Prior trauma exposure, posttraumatic stress symptoms, and COVID-19 vaccine hesitancy

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.

The experience of traumatic events, psychological distress, and social support: links to COVID-19 vaccine hesitancy and trends with age in a group of older Australians

BACKGROUND

Vaccination is important to reduce disease-associated morbidity and mortality in an ageing global population. While older adults are more likely than younger adults to accept vaccines, some remain hesitant. We sought to understand how traumatic events, psychological distress and social support contribute to older adults' intention to receive a COVID-19 vaccine and whether these experiences change with age.

METHODS

We analysed survey data collected as part of the Sax Institute's 45 and Up Study in a population of Australian adults aged 60 years and over. Data were derived from the COVID Insights study; a series of supplementary surveys about how participants experienced the COVID-19 pandemic.

RESULTS

Higher intention to receive a COVID-19 vaccine was associated with greater social support (adjusted odds ratio (aOR):1.08; 95%CI:1.06-1.11; p <.001) while lower intention was associated with personally experiencing a serious illness, injury or assault in the last 12 months (aOR:0.79; 95% CI:0.64-0.98; p =.03). Social support and the experience of traumatic events increased significantly with age, while psychological distress decreased.

CONCLUSIONS

There may be factors beyond disease-associated risks that play a role in vaccine acceptance with age. Older Australians on the younger end of the age spectrum may have specific needs to address their hesitancy that may be overlooked.

Associations of Mental Health and Experience of the COVID-19 Pandemic with United States Adults' Intentions to Be Vaccinated

COVID-19 vaccine uptake in the United States has proved challenging. A deeper characterization extending beyond demographics and political ideologies of those hesitating or resisting is needed to guide ongoing conversations. This study examined associations between US adults' vaccination intentions and mental health history, experience of the COVID-19 pandemic, and mental health outcomes. An online population-based cross-sectional survey was administered nationwide during January 4-7, 2021. Participants were questioned about past and current mental health, and completed the Patient Health Questionnaire 8 (PHQ-8), Generalized Anxiety Disorder 7-item (GAD-7), and Posttraumatic Diagnostic Scale (PDS)-5 (to capture symptoms of depression, anxiety, and traumatic stress, respectively). Experience of the pandemic included cumulative county-level COVID case and death rates, self-reported COVID-19 testing/exposure/diagnosis, and self-reported impact on routines, resources, and relationships. Of 936 respondents, 66% intended to be vaccinated, 14.7% responded "maybe," and 19.6% "no." Past diagnosis of obsessive compulsive disorder, less impact on routines or social supports, not having been screened or tested for COVID-19, not knowing someone who tested positive, and not self-isolating were associated with less intention to vaccinate. After controlling for demographic and pandemic experience factors, symptoms of traumatic stress, but not other mental health outcomes, were associated with less intention to vaccinate. The apparent contradiction between less negative impact of the pandemic and symptoms of traumatic stress being associated with less intention to be vaccinated indicates the complex nature of barriers to vaccine uptake. Results from this study contribute to the evidence base needed to improve ongoing and future communications about, and strategies to increase uptake of, vaccination.

Association between traumatic life events and vaccine hesitancy: A cross-sectional Australian study

OBJECTIVES

We sought to identify associations between the experience of traumatic life events and vaccination intention to inform whether trauma-affected individuals require targeted interventions when addressing vaccine hesitancy.

STUDY DESIGN

We conducted an online cross-sectional survey to identify whether direct or indirect exposure to various traumatic life events and the presence of post-traumatic stress disorder (PTSD) symptoms are associated with willingness to receive a COVID-19 vaccine in an Australian sample.

METHODS

A national online questionnaire was administered to a representative sample of 1050 Australian adults in September 2021.

RESULTS

Lower willingness to receive a COVID-19 vaccine was associated with direct experience of a fire or explosion (adjusted odds ratio [aOR]: 0.42; 95% confidence interval [CI]: 0.23-0.78; P = 0.006), direct experience of severe human suffering (aOR:0.39; 95% CI: 0.21-0.71; P = 0.002) and screening positive for PTSD symptoms (aOR:0.52; 95% CI: 0.33-0.82; P = 0.005). Conversely, higher willingness to receive a COVID-19 vaccine was associated with indirect exposure to severe human suffering (aOR: 2.0; 95% CI: 1.21-3.22; P = 0.007).

CONCLUSIONS

Our findings suggest that the experience of traumatic events and the presence of PTSD symptoms can contribute to vaccination decisions. Our work adds to the growing recognition of the need to effectively mediate the influence of traumatic experiences on encounters within the medical setting and supports the importance of addressing the needs of trauma-affected individuals in their vaccination experiences.