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31-01-2023 | Affective Disorder | Original Article

Association between attitudes toward the COVID-19 vaccines and mental health among 140,259 college students in China

Authors: Qingqing Xu, Keliang Fan, Dandan Wei, Juan Wang, Xian Wang, Xiaomin Lou, Hualiang Lin, Chongjian Wang, Cuiping Wu, Zhenxing Mao

Published in: Journal of Public Health | Issue 3/2024

Abstract

Background

With the launch of the COVID-19 vaccines, the vaccination rate has become a hot issue of concern. However, the evidence for the relationship between college students’ attitudes toward vaccines and anxiety and depressive symptoms has been limited.

Methods

In total, 140,259 college students were recruited using a cluster sampling method in Zhengzhou, Xinxiang, Xinyang city of Henan Province, China, May 21-27, 2021. Anxiety symptoms were determined by the Generalized Anxiety Disorder tool (GAD-7) and depressive symptoms were determined by the Patient Health Questionnaire (PHQ-9). Multiple logistic regression was performed to estimate the association between students’ attitudes toward the vaccines and anxiety and depressive symptoms.

Results

The results indicate that 22.45% of students are unclear whether the vaccine can protect them from infection and 45.57% are unclear whether the vaccine is safe and has no side effects. In addition, after adjusting, the model showed that students who think vaccines can protect them and are safe had 0.128 (95%CI 0.110–0.150; P_trend < 0.001) times lower risk of anxiety compared to their counterparts who think vaccines can neither protect them nor are safe. Similar ORs were found in depression (aOR = 0.157; 95%CI 0.137–0.180).

Conclusion

This large-scale study has shown an association between symptoms of anxiety and depression and reluctance to obtain vaccination.

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Alvis-Guzman N, Alvis-Zakzuk J, Paz-Wilches J, Fernandez-Mercado JC, de la Hoz-Restrepo F (2022) Willingness to receive the COVID-19 vaccine in the population aged 80 years and older in Colombia 2021. Vacunas 23:S41–s45. https://doi.org/10.1016/j.vacun.2021.07.005CrossRefPubMed

Bai W, Cai H, Liu S, Liu H, Qi H, Chen X, Liu R, Cheung T, Su Z, Ng CH, Xiang YT (2021) Attitudes toward COVID-19 vaccines in Chinese college students. Int J Biol Sci 17(6):1469–1475. https://doi.org/10.7150/ijbs.58835CrossRefPubMedPubMedCentral

Baxter AJ, Scott KM, Vos T, Whiteford HA (2013) Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 43(5):897–910. https://doi.org/10.1017/s003329171200147xCrossRefPubMed

Bendau A, Petzold MB, Pyrkosch L, Mascarell Maricic L, Betzler F, Rogoll J, Große J, Ströhle A, Plag J (2021) Associations between COVID-19 related media consumption and symptoms of anxiety, depression and COVID-19 related fear in the general population in Germany. Eur Arch Psychiatry Clin Neurosci 271(2):283–291. https://doi.org/10.1007/s00406-020-01171-6CrossRefPubMed

Bödeker B, Remschmidt C, Schmich P, Wichmann O (2015) Why are older adults and individuals with underlying chronic diseases in Germany not vaccinated against flu? A population-based study. BMC Public Health 15:618. https://doi.org/10.1186/s12889-015-1970-4CrossRefPubMedPubMedCentral

Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 395(10227):912–920. https://doi.org/10.1016/s0140-6736(20)30460-8CrossRefPubMedPubMedCentral

Brown DL, Cowdery JE (2021) College students' knowledge and attitudes toward clinical trials and their relationship with willingness to participate in COVID-19 trials or vaccines. J Am Coll Health 1–3. https://doi.org/10.1080/07448481.2021.1947840

Brown TS, Walensky RP (2020) Serosurveillance and the COVID-19 Epidemic in the US: Undetected, Uncertain, and Out of Control. Jama 324(8):749–751. https://doi.org/10.1001/jama.2020.14017CrossRefPubMed

Dong E, Du H, Gardner L (2020) An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 20(5):533–534. https://doi.org/10.1016/s1473-3099(20)30120-1CrossRefPubMedPubMedCentral

Fadda M, Albanese E, Suggs LS (2020) When a COVID-19 vaccine is ready, will we all be ready for it? Int J Public Health 65(6):711–712. https://doi.org/10.1007/s00038-020-01404-4CrossRefPubMed

de Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ (2020) Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. Lancet 396(10255):898–908. https://doi.org/10.1016/s0140-6736(20)31558-0CrossRefPubMedPubMedCentral

Frazier P, Liu Y, Asplund A, Meredith L, Nguyen-Feng VN (2021) US college student mental health and COVID-19: comparing pre-pandemic and pandemic timepoints. J Am Coll Health 1–11. https://doi.org/10.1080/07448481.2021.1987247

Froiland JM (2021) A comprehensive model of preschool through high school parent involvement with emphasis on the psychological facets. School Psychology International 42(2):103–131CrossRef

