Vaccine hesitancy prospectively predicts nocebo side-effects following COVID-19 vaccination.

The directionality between vaccine hesitancy and COVID-19 vaccine side-effects has not been hitherto examined. We hypothesized a nocebo effect, whereby vaccine hesitancy towards the second Pfizer vaccination dose predicts subsequent side-effects for a booster dose, beyond other effects. We expected these nocebo effects to be driven by (mis)information in males and prior experience in females. A representative sample of older adults (n = 756, mean age = 68.9 ± 3.43) were questioned in a typical cross-lagged design (wave 1 following a second Pfizer dose, wave 2 after their booster). As hypothesized, earlier vaccine hesitancy predicted subsequent booster side-effects for females (ß = 0.10 p = 0.025, f 2 = 0.02) and males (ß = 0.34, p < 0.001, f 2 = 0.16); effects were stronger in males (χ2Δ (1) = 4.34, p = 0.03). The (W1-to-W2) side-effect autoregression was stronger in females (ß = .34, p < 0.001; males ß = 0.18, p < 0.001), χ2Δ (1) = 26.86, p < 0.001. Results show that a quantifiable and meaningful portion of COVID-19 vaccine side-effects is predicted by vaccine hesitancy, demonstrating that side-effects comprise a psychosomatic nocebo component in vaccinated individuals. The data reveal distinct risk levels for future side-effects, suggesting the need to tailor public health messaging.

Relationship between adjustment disorder symptoms and probable diagnosis before and after second lockdown in Israel: longitudinal symptom network analysis.

BACKGROUND: There is cumulative evidence of the importance of exploring the change of dynamics between symptoms over time as reflective of consolidation of psychopathology. AIMS: To explore the interactions between symptoms of ICD-11 adjustment disorder before and after the second lockdown of the COVID-19 pandemic in Israel and identify the most central symptoms and their concurrent and prospective associations with probable adjustment disorder. METHOD: This is a population-based study drawn from a probability-based internet panel. A representative sample of the adult Israeli population was assessed at two time points (T1, pre-second lockdown, n = 1029, response rate 76.17%; T2, post-second lockdown, n = 764, response rate 74.24%). Symptoms of adjustment disorder were assessed by the International Adjustment Disorder Questionnaire (IADQ). RESULTS: Although the overall strength of associations at the two measurement points was similar and two same communities were found, there was a significant change in their structure, with a more consolidated network at T2. The most central item was 'difficult to relax' in both networks. Cross-sectionally, all symptoms of failure to adapt significantly predicted adjustment disorder. 'Worry a lot more' (preoccupation) and 'difficult to adapt to life' (failure to adapt) at T1 significantly predicted this diagnosis at T2. CONCLUSIONS: Adjustment disorder symptoms consolidated during the second lockdown of the pandemic. In line with the ICD-11 conceptualisation of adjustment disorder, both preoccupation and failure-to-adapt symptoms have prognostic validity. This highlights the importance of identifying and targeting adjustment disorder symptoms during a period of stress such as the COVID-19 pandemic.

Legal restrictions and mitigation strategies amongst a disabled population during COVID-19.

The impact of physical disability on protective behaviors during COVID-19 has been little studied. This retrospective study compared the 699 the self-declared behaviors of 699 people with disabilities before and after the relaxation of COVID-19 restrictions in England. We found that people with disabilities in England showed high compliance with protective behaviors and mitigation strategies during a period of legal restrictions. Following the lifting of restrictions, respondents engaged in less social mixing, fewer distancing and hygiene behaviors and were less likely to use face coverings. Hierarchical regressions revealed that socio-economic status, age, and gender moderated protective behaviors: while those with higher socio-economic status were more relaxed with regard to hygiene and distancing behaviors, they were more cautious about mixing with others after the end of restrictions. Age, (male) gender, and being unvaccinated were positively associated with relaxation in the use of facemasks in public places, not needing a carer with fewer out-of-home visits. Taken together these findings suggest that the removal of restrictions had an unequal impact on the population of England, placing a disproportionate burden on some people with disabilities.

For better or worse: Relationship change in Thailand during COVID-19.

