The Perfect Enemy | COVID-19 vaccine acceptance and perceived stigma in patients with depression: a network perspective | Translational Psychiatry
July 14, 2025

COVID-19 vaccine acceptance and perceived stigma in patients with depression: a network perspective | Translational Psychiatry

COVID-19 vaccine acceptance and perceived stigma in patients with depression: a network perspective | Translational Psychiatry  Nature.com

COVID-19 vaccine acceptance and perceived stigma in patients with depression: a network perspective | Translational Psychiatry
COVID-19 vaccine acceptance and perceived stigma in patients with depression: a network perspective | Translational Psychiatry
  • Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119–38.

    PubMed  PubMed Central  Article  Google Scholar 

  • World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. 2020. https://covid19.who.int/?gclid=EAIaIQobChMI2_CM6eDZ6gIVghh9Ch3nDQm1EAAYASAAEgLqwPD_BwE. Accessed 17 Jul 2020.

  • Taquet M, Luciano S, Geddes J, Harrison P. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021;8:130–40.

  • Fond G, Nemani K, Etchecopar-Etchart D, Loundou A, Goff DC, Lee SW, et al. Association between mental health disorders and mortality among patients with COVID-19 in 7 countries: a systematic review and meta-analysis. JAMA Psychiatry. 2021;78:1208–17.

  • Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim EK, et al. A meta-analysis of cytokines in major depression. Biol Psychiatry. 2010;67:446–57.

    PubMed  Article  Google Scholar 

  • Fries GR, Walss-Bass C, Bauer ME, Teixeira AL. Revisiting inflammation in bipolar disorder. Pharmacol Biochem Behav. 2019;177:12–19.

    PubMed  Article  Google Scholar 

  • Toben C, Baune BT. An act of balance between adaptive and maladaptive immunity in depression: a role for T lymphocytes. J Neuroimmune Pharmacol. 2015;10:595–609.

    PubMed  Article  Google Scholar 

  • Miller AH. Depression and immunity: a role for T cells? Brain, Behav, Immun. 2010;24:1–8.

    Article  Google Scholar 

  • Villarreal‐Zegarra D, Bernabe‐Ortiz A. Association between arterial hypertension and depressive symptoms: results from population‐based surveys in Peru. Asia‐Pac Psychiatry. 2020;12:e12385.

    PubMed  Article  Google Scholar 

  • Gu Y, Zhu Y, Xu F, Xi J, Xu G. Factors associated with mental health outcomes among patients with COVID‐19 treated in the Fangcang shelter hospital in China. Asia‐Pac Psychiatry. 2021;13:e12443.

    PubMed  Article  Google Scholar 

  • Cohen S, Doyle WJ, Alper CM, Janicki-Deverts D, Turner RB. Sleep habits and susceptibility to the common cold. Arch Intern Med. 2009;169:62–67.

    PubMed  PubMed Central  Article  Google Scholar 

  • Fan B, Ma J, Zhang H, Liao Y, Wang W, Zhang S, et al. Association of FKBP5 gene variants with depression susceptibility: a comprehensive meta‐analysis. Asia‐Pac Psychiatry. 2021;13:e12464.

    PubMed  Article  Google Scholar 

  • Patel SR, Ayas, Najib T, Malhotra, Mark R, White, et al. A prospective study of sleep duration and mortality risk in women. Sleep. 2004;27:440–4.

    PubMed  Article  Google Scholar 

  • Richter D, Hoffmann H. Social exclusion of people with severe mental illness in Switzerland: results from the Swiss Health Survey. Epidemiol Psychiatr Sci. 2019;28:427–35.

    PubMed  Article  Google Scholar 

  • De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10:52.

    Article  Google Scholar 

  • Shinn AK, Viron M. Perspectives on the COVID-19 pandemic and individuals with serious mental illness. J Clin Psychiatry. 2020;81:14205.

    Article  Google Scholar 

  • Kim JH, Marks F, Clemens JD. Looking beyond COVID-19 vaccine phase 3 trials. Nat Med. 2021;27:205–11.

    PubMed  Article  Google Scholar 

  • Peiris M, Leung GM. What can we expect from first-generation COVID-19 vaccines? Lancet. 2020;396:1467.

    PubMed  PubMed Central  Article  Google Scholar 

  • Druss BG, Rosenheck RA, Desai MM, Perlin JB. Quality of preventive medical care for patients with mental disorders. Med Care. 2002;40:129–36.

    PubMed  Article  Google Scholar 

  • de Zwart PL, Jeronimus BF, de Jonge P. Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review. Epidemiol Psychiatr Sci. 2019;28:544–62.

    PubMed  Article  Google Scholar 

  • Shoib S, Ullah I, Ori D, Saleem SM, Hashmi N, Islam SMS. COVID-19, stigma and mental health: roots and solutions. Rev Colomb Psiquiatr. (2021). https://doi.org/10.1016/j.rcp.2021.10.004.

  • Zhang T-M, Wong IY-L, Yu Y-H, Ni S-G, He X-S, Bacon-Shone J, et al. An integrative model of internalized stigma and recovery-related outcomes among people diagnosed with schizophrenia in rural China. Soc Psychiatry Psychiatr Epidemiol. 2019;54:911–8.

    PubMed  Article  Google Scholar 

  • Latalova K, Kamaradova D, Prasko J. Perspectives on perceived stigma and self-stigma in adult male patients with depression. Neuropsychiatr Dis Treat. 2014;10:1399.

    PubMed  PubMed Central  Article  Google Scholar 

  • Knaak S, Mantler E, Szeto A. Healthcare management forum. Los Angeles, CA: SAGE Publications; 2017. p. 111–6. No pages are available now. https://doi.org/10.1002/14651858.CD009453.pub2.

  • Barney LJ, Griffiths KM, Christensen H, Jorm AF. Exploring the nature of stigmatising beliefs about depression and help-seeking: implications for reducing stigma. BMC Public Health. 2009;9:1–11.

    Article  Google Scholar 

  • Clarke DE, Dusome D, Hughes L. Emergency department from the mental health client’s perspective. Int J Ment Health Nurs. 2007;16:126–31.

    PubMed  Article  Google Scholar 

  • Fernandez Y-Garcia E, Duberstein P, Paterniti DA, Cipri CS, Kravitz RL, Epstein RM. Feeling labeled, judged, lectured, and rejected by family and friends over depression: Cautionary results for primary care clinicians from a multi-centered, qualitative study. BMC Fam Pract. 2012;13:1–9.

    Article  Google Scholar 

  • Hamilton S, Pinfold V, Cotney J, Couperthwaite L, Matthews J, Barret K, et al. Qualitative analysis of mental health service users’ reported experiences of discrimination. Acta Psychiatr Scandinavica. 2016;134:14–22.

    Article  Google Scholar 

  • Thornicroft G, Rose D, Mehta N. