Social cohesion and loneliness are associated with the antibody response to COVID-19 vaccination

Psychological correlates of antibody response to mRNA SARS-CoV-2 vaccination: A prospective observational cohort study

BACKGROUND

Vaccines fundamentally changed the course of the COVID-19 pandemic, saving > 14 million lives within a year. However, vaccine-conferred protection showed inter-individual variability, with many identified correlates of protection (e.g., age) not amenable to change. This prospective observational cohort study examined whether modifiable psychological factors (depressive symptoms, anxiety, perceived stress and positive mood), which predict antibody responses to other vaccines, also influenced the effectiveness of COVID-19 vaccines. We focussed on novel mRNA vaccines as these conferred greater clinical protection and psychological correlates have not been investigated in these vaccines previously.

METHODS

One-hundred and eighty-four adults attending a mass-vaccination centre in the UK received a two-dose BNT162b2 mRNA SARS-CoV-2 vaccine course, completed validated psychological measures, and provided blood samples prior to vaccination and 4 weeks following the second vaccine dose.

RESULTS

In separate linear regression models controlling for pre-vaccination antibody levels, demographic and clinical factors, higher levels of depressive symptoms (β = -0.15 [95 % CI: -0.30, -0.01], p = 0.041, partial f2 = 0.009) and lower levels of positive mood (β = 0.16 [95 % CI: 0.01, 0.30], p = 0.036, partial f2 = 0.011) were significantly associated with lower SARS-CoV-2 spike-specific antibody levels following vaccination. No significant relationships were observed between measures of anxiety or perceived stress and antibody responses.

CONCLUSIONS

Lower levels of depressive symptoms and greater positive mood were associated with larger antibody responses following mRNA SARS-CoV-2 vaccination in a community sample attending for their first course of COVID-19 vaccinations. As both are amenable to change, they could offer mechanisms for enhancing vaccine effectiveness particularly among populations at greater risk of vaccine failure.

Understanding and mitigating negative affect in preventive health behaviors: Evidence from the COVID-19 vaccination process

The study investigated the willingness for vaccine uptake during the COVID-19 pandemic (April-June 2021), and explored the effect of both mindfulness and health education in managing negative affect post-vaccination. In study 1, a sample of 468 Chinese college students completed a one-time survey, assessing loneliness, stress, medical fear, and vaccination likelihood. Results showed that medical fear mediated the relationship between loneliness, stress and vaccination likelihood. In study 2, 70 college students were randomly assigned to one of three intervention conditions (mindfulness, health education, and control) during vaccination. Participants in mindfulness group showed lower negative affect scores than the control group post-intervention (p = 0.019). However, no significant difference was reported between health education with the other two conditions. As such, medical fear would be an important factor to target for improving the likelihood of vaccine uptake. Furthermore, a short mindfulness intervention was effective to improve experience of vaccination through mitigating negative affect.

Recorded Loneliness and Adverse Outcomes in Older Acute Care Inpatients Receiving Psychiatric Assessment

OBJECTIVES

We investigated the prevalence of loneliness recorded during assessment of general hospital inpatients by older adult liaison psychiatry services and its associations with level of subsequent hospitalisation, emergency presentation and mortality.

METHODS

Data were drawn from a large south London mental healthcare provider of older adult liaison psychiatry services to four acute general hospitals. The sample comprised all patients receiving assessments from these services from 2007-2017. Recorded loneliness was ascertained from text fields via a bespoke natural language processing algorithm and, via a linkage with national hospitalisation data, was investigated as a risk factor for repeat emergency department (ED) attendance, inpatient days in the subsequent 12 months, and mortality.

RESULTS

In 11,631 patients assessed, loneliness was recorded in 11.2%. After adjustment for a range of demographic and health covariates, recorded loneliness was associated with an increased risk of ED attendance, but with lower mortality and, in survivors, with fewer hospitalisation days over a 12-month follow-up.

CONCLUSIONS

Loneliness is recorded in over 10% of inpatients assessed by older adult liaison services and is likely to be present in substantially more. Lack of recording in more severe illness and/or cognitive disorders may explain associations with lower mortality and hospitalisation days. Its association with higher likelihood of repeat ED attendance suggests that loneliness should be considered more routinely in clinical assessments, possibly with formal screening.

Impact of perceived neighborhood social cohesion on vaccination intentions in the post-pandemic era

OBJECTIVE

To examine the relationship between perceived neighborhood social cohesion (NSC) and intentions to obtain seasonal influenza and COVID-19 vaccines among US adults post COVID-19 pandemic.

