Pre-pandemic mental and physical health as predictors of COVID-19 vaccine hesitancy: evidence from a UK-wide cohort study

Abstract

Background Although several predictors of COVID-19 vaccine hesitancy have been identified, the role of physical health and, particularly, mental health, is poorly understood. Methods We used individual-level data from a pandemic-focused investigation (COVID Survey), a prospective cohort study nested within the UK Understanding Society (Main Survey) project. In the week immediately following the announcement of successful testing of the first efficacious inoculation (Oxford University/AstraZeneca, November/December 2020), data on vaccine intentionality were collected in 12,035 individuals aged 16–95 years. Pre-pandemic, study members had responded to enquiries about diagnoses of mental and physical health, including the completion of the 12-item General Health Questionnaire for symptoms of psychological distress (anxiety and depression). Peri-pandemic, individuals indicated whether they or someone in their household was shielding; that is, people judged by the UK National Health Service as being particularly clinically vulnerable who were therefore requested to remain at home. Intention to take up vaccination for COVID-19 was also self-reported. Results In an analytical sample of 11,955 people (6741 women), 15.4% indicated that they were vaccine-hesitant. Relative to their disease-free counterparts, shielding was associated with a 24% lower risk of being hesitant (odds ratio; 95% confidence interval: 0.76; 0.59, 0.96), after adjustment for a range of covariates which included age, education, and ethnicity. Corresponding results for cardiometabolic disease were 22% (0.78; 0.64, 0.95), and for respiratory disease were 26% (0.74; 0.59, 0.93). Having a pre-pandemic diagnosis of anxiety or depression, or a high score on the distress symptom scale, were all unrelated to the willingness to vaccine-hesitancy. Conclusions People with a physical condition were more likely to take up the potential offer of a COVID-19 vaccination. These effects were not apparent for indices of mental health. Key messages In understanding predictors of COVID-19 vaccine hesitancy, the role of physical and mental health has not been well-examined despite both groups seemingly experiencing an elevated risk of the disease. In a large UK cohort study, people with a pre-pandemic physical condition were more likely to take up the theoretical offer of vaccination. There were no apparent effects for indices of pre-pandemic mental health.

Community-level characteristics of COVID-19 vaccine hesitancy in England: A nationwide cross-sectional study

“…[ 10 , 49 ]). Additionally, in line with [ 50 ], who found that people with a physical health condition before the pandemic were more likely to take up the offer of vaccination, we also highlighted that areas more aware of the health risk due to COVID-19 are characterised by higher uptake. We also show that areas around the largest cities are more likely to be hesitant to the vaccination, in line with [ 51 ], a cross-sectional spatial modelling study in the UK conducted prior to the mass vaccination campaign, which revealed that London, Greater Manchester and Liverpool regions and minority ethnic groups were more resistant towards a new vaccine.…”

COVID-19 vaccine hesitancy and resistance in an urban Chinese population of Hong Kong: a cross-sectional study

“… 40 Chinese people have a strong sense of responsibility toward their families, and they probably hold the view that being vaccinated is an action they can do to protect their families. Moreover, emerging studies yielded mixed results on the effects of mental health on vaccine hesitancy 15 , 16 , 27 , 41 , 42 although no significant association was found between current mental health status (depression, anxiety, and insomnia) and vaccine hesitancy in this study.…”

COVID-19 and severe mental illness in Israel: testing, infection, hospitalization, mortality and vaccination rates in a countrywide study

“…The vaccine hesitancy reported here might be attributed to lack of awareness related to cognitive impairment, lack of motivation and low levels of activity. In a minority of patients, paranoia might be a factor [ 26 , 27 ]. The lower vaccination rate for COVID-19 in individuals with a history of hospitalization for a psychiatric disorder is consistent with the literature regarding other preventive vaccines.…”