Intent to Receive COVID-19 Vaccines in the United States: Associations with Mental Health and Impact of the Pandemic on Daily Lives

Introduction: COVID-19 vaccine uptake in the United States continues to raise challenges. A deeper characterization extending beyond demographics and political ideologies of those hesitating or resisting is needed to guide ongoing conversations. We examined associations between U.S. adults’ vaccination intentions and mental health history, experience of the COVID-19 pandemic, and mental health outcomes.

Methods: An online population-based cross-sectional survey was administered nationwide 01/04/2021-01/07/2021. Demographic information included age, gender, race, ethnicity, income, education, occupation, marital status, and geographic location. Participants were questioned about past and current mental health, and completed the PHQ-8, GAD-7, and PDS-5 (to capture symptoms of depression, anxiety, and traumatic stress, respectively). Experience of the pandemic included cumulative county-level COVID case and death rates, self-reported COVID-19 testing/exposure/diagnosis, and self-reported impact on routines, resources, and relationships. Numerical variables were summarized with means and standard deviations or medians and interquartile ranges, and categorical variables were summarized with counts and percentages. To determine which participant characteristics were associated with vaccine intentions, comparisons were performed using analysis of variance (ANOVA) for most continuous variables, Kruskal Wallis tests for skewed continuous and ordinal variables, and chi-square test for categorical variables. Multivariable ordinal logistic regression was performed to determine how symptoms of depression, anxiety, and PTSD were associated with intention to vaccinate, while controlling for demographic and pandemic experience factors. A 5% level was used to determine significance, and all analyses were performed using SAS 9.4. No adjustment was made for multiple testing.

Results: Of 936 respondents, 66% intended to be vaccinated, 14.7% responded “maybe” and 19.6% “no.” Concerns regarding potential side effects was the most common explanation (72%) given by participants who responded “maybe” to planning to get the vaccine, and about safety (66%) for those who responded “no.” Past diagnosis of obsessive compulsive disorder, less impact on routines or social supports, not having been screened or tested for COVID-19, not knowing someone who tested positive, and not self-isolating were associated with less intention to vaccinate. After controlling for demographic and pandemic experience factors, symptoms of traumatic stress, but not other mental health outcomes, were associated with less intention to vaccinate.

Conclusions: In this survey of U.S. adults approximately 3 weeks after the first COVID-19 vaccine was authorized by the FDA for emergency use, the vast majority of respondents planned to be vaccinated when the vaccine became available. Among mental health diagnoses, only a history of OCD and elevated scores on the PTSD measure were significantly associated with decreased vaccine intention. Perhaps not surprising, people who reported not self-isolating and had never been tested for COVID-19, or known anyone who had tested positive for COVID-19, also indicated less intention to seek a vaccine. The apparent contradiction between less negative impact of the pandemic and symptoms of traumatic stress being associated with less intention to be vaccinated indicates the complex nature of barriers to vaccine uptake. Our results can complement primary care providers’ experience in holding discussions about vaccination in tailoring approaches for individuals who remain hesitant.