METHODS

We conducted a cross-sectional, nationally representative survey of US residents (N = 2189) in May 2023 on their perceived NSC, COVID-19 and seasonal influenza vaccination intentions, healthcare access, perceived risk of COVID-19 or flu infection, loneliness, and trust in doctors. We used bivariate probit regressions to examine joint associations between perceived NSC and intentions to receive influenza and COVID-19 vaccines, controlling for several participant characteristics (e.g., race).

RESULTS

2164 respondents provided consent to study questions. Trust-related NSC (trust in neighbors) was positively associated with intentions to become vaccinated against both influenza and COVID-19 viruses. Higher relational NSC (perception of a close-knit neighborhood) was positively associated while higher value-based NSC (perception that neighbors share the same values) was negatively associated with intentions to become vaccinated against COVID-19. Healthcare access, perceived risk of infection (COVID-19 or flu), and trust in doctors were positively associated with intentions to become vaccinated against both viruses.

CONCLUSIONS

In a post-pandemic era, higher trust-related and relational, perceived NSC (vaccine-dependent), greater access to healthcare, higher perceived risk of infection, and greater trust in doctors were related to higher influenza and COVID-19 vaccination intentions, while higher value-based NSC was related to lower COVID-19 vaccination intentions among US adults. Thus, specific aspects of NSC, healthcare access barriers, misinformation on infection risk, and medical mistrust may influence an individual's willingness and ultimate decision to become vaccinated.

Social Cohesion and COVID-19: Integrative Review

BACKGROUND

Nations of considerable wealth and sophisticated health care infrastructures have experienced high rates of illness and death from COVID-19. Others with limited economic means and less developed health systems have achieved much lower burdens. To build a full understanding, an appraisal of the contribution of social relationships is necessary. Social cohesion represents a promising conceptual tool.

OBJECTIVE

This study aimed to examine scholarship on social cohesion during the COVID-19 pandemic: specifically, the constructions of social cohesion being deployed, the variables chosen for representation, and the effects of and on social cohesion being reported.

METHODS

The PubMed, Scopus, and JSTOR databases were searched for relevant journal articles and gray literature. A total of 100 studies met the inclusion criteria. Data were extracted and analyzed from these using spreadsheet software.

RESULTS

Several constructions of social cohesion were found. These concerned interpersonal relationships, sameness and difference, collective action, perceptions or emotions of group members, structures and institutions of governance, locally or culturally specific versions, and hybrid or multidimensional models. Social cohesion was reported to be influential on health outcomes, health behaviors, resilience, and emotional well-being, but there was some potential for it to drive undesirable outcomes. Scholarship reported increases or decreases in quantitative measures of social cohesion, a temporary "rally round the flag" effect early in the pandemic, the variable impacts of policy on social cohesion, and changing interpersonal relationships due to the pandemic conditions. There are numerous issues with the literature that reflect the well-documented limitations of popular versions of the concept.

CONCLUSIONS

Social cohesion has been used to express a range of different aspects of relationships during the pandemic. It is claimed to promote better health outcomes, more engagement with positive health behaviors, and greater resilience and emotional well-being. The literature presents a range of ways in which it has been altered by the pandemic conditions. There are significant weaknesses to this body of knowledge that greatly impede its overall quality.

Religious engagement and antibody response to the COVID-19 vaccine

This research examined religious engagement and subsequent antibody responses to the COVID-19 vaccine. Using publicly available data from the Understanding Society survey, we employed a longitudinal design. Between January 2016 and May 2018, respondents completed measures of religious belonging, frequency of attending religious services (i.e., extrinsic religiosity), and the difference religion made to their lives (i.e., intrinsic religiosity). A COVID-19 survey wave was collected in March 2021 and measured antibody responses to the COVID-19 vaccine via blood draw. A final sample of 746 adults [462 (61.9%) females, Mage = 61.94, SD = 19.07] was achieved. Mediation analyses (PROCESS, Model 4; Hayes, Introduction to mediation, moderation, and conditional process analysis: A regression-based approach, The Guildford Press, 2022; Introduction to mediation, moderation, and conditional process analysis: A regression-based approach; The Guildford Press) revealed one pathway through which religion and antibody responses to the COVID-19 vaccine are associated, namely via extrinsic factors-attendance at religious services. In contrast, intrinsic religious factors which is the difference religion can make to one's life, was not a significant mediator. Overall, this analysis provides evidence that behavioural enactment of religion matters to the effectiveness of vaccination and the management of public health crises. It also highlights the value of social resources associated with engagement in valued social groups-and in particular religious social groups-for public health.