González-Sanguino C, Ausín B, Castellanos MA, Saiz J, Muñoz M (2021) Mental health consequences of the Covid-19 outbreak in Spain. A longitudinal study of the alarm situation and return to the new normality. Prog Neuropsychopharmacol Biol Psychiatry 107:110219. https://doi.org/10.1016/j.pnpbp.2020.110219CrossRefPubMed

Gupta AK, Maity C (2021) Efficacy and safety of Bacillus coagulans LBSC in irritable bowel syndrome: a prospective, interventional, randomized, double-blind, placebo-controlled clinical study [CONSORT Compliant]. Medicine (Baltimore) 100(3):e23641. https://doi.org/10.1097/md.0000000000023641CrossRefPubMed

Han W, Xu L, Niu A, Jing Y, Qin W, Zhang J, Jing X, Wang Y (2021) Online-based survey on college students' anxiety during COVID-19 outbreak. Psychol Res Behav Manag 14:385–392. https://doi.org/10.2147/prbm.S298539CrossRefPubMedPubMedCentral

Iwasa T, Wada K (2013) Reasons for and against receiving influenza vaccination in a working age population in Japan: a national cross-sectional study. BMC Public Health 13:647. https://doi.org/10.1186/1471-2458-13-647CrossRefPubMedPubMedCentral

Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, Chae JH (2016) Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health 38:e2016048. https://doi.org/10.4178/epih.e2016048CrossRefPubMedPubMedCentral

Kennedy J (2020) Vaccine Hesitancy: A Growing Concern. Paediatr Drugs 22(2):105–111. https://doi.org/10.1007/s40272-020-00385-4MathSciNetCrossRefPubMed

Kessler RC, Angermeyer M, Anthony JC, R DEG, Demyttenaere K, Gasquet I, G DEG, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Ustün TB. (2007) Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry, 6(3):168–176.

Khadse PA, Gowda GS, Ganjekar S, Desai G, Murthy P (2020) Mental Health Impact of COVID-19 on Police Personnel in India. Indian J Psychol Med 42(6):580–582. https://doi.org/10.1177/0253717620963345CrossRefPubMedPubMedCentral

Kini A, Morgan R, Kuo H, Shea P, Shapiro J, Leng SX, Pekosz A, Klein SL (2022) Differences and disparities in seasonal influenza vaccine, acceptance, adverse reactions, and coverage by age, sex, gender, and race. Vaccine 40(11):1643–1654. https://doi.org/10.1016/j.vaccine.2021.04.013CrossRefPubMed

Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.xCrossRefPubMedPubMedCentral

Lane S, MacDonald NE, Marti M, Dumolard L (2018) Vaccine hesitancy around the globe: analysis of three years of WHO/UNICEF joint reporting form data-2015-2017. Vaccine 36(26):3861–3867. https://doi.org/10.1016/j.vaccine.2018.03.063CrossRefPubMedPubMedCentral

Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, Kimball S, El-Mohandes A (2021) Author Correction: a global survey of potential acceptance of a COVID-19 vaccine. Nat Med 27(2):354. https://doi.org/10.1038/s41591-020-01226-0CrossRefPubMedPubMedCentral

Li Q, Miao Y, Zeng X, Tarimo CS, Wu C, Wu J (2020) Prevalence and factors for anxiety during the coronavirus disease 2019 (COVID-19) epidemic among the teachers in China. J Affect Disord 277:153–158. https://doi.org/10.1016/j.jad.2020.08.017CrossRefPubMedPubMedCentral

Ljungberg T, Bondza E, Lethin C (2020) Evidence of the importance of dietary habits regarding depressive symptoms and depression. Int J Environ Res Public Health 17(5). https://doi.org/10.3390/ijerph17051616

Luz PM, Johnson RE, Brown HE (2017) Workplace availability, risk group and perceived barriers predictive of 2016-17 influenza vaccine uptake in the United States: a cross-sectional study. Vaccine 35(43):5890–5896. https://doi.org/10.1016/j.vaccine.2017.08.078CrossRefPubMed

Ma Z, Zhao J, Li Y, Chen D, Wang T, Zhang Z, Chen Z, Yu Q, Jiang J, Fan F, Liu X (2020) Mental health problems and correlates among 746 217 college students during the coronavirus disease 2019 outbreak in China. Epidemiol Psychiatr Sci 29:e181. https://doi.org/10.1017/s2045796020000931CrossRefPubMedPubMedCentral

Ma ZR, Idris S, Pan QW, Baloch Z (2021) COVID-19 knowledge, risk perception, and information sources among Chinese population. World J Psychiatry 11(5):181–200. https://doi.org/10.5498/wjp.v11.i5.181CrossRefPubMedPubMedCentral

Manzanares I, Sevilla Guerra S, Lombraña Mencía M, Acar-Denizli N, Miranda Salmerón J, Martinez EG (2021) Impact of the COVID-19 pandemic on stress, resilience and depression in health professionals: a cross-sectional study. Int Nurs Rev 68(4):461–470. https://doi.org/10.1111/inr.12693CrossRefPubMedPubMedCentral

