Vaccination rates against COVID-19 in patients with severe mental illness attending community mental health services in rural Greece

Abstract

Background: Patients with severe mental illness (SMI) may be at increased risk for COVID-19-related severe morbidity and mortality. There is limited research on the vaccination rates against COVID-19 in patients with SMI. Aims: The objective of the present study is to explore vaccination rates and co-relations in patients with SMI, attending community mental health services, namely the Mobile Mental Health Units (MMHUs) in rural Greece. Method: All treatment engaged patients with SMI (schizophrenia-spectrum or bipolar disorder) with two MMHUs (MMHU of Kefalonia, Zakynthos and Ithaca, [MMHU KZI] and MMHU of the prefectures of Ioannina and Thesprotia [MMHU I-T]) in rural Greece were enrolled prospectively over a six-month period. The MMHU I-T had adopted a more proactive approach to patients’ vaccination, by informing patients and caregivers for its benefits. Results: Data were analyzed for 197 patients with SMI. The overall vaccination rate was 68.5% and did not differ from the respective rates in the general population. There were no differences in vaccination rates among patients attending the two MMHUs, nor among patients with different diagnoses (schizophrenia spectrum disorders or bipolar disorder). Vaccination was not associated with gender, educational level, history of alcohol and substance abuse, illness duration, or number of previous hospitalizations, whereas the effect size of age was moderate. In more than half non-vaccinated patients the refusal to get vaccinated was associated with fears and concerns as well as false beliefs that are encountered in the general population. Conclusion: In the present sample of treatment-engaged rural patients vaccination rates against COVID-19 appear to be satisfactory. There were no differences in vaccination rates with regard to the interventions that were applied to enhance vaccination. It seems that other forms of intervention should be applied to reluctant patients to modify their attitudes toward vaccination.

COVID-19 vaccination rates in hospitalized mentally ill patients compared to the general population in Germany: Results from the COVID Ψ Vac study

“…This effect was largely due to in-hospital vaccination programs in some of the participating institutions, where patients hospitalized for mental illness got weekly vaccination offerings. Thereby, these routine care results confirm studies, which attributed lower vaccination rates in those with mental illness mainly to access barriers and not to a generally higher vaccination unwillingness [ 10 – 12 , 17 – 19 , 24 ]. They highlight the need to offer people with mental disorders repeatedly and actively COVID-19 vaccinations at all those health care providers, where they are in trusting and stigmatization-free contact with the health care system, thus psychiatric hospitals, outpatient clinics, and office-based psychiatrists and not only at centralized vaccination facilities or somatic medicine providers.…”

“…In the initial COVID-19 vaccination campaign in 2021, in some countries like Denmark, the Netherlands, the UK, and Germany populations with severe mental illness were prioritized for vaccination [9] but it remained unclear to what degree at-risk groups with mental illness were reached by vaccination campaigns in every-day routine health-care practice. Studies on vaccination rates of populations with mental illness in comparison to the general population showed heterogenous results: In some studies vaccination rates were comparable to or better than the general population [10][11][12][13] but in others people with mental illness showed much lower vaccination rates [14][15][16][17]. A common factor for vaccination rates similar to the general population seemed to be vaccination offerings by mental health institutions [10][11][12].…”

“…Studies on vaccination rates of populations with mental illness in comparison to the general population showed heterogenous results: In some studies vaccination rates were comparable to or better than the general population [10][11][12][13] but in others people with mental illness showed much lower vaccination rates [14][15][16][17]. A common factor for vaccination rates similar to the general population seemed to be vaccination offerings by mental health institutions [10][11][12]. This corresponds to studies on reasons for non-vaccination that did not show a general vaccine hesitancy among people with mental illness but were organizational access issues appeared to be the most relevant factors [15,[17][18][19].…”

“…This corresponds to studies on reasons for nonvaccination that did not show a general vaccine hesitancy among people with mental illness but were organizational access issues appeared to be the most relevant factors [ 15 , 17 – 19 ]. Some studies on risk groups for nonvaccination identified a younger age [ 12 , 17 ] and a schizophrenia diagnosis [ 13 , 15 , 16 ] associated with nonvaccination while others found no such differences [ 11 , 20 ].…”

The Network of Services for COVID-19 Vaccination in Persons With Mental Disorders: The Italian Social Health System, Its Organization, and Bioethical Issues

“…People with mental disorders, especially severe mental illness, have shown higher rates of COVID-19 morbidity and mortality ( 1 ); therefore, vaccination against COVID-19 should be prioritized for this vulnerable group, and this has already been assured in several countries ( 2 , 3 ).…”