Greater depression stigma linked to lower COVID-19 vaccine acceptance

For individuals diagnosed with recurrent depressive disorder, a higher level of stigma related to their condition was linked to lower COVID-19 vaccine acceptance, according to a study published in Translational Psychiatry.

“Psychiatric disorders are associated with an increased risk of COVID-19 infections in addition to higher hospitalization, morbidity and mortality rates due to its variants,” Hong Cai, of the department of public health and medicinal administration and the Institute of Translational Medicine at the University of Macau, and colleagues wrote.

Because associations between COVID-19 vaccine acceptance and perceived stigma of having a mental illness is not clear, Cai and colleagues aimed to examine the connection between these two factors among patients with recurrent depressive disorder.

They conducted a cross-sectional, observational study in six major psychiatric hospitals across China from October 2020 to August 2021. Included were 1,189 individuals (842 men, 307 women) aged 18 years or older, who were diagnosed with recurrent depressive disorder and who completed online survey measures of perceived stigma and COVID-19 vaccine attitudes.

Of that initial cohort, 1,149 completed the survey. T-tests, chi-square tests and Kruskal–Wallis tests were used to compare differences in demographic and clinical characteristics between depressed patients who accepted vaccines and those who were hesitant. Hierarchical multiple regression analyses assessed the unique association between COVID-19 vaccine acceptance and perceived stigma, independent of depression severity. Network analysis examined item-level relations between COVID-19 vaccine acceptance and perceived stigma after controlling for depressive symptoms.

Results revealed that 617 participants (53.7%, 95% CI: 50.82%–56.58%) reported they would accept future COVID-19 vaccination. Hierarchical multiple regression analyses indicated higher perceived stigma scores predicted lower levels of COVID-19 vaccination acceptance (=0.125), even after controlling for depression severity.

In the network model of COVID-19 vaccination acceptance and perceived stigma nodes, “Feel others avoid me because of my illness,” “Feel useless,” and “Feel less competent than I did before” were the most influential symptoms.

Data further showed that “COVID-19 vaccination acceptance” had the strongest connections with illness stigma items reflecting social rejection or social isolation concerns (“Employers/co-workers have discriminated,” “Treated with less respect than usual,” “Sense of being unequal in my relationships with others”).

“Interventions to reduce stigmatizing attitudes of the general public as well as social inclusion opportunities for patients with heightened stigma concerns should be developed in tandem with traditional interventions to reduce depression severity,” Cai and colleagues wrote.