Examining the association of vaccine-related mindsets and post-vaccination antibody response, side effects, and affective outcomes

Background

Although vaccines are largely effective and safe, there is variability in post-vaccination experience regarding antibody response, side effects, and affective outcomes. Vaccine mindsets, specific beliefs about the vaccine, may be associated with post-vaccination experience. This is important since mindsets are malleable and may help decrease vaccine hesitancy and improve post-vaccination experience.

Methods

In a prospective study, we measured overall positive vaccine mindset and specific mindsets regarding efficacy, body response, and side effects. We tested whether vaccine mindsets before vaccination predicted neutralizing antibody response, side effects, vaccine-related stress, and affective outcomes (general stress, sadness, and happiness). Antibody response was assessed one month and six months after participants completed a SARS-CoV-2 vaccination series. Side effect experience and affective reactions were assessed daily on the vaccination day and the subsequent five days.

Results

There was no significant association between the aggregate vaccine mindset score and neutralizing antibody response; however, people with a more positive vaccine mindset reported fewer side effects, less same-day vaccine-related anxiety, and improved affective outcomes after vaccination. In secondary analyses, when specific mindsets were explored, the mindset that vaccine side effects are a sign of treatment efficacy predicted higher antibodies, but not side effects experience and vaccine-related anxiety. Vaccine efficacy and body-response mindsets predicted fewer side effects, vaccine-related anxiety, and improved affective outcomes after vaccination.

Conclusion

These findings underscore the potential of vaccine mindsets in enhancing the overall post-vaccination experience and, in some cases, increasing antibody response.

How does geographical diversity shape vaccine efficacy?

Vaccination is a cornerstone of public health, saving millions of lives each year by preventing a variety of infectious diseases. Yet, despite global vaccination efforts, emerging research highlights significant geographical disparities in vaccine efficacy and immunogenicity. These variations underscore the critical interplay between immunological factors and environmental, genetic, and nutritional elements across different populations. Our review article aimed to explore the multifactorial reasons behind geographical variations in vaccine efficacy. Also, this study has shown how important host factors like age, obesity, gender, and genetic diversity, especially within the major histocompatibility complex, are in determining how well a vaccine works. Nutritional status, namely deficiencies in micronutrients such as vitamins and zinc, and lifestyle factors including stress, sleep, alcohol consumption, and physical activity are also shown to have profound effects on vaccine-induced immunity. Importantly, our paper also brought to light the influence of microbial and ecological factors, such as the gut microbiome and environmental pollutants, on the immune system's response to vaccination. The findings emphasize the importance of tailoring vaccination strategies to accommodate the unique immunological landscapes shaped by geographical and societal factors. This tailored approach could enhance vaccine efficacy, reduce disparities in vaccine response, and ultimately contribute to the global fight against infectious diseases.

Social trust and COVID-19 mortality in the United States: lessons in planning for future pandemics using data from the general social survey

BACKGROUND

The United States has lost many lives to COVID-19. The role of social capital and collective action has been previously explored in the context of COVID-19. The current study specifically investigates the role of social trust at the county level and COVID-19 mortality in the US, hypothesizing that counties with higher social trust will have lower COVID-19 mortality rates.

METHODS

We used cross-sectional data from the General Social Survey (GSS). We collected COVID-19 mortality data from the COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University until October 31, 2021. We obtained county characteristics from the 2019 American Community Survey and supplemented this data source with additional publicly available county-level data, such as measures of income inequality and political leanings. We measured social trust as a single item from the GSS and calculated mean social trust in a county by pooling responses from 2002 to 2018. We then modeled the relationship between mean social trust and COVID-19 mortality.

RESULTS

Results indicate that counties with higher social trust have lower COVID-19 mortality rates. Higher values of mean social trust at the county level are associated with a decrease in COVID-19 mortality (b= -0.25, p-value < 0.001), after adjustment for confounding. The direction of association is consistent in a sensitivity analysis.

CONCLUSIONS

Our findings underscore the importance of investment in social capital and social trust. We believe these findings can be applied beyond the COVID-19 pandemic, as they demonstrate the potential for social trust as a method for emergency preparedness.

From polarity to plurality: Perceptions of COVID-19 and policy measures in England and Scotland

AIM

The aim of this study was to uncover perspectives on the COVID-19 pandemic and the responses implemented by the UK and Scottish Governments to help control the spread of infection. Such understanding could help to inform future responses to pandemics at individual, community and national levels.