OBJECTIVE: Novel infectious diseases have the potential to both strengthen or weaken interpersonal relationships within a society. In a collectivist setting such as Thailand amplification of relationships may be particularly marked, but may be associated with individual factors, including personal values and perceived control over the virus. METHODS: A national on-street survey in Thailand (April 2020, N = 1,000), collected data from five regions across the country (response rate 82.6%). Participants reported demographics, anxiety, perceived control, and personal values of security and universalism, and indicated changes, from negative to positive, across four relationship types (relationship partners, family, friendships and neighbourhood). RESULTS: While relationship changes were small overall, there was an improvement in close relations (partners, family members) but not amongst friends and neighbours. Respondents who were married without children recorded less enhancement of partnerships, friendships and neighbourhood relations. Those with less perceived control over the infection reported relationship decline, while single people reported fewer positive changes in their partnership or family relations. Multiple regression analyses demonstrated the prioritisation of security was associated with a decline in each of the relationships, while universalism was positively associated with change in the family, in friendships and neighbourly relations. CONCLUSIONS: Personal values and marital status may impact on relationship functioning during a national health crisis. These issues should be considered by clinicians and health practitioners when trying to assist those struggling with interpersonal relations during a pandemic.

Two-Tailed Dogs, Social Unrest and COVID-19 Vaccination: Politics, Hesitancy and Vaccine Choice in Hungary and Thailand.

BACKGROUND: A long tradition of research has shown an association between political orientation and vaccine uptake. However, we know little about political preferences and the choice of specific vaccines. METHODS: We conducted two national surveys, in Hungary (Study 1, online, n = 1130) and Thailand (Study 2, on the street survey: n = 1052), testing associations between political allegiance, trust in government, vaccine willingness, and vaccine choice. RESULTS: In Hungary, those supporting the government or on the political right were more willing to be vaccinated, with this association strongest for government approved vaccines. These respondents were also more likely to accept Chinese and Russian vaccines and reject the Moderna vaccine. In Thailand, vaccinated respondents reported greater trust in the government, with preference for AstraZeneca associated with support for pro-government political parties and preference for Pfizer with anti-government attitudes. CONCLUSIONS: Vaccine campaigns need to recognise the role of political loyalties not only in vaccine willingness, but in vaccine choice, especially given the mixing of vaccines across doses.

Association between mental health trajectories and somatic symptoms following a second lockdown in Israel: a longitudinal study

ObjectivesTo identify mental health prospective trajectories before and after a second lockdown during the COVID-19 pandemic and their associations with somatic symptoms.DesignProspective Study.SettingPopulation-based study drawn from a probability-based internet panel of over 100 000 Israelis.ParticipantsAdults aged 18 years or more, representative of the adult Israeli population. The participants were measured at two time points (time 1 (T1) pre-second lockdown N=1029;response rate=76.17%;time 2 (T2) post-second lockdown N=764;response rate=74.24%).Main outcome measuresTrajectories of anxiety and adjustment disorder based on clinical cut-off score for probable diagnoses across T1-T2, somatic symptoms at T2. The four trajectories: stable-low, (no probable diagnosis), stable-high (stable probable diagnosis), exacerbation (no probable diagnosis at T1, probable diagnosis at T2), recovery (probable diagnosis at T1, no probable diagnosis at T2).ResultsThree anxiety trajectories predicted probable somatic symptoms (stable-high OR=6.451;exacerbation OR=5.379;recovery OR=2.025) compared with the stable-low trajectory. The three adjustment disorder trajectories also predicted somatic symptoms (stable-high OR=4.726;exacerbation OR=6.419;recovery OR=4.666) compared with the stable-low trajectory.ConclusionsOur data show elevated somatic symptoms among those whose mental health trajectories were poor, exacerbated and those who recovered following the second lockdown. The presentation of somatic symptoms may mask psychological vulnerabilities, even among those who appear to have recovered from the stressor. This indicates that lockdown may be a double-edged sword and should be carefully administered given these populations vulnerabilities.

Anxiety, past trauma and changes in relationships in Japan during COVID-19.

Widely shared traumas have the potential to both improve and impair our relationships with others. During COVID-19 anxiety has been seen as a major individual vulnerability associated with relationship change, as have the wider economic, situational factors facing families and communities. In this national sample of 997 Japanese respondents we assessed perceived relationship changes in couple relations, neighbourhood relations, and wider relations with Japanese nationals, alongside anxiety, exposure to previous mass traumas, household economics, education, and vulnerability to COVID-19. Whilst most respondents reported little change in their relationships during this year there was a small overall improvement in couple relationships and a decline in relations with wider communities. Participant's economic resources were positively associated with an improvement in couple relationships, while anxiety was associated with a decline in relations with both the neighbourhood and the wider society. While neither prior experience of mass trauma, nor education or health vulnerability to COVID-19, were associated with relationship change, having time to talk, and younger age, was positively associated with improvement in couple relations. Findings suggest that anxiety can function to distance relationships during a time of stress, but perceived changes in relationships are little effected by experience of previous trauma. Relationship growth is likely to be greatest in those with better economic conditions. Practitioners need to be mindful of the impact of enhanced anxiety during the pandemic on interpersonal relations, and a potential threat to the relationships of older couples during this time of pandemic threat.

