National Institute of Mental Health, Neurology and Neurosurgery, Budapest.
János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest.
Ideggyogy Sz. 2022 Mar 31;75(3-04):111-116. doi: 10.18071/isz.75.0111.
Vaccination refusal is a serious obstacle to minimizing the spread of COVID-19. Nevertheless, the rejection of vaccine can be considered the result of a negative attitude towards medical treatment, and according to our previously published data, it can be influenced by the underlying affective state. Increased incidence of affective disorders and anxiety could be observed globally during the pandemic, which may have a significant impact on vaccination acceptance. The aim of our pilot study was to determine the association between clinical improvement of affective and neurocognitive symptoms and change of drug attitude and health control beliefs in a sample of psychiatric patients.
A data set of 85 patients with psychiatric disorder has been analysed with the use of Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) with 5 subscales (Negative Aspect of Medication - NA; Positive Aspect of Medication - PA; Doctor health locus of control- Doctor HLOC; Internal HLOC; Psychological Reactance - PR); Hospital Anxiety Depression Scale (HADS-Anx; HADS-Dep) and neurocognitive tests, such as the Stroop test and the Trail Making Tests. All the tests were performed before and after a 14 days treatment. Paired t-tests and generalized linear models were performed to assess the associations between the variables.
The baseline scores of NA and HADS-Anx correlated significantly (p=0.001) and after two weeks of treatment NA decreased (p=0.001), while Doctor HLOC and Internal HLOC increased (p=0.001 and p=0.006). The patients performance of the neurocognitive tests improved (all p<0.05). The reduction of HADS-Anx (p=0.002) and HADS-Dep (p=0.006) scores showed significant associations with the decrease of NA. Increase of the PA score was associated with reduction of HADS-Dep (p=0.028). Improvement of neurocognitive functions had no effect on PHBQPT scores.
Important conclusions can be drawn regarding the rejection of the COVID-19 vaccine based on the associations found between the intensity of affective and anxiety symptoms and the attitude towards treatment. Our findings suggest that affective symptoms have a negative influence on the attitude towards treatment and that the improvement of these symptoms can facilitate the acceptance of the therapy, regardless of diagnosis. The modest effect of the improvement of neurocognitive functioning on the attitude towards drugs and the significant role of affective-emotional factors suggest that the accep-tance of vaccination probably cannot be facilitated solely with the aid of educational programs. Considering the increasing incidence of affective disorders during the COVID-19 pandemic, the screening of affective and anxiety symptoms and treatment of these disorders could be an important step towards the acceptance of the vaccine. Although psychiatry is not considered as a frontline care unit of the COVID cases, more attention is needed to pay on the availability of mental health services because refuse of vaccine can develop due to affective disorders too.
疫苗接种的拒绝是最小化 COVID-19 传播的严重障碍。然而，疫苗的拒绝可以被认为是对医疗的负面态度的结果，并且根据我们之前发表的数据，它可以受到潜在的情感状态的影响。在大流行期间，全球范围内观察到情感障碍和焦虑症的发病率增加，这可能对疫苗接种的接受产生重大影响。我们的初步研究的目的是确定在一组精神病患者中，情感和神经认知症状的临床改善与药物态度和健康控制信念的变化之间的关联。
使用精神病治疗患者健康信念问卷（PHBQPT），使用 5 个子量表（药物的负面方面 - NA；药物的正面方面 - PA；医生健康控制 - 医生 HLOC；内部 HLOC；心理反应 - PR）；汉密尔顿焦虑抑郁量表（HADS-Anx；HADS-Dep）和神经认知测试，如斯特鲁普测试和追踪测试，对 85 名患有精神疾病的患者进行了数据分析。所有测试均在 14 天治疗前后进行。进行配对 t 检验和广义线性模型，以评估变量之间的关联。
NA 和 HADS-Anx 的基线得分显著相关（p=0.001），两周后治疗后 NA 降低（p=0.001），而医生 HLOC 和内部 HLOC 增加（p=0.001 和 p=0.006）。患者的神经认知测试表现有所改善（均 p<0.05）。HADS-Anx（p=0.002）和 HADS-Dep（p=0.006）评分的降低与 NA 的降低显著相关。PA 评分的增加与 HADS-Dep 的降低相关（p=0.028）。神经认知功能的改善对 PHBQPT 评分没有影响。
根据发现的情感和焦虑症状的强度与治疗态度之间的关联，可以得出有关 COVID-19 疫苗接种拒绝的重要结论。我们的研究结果表明，情感症状对治疗态度有负面影响，改善这些症状可以促进治疗的接受，无论诊断如何。神经认知功能改善对药物态度的适度影响和情感因素的显著作用表明，仅通过教育计划可能无法促进疫苗接种的接受。考虑到大流行期间情感障碍发病率的增加，筛查情感和焦虑症状并治疗这些疾病可能是接受疫苗的重要步骤。尽管精神病学不被认为是 COVID 病例的一线护理单位，但需要更加关注心理健康服务的可用性，因为情感障碍也可能导致疫苗接种的拒绝。