METHOD

Q methodology was used to elicit perspectives from people in England and Scotland with different experiences of the pandemic including public health officials, key workers, those on furlough, those who were unvaccinated or vaccinated to different levels, those who were 'shielding' because they were at higher risk and people with different scientific expertise. Participants rank-ordered phrases about different aspects of COVID-19 according to their viewpoint. Factor analysis was then conducted in conjunction with interview material from the same respondents.

RESULTS

A four-factor solution was statistically supported and was interpretable alongside the qualitative accounts of participants loading on these factors. These four perspectives are titled Dangerous and Unaccountable Leadership, Fear and Anger at Policy and Public responses, Governing Through a Crisis and Injustices Exposed.

CONCLUSION

The four perspectives demonstrate plurality and nuance in views on COVID-19 and the associated policies and restrictions, going beyond a binary narrative that has been apparent in popular and social media. The four perspectives include some areas of common ground, as well as disagreement. We argue that understanding the detail of different perspectives might be used to build cohesion around policy initiatives in future.

PATIENT OR PUBLIC CONTRIBUTION

The development of the statement set, which is rank-ordered by participants in a Q study, and factor interpretations were informed by views of the general public. The statement set was initially developed using existing publicly available material based on members of the general public experiencing the pandemic first hand. It was then piloted with members of the public experiencing different challenges as a result of COVID-19 and the subsequent lockdown and updated based on feedback. Finally, interpretations of the identified factors were presented publicly and edited according to their feedback.

Social network size moderates the association between loneliness and cardiovascular reactivity to acute stress

Loneliness and objective measures of social isolation (e.g., social network size) have been associated with increased risk of cardiovascular disease (CVD). However, the evidence is mixed and the precise causal mechanisms remain unclear. Cardiovascular reactivity (CVR) to acute stress has been posited as a proposed mechanism. This study aimed to investigate: (i) effects of loneliness and social isolation on CVR to stress and, (ii) whether the loneliness - CVR relationship was moderated by social network size. Two hundred and six participants from the Pittsburgh Cold Study underwent a modified version of the Trier Social Stress Task. Cardiovascular measures of systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were taken throughout the laboratory stress trial. Hierarchical regression analyses found that social network size was positively associated with DBP reactivity (β = 0.19 95 % CI [0.05, 0.29] p = 0.005), while loneliness was not. In addition, social network size moderated the loneliness - DBP reactivity relationship such that a higher number of outer social network ties were beneficial at lower levels of loneliness but not higher. The current study contributes new evidence linking loneliness and social network size to cardiovascular psychophysiology but raises questions about the loneliness - CVD relationship. The findings confirm the importance of social network size and highlight that the characteristics of the networks may be more important than the number of networks.

The mediating role of loneliness in the association between exposure to terror and psychological distress in older adults

Terror attacks are known to bear detrimental effects on psychological distress in children, adolescents and young adults, but less is known about their influence on older adults. There is also evidence for increased loneliness following stressful events, but less is known about the mediating role of loneliness on the relation between terror attacks and psychological distress. The present study investigated the relation between exposure to terror attacks and psychological distress in older adults, as well as the potential mediating role of loneliness. Data were collected from 686 older adults (Mage= 73.49, SD= 6.02, range=65-94), who provided information regarding exposure to terror, loneliness, and psychological distress. Exposure to terror was positively associated with loneliness, which was, in turn, positively associated with psychological distress. Moreover, the link between terror exposure and psychological distress was mediated by loneliness. Our findings demonstrate the relation between exposure to terror and psychological distress in old age and suggest that loneliness contributes to this association.

Social Isolation Activates Dormant Mammary Tumors, and Modifies Inflammatory and Mitochondrial Metabolic Pathways in the Rat Mammary Gland

