Public anxiety and health policy: A psychodynamic perspective

The Role of Denial in Vaccine Skeptics and “Anti-vax” Blame: A Psychodynamic Approach

In this paper, we propose to account for the blame addressed to vaccine skeptics and “anti-vax” (VS and AV) by considering their attitude as the result of the psychological mechanism of denial, understood in a psychodynamic manner. To that effect, we draw on a secondary account of our clinical experience in two hospital units (psychiatry and intensive care unit), and on openly available media material. First, we lay out how VS and AV can be understood as the result from fetishist risk denial, a specific psychological transaction with an object by which VS and AV people feel intimately protected; this object is viewed as so powerful that its protection makes the vaccine appear irrelevant. Second, we show how this mechanism can explain the specific content of the blame frequently addressed to VS and AV, who are reproached with being selfish by vaccinated people and caregivers. We contend that, contrary to common belief, they are thus blamed because they force others (and especially caregivers) to compensate their lack of self-protection and preservation, which derives from their exclusive relation to an almighty object. While such a relation accounts for the unwillingness to consider vaccination, it also explains the harshness of the blame voiced by caregivers, who feel helpless in most situations as they cannot effectively force VS and AV to take care of themselves and others.

Antecedents of Individuals' Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-sectional, Web-Based Survey Study

BACKGROUND

The COVID-19 pandemic poses a major challenge to people's everyday lives. In the context of hospitalization, the pandemic is expected to have a strong influence on affective reactions and preventive behaviors. Research is needed to develop evidence-driven strategies for coping with the challenges of the pandemic. Therefore, this survey study investigates the effects that personality traits, risk-taking behaviors, and anxiety have on medical service-related affective reactions and anticipated behaviors during the COVID-19 pandemic.

OBJECTIVE

The aim of this study was to identify key factors that are associated with individuals' concerns about hygiene in hospitals and the postponement of surgeries.

METHODS

We conducted a cross-sectional, web-based survey of 929 residents in Germany (women: 792/929, 85.3%; age: mean 35.2 years, SD 12.9 years). Hypotheses were tested by conducting a saturated path analysis.

RESULTS

We found that anxiety had a direct effect on people's concerns about safety (β=-.12, 95% CI -.20 to -.05) and hygiene in hospitals (β=.16, 95% CI .08 to .23). Risk-taking behaviors and personality traits were not associated with concerns about safety and hygiene in hospitals or anticipated behaviors.

CONCLUSIONS

Our findings suggest that distinct interventions and information campaigns are not necessary for individuals with different personality traits or different levels of risk-taking behavior. However, we recommend that health care workers should carefully address anxiety when interacting with patients.

Influencing Factors in the Development of State-Level Movement Restriction and Monitoring Policies in Response to Ebola, United States, 2014-15

During the 2014-15 domestic Ebola response, US states developed monitoring and movement restriction policies for potentially exposed individuals. We describe decision-making processes and factors in the development of these policies. Results may help health officials anticipate potential concerns and policy influencers in future infectious disease responses. Thirty individuals with knowledge of state-level Ebola policy development participated in semi-structured interviews conducted from January to May 2017. Interviewees represented 18 jurisdictions from diverse census regions, state political affiliations, and public health governance structures as well as the US Centers for Disease Control and Prevention (CDC). Limited and/or changing guidance and unique state-level public health, legal, and operational environments resulted in variation in policy responses. Federal guidance developed by the CDC was an important information source influencing state-level policy responses, as was available scientific evidence; however, other external factors, such as local events, contributing experts, political environment, public concern, news media, and the influence of neighboring states, contributed to additional variation. Improvements in timing, consistency, and communication of federal guidance for monitoring and movement restrictions at the state level-along with balanced approaches to addressing ethical concerns, scientific evidence, and public concern at the state level-are considerations for policy development for future disease responses.