The present study aimed to investigate the association between COVID-19 and the cumulative incidence of depression and the potential role of sick leave in a large representative sample of German adults.

This retrospective cohort study was based on the Disease Analyzer database (IQVIA) data. This study included individuals aged ≥16 years with a COVID-19 diagnosis in 1,284 general practices in Germany between March 2020 and December 2021, and the propensity score matched cohort without COVID-19. Univariable Cox regression analysis assessed the association between COVID-19 and depression.

The present study included 61,736 individuals with and 61,736 without COVID-19 (mean age 46.1 years; 49% women). Patients visited their physicians about 4.3 times per year during the follow-up period. About 25.5% of patients were diagnosed with COVID-19 in 2020 and 74.5% in 2021. In this representative sample of German adults, COVID-19 infection was associated with a higher cumulative incidence of depression, and this cumulative incidence was greater in women than men. As compared with non-COVID-19, COVID-19 with ≤ 2 weeks sick leave duration was associated with 17% higher depression risk (HR: 1.17; 95% CI: 1.09-2.16), COVID-19 with >2-4 weeks sick leave duration with 37% higher depression risk (HR: 1.37; 95% CI: 1.11-1.69), and COVID-19 with >4 weeks sick leave duration with 2 times higher depression risk (HR: 2.00; 95% CI: 1.45-2.76).

COVID-19 sick leave was positively associated with a risk for depression, and the longer the duration of sick leave, the higher the cumulative incidence of depression.