COVID-19 vaccine acceptance and perceived stigma in patients with depression: a network perspective

Comparative Study of COVID-19 Vaccination Frequency Between Chronic Psychiatric Patients and the General Population

Background: COVID-19 vaccination rates among individuals with mental illness have raised concerns due to these individuals' increased vulnerability to infection and complications. Objectives: This study aimed to compare the frequency of COVID-19 vaccination between individuals with chronic psychiatric conditions and the general population. Methods: A descriptive-analytical study was conducted, including patients with psychiatric disorders and a comparison group without psychiatric problems. Data were collected between May 2023 and August 2023 using a simple random sampling method. Participants were diagnosed with psychiatric disorders according to DSM-5 criteria and completed a questionnaire. Results: In a study of 137 participants, including 67 healthy individuals, 38 with schizophrenia, and 32 with affective disorders, psychiatric patients had lower full vaccination rates (P < 0.001). Patients with schizophrenia received fewer doses than healthy individuals and those with affective disorders (coefficient = -0.54, P = 0.007). Even after adjusting for demographics, the relationship between schizophrenia and vaccination rates remained significant. Conclusions: Chronic psychiatric patients have lower COVID-19 vaccination rates compared to the general population. Targeted vaccination programs and improved access to psychiatric healthcare facilities are crucial for addressing the pandemic's disproportionate impact on this vulnerable group.

Mental health conditions and COVID-19 vaccine outcomes: A scoping review

OBJECTIVE

Research shows that people with a history of mental health conditions were at increased risk of COVID-19 infection, hospitalisation, and mortality. However, the relationship between mental health conditions and COVID-19 vaccine outcomes such as vaccine intention, uptake and vaccine breakthrough is not yet well-understood.

METHODS

We conducted a systematic search on the topics of COVID-19 vaccine intentions, vaccine uptake, and vaccine breakthrough, in relation to mental health conditions (e.g., depression, schizophrenia), in four databases: PubMed, MEDLINE, SCOPUS, and PsychINFO, and the publication lists of Clinical Practice Research Datalink (CPRD), The Health Improvement Network (THIN), OpenSAFELY, and QResearch. Inclusion criteria focussed on studies reporting any of the aforementioned COVID-19 vaccine outcomes among people with mental health conditions.

RESULTS

Of 251 publications initially identified, 32 met our inclusion criteria. Overall, the evidence is inconclusive regarding the levels of intention to accept COVID-19 vaccines among people with mental health conditions. People with mental health conditions were more likely to have lower uptake of COVID-19 vaccines, compared to people without. Common barriers to COVID-19 vaccine uptake included concerns about the safety, effectiveness, and side effects of the vaccines. Limited evidence also suggests that vaccine breakthrough may be a particular risk for those with substance use disorder.

CONCLUSIONS

Evidence for the association between COVID-19 vaccine intentions and mental health conditions is mixed. Vaccine uptake might be lower in people with mental health conditions compared to people without, yielding interventions to encourage vaccine uptake in this population. Our understanding of COVID-19 vaccine breakthrough in this population also needs enhancing.

Vaccination status and self-reported side effects after SARS-CoV-2 vaccination in relation to psychological and clinical variables in patients with multiple sclerosis

The recent SARS-CoV-2 pandemic and the vaccination campaign posed a challenge to patients with autoimmune disease, such as multiple sclerosis (MS). We aimed for investigating whether psychological/sociodemographic/clinical characteristics of MS patients are associated with SARS-CoV-2 vaccination status and self-reported vaccination side effects (SEs). We have asked patients with MS about their willingness to receive recommended standard vaccinations pre-pandemically since June 2019. Between 10/2021 and 01/2022, we surveyed 193 of these MS patients about their current SARS-CoV-2 vaccination status, their perception of vaccination-related SEs, and reasons for and against SARS-CoV-2 vaccination. 75.6% of the patients declared their willingness to receive standard vaccinations before the pandemic. 84.5%, 78.2%, and 13.0% of the patients had received the first, second, and third SARS-CoV-2 vaccination, respectively, until the follow-up survey. The most common reason for not getting vaccinated against SARS-CoV-2 was concern about possible side effects (82.1%), followed by the belief that the vaccines had not been adequately tested (64.3%). Vaccination-related SEs were reported by 52.8% of the patients. Younger age, higher education, lower degree of disability, relapsing disease course, shorter disease duration, not receiving a disease-modifying therapy and higher anxiety and depression levels were associated with the occurrence of certain vaccination-related SEs. Concerns about novel vaccines are widespread among MS patients and necessitate targeted education of the patients, especially to those with more severe psychopathological symptoms (anxiety or depression) and those who are generally skeptical of vaccination.