Although multifactorial in origin, one of the most impactful consequences of social isolation is an increase in breast cancer mortality. How this happens is unknown, but many studies have shown that social isolation increases circulating inflammatory cytokines and impairs mitochondrial metabolism. Using a preclinical Sprague Dawley rat model of estrogen receptor-positive breast cancer, we investigated whether social isolation impairs the response to tamoxifen therapy and increases the risk of tumors emerging from dormancy, and thus their recurrence. We also studied which signaling pathways in the mammary glands may be affected by social isolation in tamoxifen treated rats, and whether an anti-inflammatory herbal mixture blocks the effects of social isolation. Social isolation increased the risk of dormant mammary tumor recurrence after tamoxifen therapy. The elevated recurrence risk was associated with changes in multiple signaling pathways including an upregulation of IL6/JAK/STAT3 signaling in the mammary glands and tumors and suppression of the mitochondrial oxidative phosphorylation (OXPHOS) pathway. In addition, social isolation increased the expression of receptor for advanced glycation end-products (RAGE), consistent with impaired insulin sensitivity and weight gain linked to social isolation. In socially isolated animals, the herbal product inhibited IL6/JAK/STAT3 signaling, upregulated OXPHOS signaling, suppressed the expression of RAGE ligands S100a8 and S100a9, and prevented the increase in recurrence of dormant mammary tumors. Increased breast cancer mortality among socially isolated survivors may be most effectively prevented by focusing on the period following the completion of hormone therapy using interventions that simultaneously target several different pathways including inflammatory and mitochondrial metabolism pathways.

Psychology Meets Biology in COVID-19: What We Know and Why It Matters for Public Health

Psychosocial factors are related to immune, viral, and vaccination outcomes. Yet, this knowledge has been poorly represented in public health initiatives during the COVID-19 pandemic. This review provides an overview of biopsychosocial links relevant to COVID-19 outcomes by describing seminal evidence about these associations known prepandemic as well as contemporary research conducted during the pandemic. This focuses on the negative impact of the pandemic on psychosocial health and how this in turn has likely consequences for critically relevant viral and vaccination outcomes. We end by looking forward, highlighting the potential of psychosocial interventions that could be leveraged to support all people in navigating a postpandemic world and how a biopsychosocial approach to health could be incorporated into public health responses to future pandemics.

Long-term outcomes of COVID-19 convalescents: An 18.5-month longitudinal study in Wuhan

OBJECTIVES

This study aimed to describe the full scope of long-term outcomes and the ongoing pathophysiological alterations among COVID-19 survivors.

METHODS

We established a longitudinal cohort of 208 COVID-19 convalescents and followed them at 3.3 (interquartile range [IQR]: 1.3, 4.4, visit 1), 9.2 (IQR: 9.0, 9.6, visit 2), and 18.5 (IQR: 18.2, 19.1, visit 3) months after infection, respectively. Serial changes in multiple physical and psychological outcomes were comprehensively characterized. We, in addition, explored the potential risk factors of SARS-CoV-2 antibody response and sequelae symptoms.

RESULTS

We observed continuous improvement of sequelae symptoms, lung function, chest computed tomography (CT), 6-minute walk test, and the Borg dyspnea scale, whereas sequelae symptoms (at least one) and abnormal chest CT patterns still existed in 45.2% and about 30% of participants at 18.5 months, respectively. Anxiety and depression disorders were alleviated for the convalescents, although depression status was sustained for a longer duration.

CONCLUSIONS

Most COVID-19 convalescents had an overall improved physical and psychological health status, whereas sequelae symptoms, residual lesions on lung function, exercise impairment, and mental health disorders were still observed in a small proportion of participants at 18.5 months after infection. Implementing appropriate preventive and management strategies for the ever-growing COVID-19 population is warranted.

Neighborhood social cohesion is associated with the willingness toward the booster dose of COVID-19 vaccines among the Chinese older population

Neighborhood social cohesion is a prominent psychosocial factor during the pandemic, and trust in neighbors is critical for implementing health prevention-related behaviors with public health messages. We planned to specifically explore the association between neighborhood social cohesion and vaccine acceptability among older adults (≥60 years) in China. Using a random stratified sampling method, an anonymous cross-sectional online survey was conducted in mainland China via a professional scientific data platform from May 25 to June 8, 2022. A revised Social Cohesion Scale was applied to evaluate the level of neighborhood social cohesion. Of the 3,321 recruited respondents aged 60 and above, 82.8% (95% CI: 81.5-84.1) reported their willingness to be vaccinated. With all significant covariates adjusted, older adults with moderate (aOR = 1.77, 95% CI: 1.04-3.04) and high level of social cohesion (aOR = 2.21, 95% CI: 1.29-3.77) were more likely to receive the booster dose. Our findings remained robust in a series of models after controlling for different covariates. Uncertainty about contraindications (38.3%), underestimation of their vulnerability (33.1%), and concerns about vaccine safety (32.0%) were the three main reasons for vaccine hesitancy. Therefore, building a harmonious community environment, strengthening neighborhood communication and exchange, and making good use of peer education among neighbors may become a breakthrough to promote herd immunity, especially for vulnerable older adults with limited social networks.