Mayr V, Nußbaumer-Streit B, Gartlehner G (2020) Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Gesundheitswesen 82(6):501–506. https://doi.org/10.1055/a-1164-6611CrossRefPubMedPubMedCentral

Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, Huang J, He N, Yu H, Lin X, Wei S, Wu T (2020) Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China. Jama 323(19):1915–1923. https://doi.org/10.1001/jama.2020.6130CrossRefPubMed

Qiao S, Tam CC, Li X (2022) Risk exposures, risk perceptions, negative attitudes toward general vaccination, and COVID-19 vaccine acceptance among college students in South Carolina. Am J Health Promot 36(1):175–179. https://doi.org/10.1177/08901171211028407CrossRefPubMed

Reeve J, Shin SH (2020) How teachers can support students’ agentic engagement. Theory Into Practice 59(2):150–161CrossRef

Roy M, Sherrard L, Dubé È, Gilbert NL (2018) Determinants of non-vaccination against seasonal influenza. Health Rep 29(10):12–22PubMed

Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, Rasoulpoor S, Khaledi-Paveh B (2020) Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Global Health 16(1):57. https://doi.org/10.1186/s12992-020-00589-wCrossRefPubMedPubMedCentral

Schaffer DeRoo S, Pudalov NJ, Fu LY (2020) Planning for a COVID-19 Vaccination Program. Jama 323(24):2458–2459. https://doi.org/10.1001/jama.2020.8711CrossRefPubMed

Sharma M, Davis RE, Wilkerson AH (2021) COVID-19 vaccine acceptance among college students: a theory-based analysis. Int J Environ Res Public Health 18(9). https://doi.org/10.3390/ijerph18094617

Son C, Hegde S, Smith A, Wang X, Sasangohar F (2020) Effects of COVID-19 on college students' mental health in the United States: interview survey study. J Med Internet Res 22(9):e21279. https://doi.org/10.2196/21279CrossRefPubMedPubMedCentral

Spitzer RL, Kroenke K, Williams JB, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097. https://doi.org/10.1001/archinte.166.10.1092CrossRefPubMed

Stepowicz A, Wencka B, Bieńkiewicz J, Horzelski W, Grzesiak M (2020) Stress and anxiety levels in pregnant and post-partum women during the COVID-19 pandemic. Int J Environ Res Public Health 17(24). https://doi.org/10.3390/ijerph17249450

Wang G, Zhang Y, Zhao J, Zhang J, Jiang F (2020) Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet 395(10228):945–947. https://doi.org/10.1016/s0140-6736(20)30547-xCrossRefPubMedPubMedCentral

Wilson SL, Wiysonge C (2020) Social media and vaccine hesitancy. BMJ Glob Health 5(10). https://doi.org/10.1136/bmjgh-2020-004206

Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, van Os J, Preisig M, Salvador-Carulla L, Simon R, Steinhausen HC (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21(9):655–679. https://doi.org/10.1016/j.euroneuro.2011.07.018CrossRefPubMed

Yu MC, Chou YL, Lee PL, Yang YC, Chen KT (2014) Influenza vaccination coverage and factors affecting adherence to influenza vaccination among patients with diabetes in Taiwan. Hum Vaccin Immunother 10(4):1028–1035. https://doi.org/10.4161/hv.27816CrossRefPubMedPubMedCentral

Zhu FC, Guan XH, Li YH, Huang JY, Jiang T, Hou LH, Li JX, Yang BF, Wang L, Wang WJ, Wu SP, Wang Z, Wu XH, Xu JJ, Zhang Z, Jia SY, Wang BS, Hu Y, Liu JJ et al (2020a) Immunogenicity and safety of a recombinant adenovirus type-5-vectored COVID-19 vaccine in healthy adults aged 18 years or older: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet 396(10249):479–488. https://doi.org/10.1016/s0140-6736(20)31605-6CrossRefPubMedPubMedCentral

Zhu FC, Li YH, Guan XH, Hou LH, Wang WJ, Li JX, Wu SP, Wang BS, Wang Z, Wang L, Jia SY, Jiang HD, Wang L, Jiang T, Hu Y, Gou JB, Xu SB, Xu JJ, Wang XW et al (2020b) Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial. Lancet 395(10240):1845–1854. https://doi.org/10.1016/s0140-6736(20)31208-3CrossRefPubMedPubMedCentral

Title: Association between attitudes toward the COVID-19 vaccines and mental health among 140,259 college students in China
Authors: Qingqing Xu
Keliang Fan
Dandan Wei
Juan Wang
Xian Wang
Xiaomin Lou
Hualiang Lin
Chongjian Wang
Cuiping Wu
Zhenxing Mao
Publication date: 31-01-2023
Publisher: Springer Berlin Heidelberg
Keywords: Affective Disorder
COVID-19 Vaccination
Affective Disorder
COVID-19
Anxiety
Published in: Journal of Public Health / Issue 3/2024
Print ISSN: 2198-1833
Electronic ISSN: 1613-2238
DOI: https://doi.org/10.1007/s10389-023-01830-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Association between attitudes toward the COVID-19 vaccines and mental health among 140,259 college students in China

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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