaccine uptake in this population.

  • Lead Site: KPGA (PI Ashli Owen-Smith)
  • Participating Sites:
    • KPSC (Co-I Karen Coleman)
    • KPWA (Lead Analyst Chris Stewart)

Current Status:

Manuscript is in-progress (will be ready to submit for publication by end of the year)

Summary of Findings:


Telehealth: Assessing Services in Kaiser Permanente (TASK)

Grant Details

Title: Telehealth: Assessing Services in Kaiser Permanente (TASK)

Funder: Kaiser Permanente Research

Grant Number: KPR-HPHQ-2021-01

Grant Period: 07/01/2021 – 12/31/2022

Brief Narrative: There is considerable optimism that telehealth –especially telephone and video-based visits –can transform care delivery within Kaiser Permanente (KP) and across the United States. Mental Health and Wellness (MHW) is the service line with the greatest potential to realize the benefits of expanding telehealth and transfer learning across service lines and regions. This mixed-methods project will study the quality, efficiency, and value of MHW services in six KP regions using generalized estimating equations, predictive analytics, and semi-structured interviews with members, clinicians, and administrators. The work will advance KP’s national telehealth strategy and inform capital and operational investments by improving our understanding of clinical, technical, and legal barriers and facilitators to telehealth as well as by furthering our ability to measure telehealth encounters and the relationship between telehealth and face-to-face care.

  • Lead sites:
    • KPNW (Administrative lead site, Co-PI Greg Clarke)
    • KPWA (Scientific lead site, Co-PI Robert Penfold)
  • Participating sites
    • KPCO (Site PI Jennifer Boggs)
    • KPGA (co-Site PIs Teaniese Davis& Courtney McCracken)
    • KPHI (Site PI Yihe Daida)
    • KPSC (Site PI Corinna Koebnick)

Awarded budget (total cost): $998,145

Personnel Contact List

Human Subjects: NO. All participating sites’ IRBs made a determination of quality improvement.

Current Status

Analyses are ongoing. We are evaluating:

  1. Changes in depression treatment outcomes and follow-up care with the switch to virtual care
  2. Assessing the clinical content of unscheduled telephone visits and developing measures to differentiate meaningful clinical content at these visits.
  3. Interviewing clinicians and members about their experiences
  4. Developing an updated predicting model for “no-shows” in the new (mostly) virtual environment in specialty mental health care.

Summary of findings

Interim findings suggest that positive outcomes for depression treatment were not substantially reduced by the move to virtual care. Some differences in follow-up PHQ9 administration were observed by race/ethnicity.

Qualitatively, most KP members are happy (or happier) with virtual care because of its convenience. They report only minor differences in interacting with their providers. Moderate irritation with technical issues is pervasive.


None yet.

MHRN III Supplemental Project: Effect of COVID-19 Pandemic on Mental Health Service Use

Grant Details

Title: Impact and Implications of Rapid Transition to Virtual Mental Health Care during COVID-19

Funder: NIMH

Grant Number: 3U19MH121738-02S1

Grant Period: 9/30/2020 – 6/30/2021

Narrative: The Mental Health Research Network conducts practice-based mental health research in large healthcare systems serving over 25 million patients in 16 states, with a focus on having large-scale data infrastructure available for rapid analyses. This study takes advantage of that infrastructure to study how changing from in-person to phone- or video visits during the COVID-19 crisis disrupts care of people with mental health conditions, including those in important and potentially disadvantaged subgroups. This work will help us understand who needs more support during crises as well as determine who benefits most from telehealth visits as the field of behavioral health care continues to transition to using more of these services.

  • Lead Site:
    • Overall PI: HPI (Project lead/site PI Rebecca Rossom)
  • Participating Sites/Subcontractors:
    • HFHS (project co-lead/site PI Brian Ahmedani)
    • KPWA (PI Greg Simon, co-I Rob Penfold)
  • Funder Contacts
    • Science Officer: Susan Azrin
    • Program Official: Michael Freed
    • Grants Management Official: Julie Bergerud
  • Awarded Budget (Total Cost)
    •  $344,930


Funding Announcement

Personnel Contact List

Current status

Data extraction is completed at all participating sites.  The first set of analyses examining changes in suicide death outcomes before and after onset of the COVID-19 pandemic were completed and the manuscript was published in Medical Care.  Preliminary analyses of counts and rates examining visit patterns, diagnoses, and treatment patterns before and after onset of the pandemic have been completed.  Additional primary analyses are ongoing for each of these metrics.  Final data analyses will be completed in late 2022.

Summary of findings

In participating health systems, overall suicide mortality declined slightly during the first months of the COVID-19 pandemic.

Among people receiving specialty mental health care, likelihood of interrupting treatment was slightly lower after the shift to telehealth delivery than before the pandemic.


Rossom RC, Penfold RB, Owen-Smith AA, Simon GE, Ahmedani BK. Suicide Deaths Before and During the Coronavirus Disease 2019 Pandemic: An Interrupted Time-series Study. Med Care. 2022 Mar 1. doi: 10.1097/MLR.0000000000001700. Online ahead of print. PMID: 35230276.