Desire to get COVID-19 vaccine not linked to mental illness severity

People with severe mental illness in an Israeli public psychiatric hospital opted to be vaccinated against COVID-19 based on their opinion of the vaccine, not distress level, researchers wrote in a study published in Journal of Psychiatric Research.

“Being hospitalized in psychiatric wards poses a risk for getting infected and spreading the virus to others in the ward, at times with detrimental consequences,” Renana Danenberg, of Shalvata Mental Health Center and Tel Aviv University Sackler Faculty of Medicine, and colleagues wrote. “Thus, examining the feasibility of vaccinating inpatients is extremely important.

“An important factor regarding the applicability of vaccinating this population is the patients’ attitudes toward the vaccine,” they continued. “It is therefore important to study reluctance towards being vaccinated.”

Danenberg and colleagues enrolled 51 patients (average age, 37.22 years; 54.9% men) at Shalvata Mental Health Center between Jan. 6 and Feb. 2. Most had severe mental illness, with the most common diagnoses being psychotic spectrum and personality disorders with comorbidities. Participants who were not vaccinated at enrollment were asked after 1 month if they had been vaccinated yet.

All participants completed questionnaires to assess their clinical condition including symptom distress, interpersonal relationships and social role performance, fear of COVID-19 and hesitation to get vaccinated against it. Researchers also asked about participants’ intent to get vaccinated.

Among all participants, 22 were vaccinated by the time of follow-up. Fear of COVID-19 and clinical condition did not differ between vaccinated and unvaccinated participants. Based on the COVID-19 Vaccine Hesitation Scale (C19-VHS), those who were vaccinated scored higher (mean [SD], 3.79 [0.73]) — and thus had a more positive perspective on the COVID-19 vaccine — than unvaccinated participants (mean [SD], 3.15 [1.07]).

Within the unvaccinated group, 14 said they intended to get vaccinated, while 12 did not. Like the difference in hesitancy between vaccinated and unvaccinated participants, those who intended to get vaccinated scored higher on the C19-VHS (mean [SD], 4.09 [0.57]) than those who did not intend to be vaccinated (mean [SD], 2.18 [0.53]).

The researchers also predicted participants who were unvaccinated at baseline would be vaccinated at follow-up if they had C19-VHS scores higher than the median. This had 65% sensitivity, 73% specificity, 79% positive predictive value and 57% negative predictive value.

“The influence of mistrust towards society and authorities, suspiciousness, and disregarding scientific evidence have been marked as central contributors to the hesitance,” Danenberg and colleagues wrote. “Since many of these attitudes are common in severe mental states, especially in psychotic disorders and severe personality disorder, it was likely to see an effect on opposing the vaccine. The results of the present study do not support such an effect.”

Limitations included small sample size and no information on what persuaded reluctant participants to get vaccinated. Moving forward, the researchers emphasized the need for larger study populations and investigation of the reasons behind patient opinions on COVID-19 vaccination.