COVID-19 post-vaccination depression in older Israeli adults: the role of negative world assumptions

Background With the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the aging population has been shown to be highly vulnerable. As a result, policy makers and the media urged older adults to restrict social interactions, placing them at greater risk of mental health problems, such as depression. However, there has been a little previous attempt to examine coronavirus disease-2019 (COVID-19) vaccine-related risk factors and depressive symptoms amongst older adults. Methods Participants (938 older adults, Mage = 68.99, s.d. = 3.41, range 65–85) answered an online questionnaire at the start of the COVID-19 vaccination program in Israel. Participants completed measures of background characteristics, world assumptions, COVID-19 vaccine-related variables, and symptoms of depression. Results Univariate logistic regression revealed that more negative world assumptions were linked with clinical depression levels. Conclusions Older adults in our sample were susceptible to unique factors associated with clinical depression influenced by their world assumptions during their COVID-19 vaccination. The high level of depression following vaccination indicates that it may take time to recover from depression associated with pandemic distress. Cognitive interventions that focus on world assumptions are recommended.

COVID-19 post-vaccination depression in older Israeli adults: the role of negative world assumptions.

Background: With the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the aging population has been shown to be highly vulnerable. As a result, policy makers and the media urged older adults to restrict social interactions, placing them at greater risk of mental health problems, such as depression. However, there has been a little previous attempt to examine coronavirus disease-2019 (COVID-19) vaccine-related risk factors and depressive symptoms amongst older adults. Methods: Participants (938 older adults, Mage = 68.99, s.d. = 3.41, range 65-85) answered an online questionnaire at the start of the COVID-19 vaccination program in Israel. Participants completed measures of background characteristics, world assumptions, COVID-19 vaccine-related variables, and symptoms of depression. Results: Univariate logistic regression revealed that more negative world assumptions were linked with clinical depression levels. Conclusions: Older adults in our sample were susceptible to unique factors associated with clinical depression influenced by their world assumptions during their COVID-19 vaccination. The high level of depression following vaccination indicates that it may take time to recover from depression associated with pandemic distress. Cognitive interventions that focus on world assumptions are recommended.

Psychological factors underpinning vaccine willingness in Israel, Japan and Hungary.

The spread of SARS-CoV-2 led to rapid vaccine development. However, there remains considerable vaccine hesitancy in some countries. We investigate vaccine willingness in three nations with very different vaccine histories: Israel, Japan and Hungary. Employing an ecological-systems approach we analyse associations between health status, individual cognitions, norms, trust in government, COVID-19 myths and willingness to be vaccinated, with data from three nationally representative samples (Israel, Jan. 2021, N = 1011; Japan, Feb. 2021, N = 997; Hungary, April 2021, N = 1130). Vaccine willingness was higher in Israel (74%) than Japan (51%) or Hungary (31%). In all three countries vaccine willingness was greatest amongst who would regret not being vaccinated and respondents who trusted their government. Multi-group latent class analysis identified three groups of COVID myths, with particular concern about alteration of DNA (Israel), allergies (Hungary) and infection from the vaccine (Japan). Intervention campaigns should address such cultural myths while emphasising both individual and social benefits of vaccination.

Factors associated with current posttraumatic stress disorder among COVID-19 vaccinated older adults in Israel.

This is the first study to examine COVID-19 vaccine-related stressors in the context of current posttraumatic stress disorder (PTSD) symptoms amongst older adults exposed to traumatic events prior to the COVID-19 outbreak, with particular focus on the associations between ageism, vaccine-related stressors and PTSD. Five hundred and sixty-three participants aged 65 and above reported exposure to at least one traumatic event, their current PTSD level, physical and mental health, ageist attitudes, and vaccine related stressors. Univariate logistic regression revealed that depressive symptoms, ageism, vaccine hesitancy and severity of side effects were the main factors associated with clinical levels of current PTSD. These results suggest that older adults were vulnerable to intensified PTSD symptoms, not only as a result of greater depression, but also as a consequence of other factors, including ageism, vaccination hesitancy and vaccination side effects. Practitioners would benefit from awareness to these factors.

The toll of a second lockdown: A longitudinal study.