Hurting myself to cope: Using network analysis to understand the association between perceived stigma and non-suicidal self-injury functions among men who have sex with men in China

Prior studies have demonstrated that perceived stigma is robustly associated with risky and life-threatening behaviors, including non-suicidal self-injury (NSSI), among men who have sex with men (MSM). However, studies regarding the relationship between perceived stigma and NSSI are limited. The present study aimed to investigate the network structure of perceived stigma and NSSI functions, along with bridge nodes, to elucidate how they co-exist. A sample of 2610 Chinese MSM (mean age = 23.99, age range: 18-68 years) was recruited from an online survey platform. All participants completed a web-based survey with measures of perceived stigma and NSSI functions. Results indicated that 'negative attitudes towards homosexuality' and 'disappointment in gay son' were identified as the most central nodes in the perceived stigma network, whereas 'seeking attention' and 'influencing others to change' ranked highest on centrality in the NSSI network. Two bridge connections were exhibited within the combined perceived stigma and NSSI network model: 'unwelcoming in public' and 'avoiding unpleasant tasks' from perceived stigma and NSSI communities, respectively. This is among the first studies investigating the co-occurrence between perceived stigma and NSSI from the network approach. Our findings provide an empirically-based perspective on the importance of family- and community-based interventions, with potential clinical implications for reducing NSSI among sexual and gender minority groups.

Understanding attitudes and beliefs regarding COVID-19 vaccines among transitional-aged youth with mental health concerns: a youth-led qualitative study

BACKGROUND

Transitional-aged youth (16-29 years) with mental health concerns have experienced a disproportionate burden of the COVID-19 pandemic. Vaccination is limited in this population; however, determinants of its vaccine hesitancy are not yet thoroughly characterised.

OBJECTIVES

This study aimed to answer the following research question: What are the beliefs and attitudes of youth with mental illness about COVID-19 vaccines, and how do these perspectives affect vaccine acceptance? The study aims to generate findings to inform the development of vaccine resources specific to youth with mental health concerns.

METHODS

A qualitative methodology with a youth engagement focus was used to conduct in-depth semistructured interviews with transitional-aged youth aged 16-29 years with one or more self-reported mental health diagnoses or concerns. Mental health concerns encompassed a wide range of symptoms and diagnoses, including mood disorders, anxiety disorders, neurodevelopmental disorders and personality disorders. Participants were recruited from seven main mental health clinical and support networks across Canada. Transcripts from 46 youth and 6 family member interviews were analysed using thematic analysis.

RESULTS

Two major themes were generated: (1) factors affecting trust in COVID-19 vaccines and (2) mental health influences and safety considerations in vaccine decision-making. Subthemes included trust in vaccines, trust in healthcare providers, trust in government and mistreatment towards racialised populations, and direct and indirect influences of mental health.

CONCLUSIONS

Our analysis suggests how lived experiences of mental illness affected vaccine decision-making and related factors that can be targeted to increase vaccine uptake. Our findings provide new insights into vaccine attitudes among youth with mental health concerns, which is highly relevant to ongoing vaccination efforts for new COVID-19 strains as well as other transmissible diseases and future pandemics. Next steps include cocreating youth-specific public health and clinical resources to encourage vaccination in this population.

"If it wasn't forced upon me, I would have given it a second thought": Understanding COVID-19 vaccine hesitancy in an outlier county in the Bay Area, California

While the San Francisco Bay Area counties rank very low in vaccine hesitancy and high in vaccination rates when compared to national numbers, Solano County has the most residents who are hesitant (6.3%) and the least who are fully vaccinated (51.6%) among Bay Area counties, according to the CDC. No studies to date have been able to provide the in-depth, localized information that would inform county-level public health interventions. This study aims to explore reasons and consequences for remaining unvaccinated in Solano County. Using a qualitative in-depth interview approach, we conducted 32 interviews with unvaccinated adults from Solano County. We used a grounded theory approach to our analysis. Using the socio-ecological model as a framework, we found that reasons for not getting vaccinated were primarily structural (mistrust of public information) and individual (bodily autonomy, personal choice) while consequences were primarily interpersonal (discrimination and stigma from friends, family, and employers). An overarching theme was that the vaccine rollout and messaging felt like an encroachment on personal choice and the feeling of being forced created more mistrust. Participants reported feeling like their decisions made them minorities among their colleagues, friends and family and that they were not persuaded by groupthink or by their relationships. Future public health responses to epidemics and pandemics might consider if a vaccine mandate is the best approach for reaching all county residents.

The relationship of intent to be COVID-19 vaccinated with depression, anxiety, insomnia, pain and smoking among Chinese patients with a pacemaker

Background

This study examined the intent to be COVID-19 vaccinated and its correlates among patients with a pacemaker.

Methods

This observational study was carried out between July 1, 2021, and May 17, 2022 in Beijing, China. Patients with a pacemaker were consecutively invited by a research physician to participate in the study. Intent to be COVID-19 vaccinated, depression, anxiety, insomnia, pain and smoking were measured with standard scales or questions.