Background The mental health toll of a second lockdown during the COVID-19 pandemic has not been yet examined. The purpose of the study was to examine psychological predictors before the second lockdown and their impact on the prediction of ICD-11 probable Adjustment Disorder (AjD) after the second lockdown. Methods Using a longitudinal design we surveyed a national representative sample of the Israeli population before and after the second lockdown. In wave 1, 1029 were surveyed (Response Rate (RR) = 76.17%) and in Wave 2, 764 were surveyed (RR = 74.24%). Participants answer a questionnaire tapping COVID-19 stressful related events, uncertainty, probable depression predicting ICD-11 and probable AjD. Results The main predictors of AjD after the second lockdown were sex (OR = 1.868; p ≤0.01), having a COVID-19 occupational related stressful event (OR = 2.855; p <0.001), probable depression (OR = 2.520; p <0.001) and Uncertainty (OR = 4.485; p <0.001). Limitations We recognise the limitations of response bias. In addition, we did not measure pre COVID-19 mental health. Conclusions The study results show the mental toll of a second lockdown during the COVID-19 pandemic.

Investigating the relationship between COVID-19-related and distress and ICD-11 adjustment disorder: two cross-sectional studies.

BACKGROUND: To assess the prevalence of elevated risk of serious mental illness and probable ICD-11 adjustment disorder in the UK population at two time points during COVID-19, and their association with COVID-19-related stressful events. AIMS: To check the dose-response model for stress between the number of COVID-19-related stressful events and mental health indices. METHOD: We conducted two cross-sectional studies, using internet survey samples across the UK (N = 1293 for study 1; N = 1073 for study 2). Samples used internet panel surveys during March-April 2020 and 3 months later (June 2020), and used random stratified samples. Studies assessed prevalence of serious risk of mental illness and probable ICD-11 adjustment disorder. RESULTS: Elevated risk of serious mental illness was found among those with COVID-19-related social life or occupationally stressful events (study 1). Elevated risk of serious mental illness and probable ICD-11 adjustment disorder was evident among those reporting COVID-19-related stressful events (personal health problems and caregiving; study 2). Cumulative COVID-19-related stressful events were associated with elevated risk of serious mental illness in study 1 (odds ratio 1.65; 95% CI 1.03-2.64; P = 0.037), and with both elevated risk of serious mental illness (odds ratio 2.19; 95% CI 1.15-4.15; P = 0.017) and probable ICD-11 adjustment disorder (odds ratio 2.45; 95% CI 1.27-4.72; P = 0.007) in study 2. CONCLUSIONS: Psychiatrists should be aware that COVID-19-related stressful events can lead to serious psychological problems. Mental health professionals need to pay particular attention to patients who report cumulative COVID-19-related stressful events, and consider them for mental health assessment and treatment.

Psychiatric symptoms and behavioral adjustment during the COVID-19 pandemic: evidence from two population-representative cohorts.

This study examined prevalences of anxiety and depression and their correlations with daily routines among Hong Kong Chinese during the COVID-19 pandemic. Random digit dialing recruited two population-representative samples of 6029 residents during a period of low infection and limited intervention (survey 1: n = 4021) and high incidence and intensive measures (survey 2: n = 2008). Prevalence of anxiety for survey 1 and survey 2 were 14.9% and 14% and depression were 19.6% and 15.3%, respectively. Increased odds of anxiety and depression were associated with disrupted routines and lower socioeconomic status in both surveys, whereas depression was inversely related to the novel preventive routine of avoiding going to crowded places in survey 1. The prevalences of anxiety and depression were higher than preceding public health/social crises. A heavier burden of psychiatric conditions was evidenced amongst people experiencing disrupted daily routines across different phases of the pandemic and without novel preventive routines in the early phase.

Anxiety, perceived control and pandemic behaviour in Thailand during COVID-19: Results from a national survey.

Anxiety, perceived control and trust in information sources have all been shown to significantly influence health and social behaviours during pandemics. We measured these factors in a nationally representative on-street survey collected across five regions of Thailand (N = 1000, May 2020, response rate 82.6%). Anxiety was positively associated with stocking up on food (OR 2.62 (95% CI 1.88-3.66)) and taking vitamins (OR 2.37 (1.59-3.54)); perceived control with (recommended) coughing into an elbow (OR 2.42 (1.80-3.26)), checking on others (OR 1.52 (1.00-2.31)), and negatively with stockpiling (OR 0.72 (0.55-0.96)). Those relying on family/friends, doctors online or foreign sources were more likely to take vitamins (ORs 4.11, 2.88. 2.82), respondents using TV news less likely to stock up on food (OR 0.57 (0.37-0.86)) and to wear a mask for self-protection (OR 0.27 (0.10-0.73)). Comparing findings with analogous cross-sectional data on anxiety collected at the start of the pandemic (Feb 2020, Goodwin et al., 2020) there was no significant difference between personal anxiety in the two surveys (F (1, 1197) = 0.72, p = .40)) but perceived control was lower in the later survey (F (1, 1197) = 6.72 p = .01)). Findings suggest reduced perceived control as the pandemic developed and illuminate possible negative impacts of anxiety and low sense of control on pandemic behaviours.