Results

Of the 206 participating patients, 72.82% (N = 150; 95% confidence interval [CI]: 66.74%-78.89%) expressed an intention to be COVID-19 vaccinated. Intent to be COVID-19 vaccinated was not significantly associated with severity of depression, anxiety, and insomnia. Multiple logistic regression analysis revealed that patients believing that COVID-19 vaccines provided protection and smokers were more likely to express an intention to receive COVID-19 vaccines. In contrast, older patients and those with higher level of physical pain were less likely to express an intention to be vaccinated against COVID-19.

Conclusions

Specific vaccination promotion strategies should be implemented targeting this vulnerable segment of the population.

The Relationship between Depression and COVID-19 Vaccine Uptake and Intention among Korean Adults: The 2021 Community Health Survey

Individuals with depressive symptoms are vulnerable to COVID-19 infection and mortality; therefore, their vaccination status must be investigated to reduce these rates. This study investigated the association between depressive symptoms and COVID-19 vaccine uptake and intention and identified the reasons for vaccine avoidance. Data were collected from the 2021 Korea Community Health Survey and analyzed using logistic regression. A statistically significant association was found between the presence of depressive symptoms and no COVID-19 vaccine uptake. Among individuals who reported experiencing depression, 4.6% were unvaccinated and 7.7% reported no intention to get vaccinated. Among the unvaccinated, the adjusted odds ratio (aOR) for depression was 1.53 (95% confidence interval: 1.45-1.61) compared to the vaccinated. Similarly, a significant association was observed between depressive symptoms and no intention to get vaccinated. In the group with no vaccine intention, the aOR for depression was 2.06 (95% CI: 1.86-2.27) compared to the group with vaccine intention. Furthermore, "health-related reasons" and "concerns about side effects or past experience of side effects" accounted for 89% of the reasons for vaccine avoidance among individuals with depression. Therefore, it is important to provide tailored information and develop programs to increase awareness and promote COVID-19 vaccine uptake among these individuals.

COVID-19 vaccine uptake in mental healthcare users: Czech nationwide register study

BACKGROUND

The excessive covid-related mortality of psychiatric patients was reduced by vaccination. The vaccine uptake in patients diagnosed with different mental health disorders is, however, not fully described.

AIMS

A nationwide, record-based retrospective cross-sectional study examines the effect of substance use, psychotic, affective, anxiety, and personality disorders on COVID-19 vaccination rates in August and December 2021. Further, it quantifies the effect of receiving mental healthcare on vaccine uptake.

METHODS

The COVID-19 vaccine rates of mental healthcare users in August and December 2021 were examined using logistic regression models adjusted for sex and age on a sample of 7,235,690 adult inhabitants of the Czech Republic. The probability of vaccine uptake in the week following mental healthcare appointment or hospitalization on any day in the fall 2021 was compared to the general probability of getting vaccinated during that week.

RESULTS

The vaccination rate in August 2021 was related to history of hospitalization due to substance use (OR = 0.71), personality (OR = 0.87), psychotic (OR = 0.92), and anxiety (OR = 1.15) disorders, while mood disorders had no effect (OR = 1.00). Compared to general population, mental healthcare users were undervaccinated in August but not in December 2021. Vaccine uptake was low in those with history of psychiatric hospitalizations but higher in those utilizing inpatient or outpatient mental healthcare recently, predominantly for affective disorders. Increased vaccine uptake was observed following utilization of mental healthcare as well as in those with repeated psychiatric hospitalizations.

CONCLUSIONS

The vaccination rates of mental healthcare users relative to general population largely differ across nosological categories and during the vaccination campaign. Psychiatrists were successful in promoting vaccination against COVID-19.

Differential COVID-19 Vaccination Uptake and Associated Factors among the Slum and Estate Communities in Uganda: A Cross-Sectional Population-Based Survey

Vaccination against COVID-19 remains one of the ultimate solutions to the ongoing pandemic. This study examined and compared the completion of primary COVID-19 vaccination series and associated factors in the slum and estate communities of Uganda. This was a cross-sectional survey conducted among 1025 slum and estate residents. Logistic regression models were fitted. Of the 1025 participants, 511 were slum residents and 514 were estate residents. Completion of COVID-19 vaccination was 43.8% in the slum community and 39.9% in the estate community (p = 0.03). Having more knowledge about COVID-19 was positively associated with completing COVID-19 vaccination in both communities. Perceived benefits and cues to action also had a positive association, but only among the slum residents. However, perceiving people infected with COVID-19 as having a high death rate, perceived barriers such as serious side effects and long distances, and depressive symptoms had negative associations with vaccine uptake among the slum community, but not in the estate community. Addressing barriers to vaccination, strengthening and utilizing the various cues to action, engagement of religious and cultural leaders, and continued community education and sensitization tailored to the needs of each community are potentially vital strategies in raising vaccination rates. Consideration of socioeconomic impact-alleviation strategies, especially among the urban poor, would also be beneficial.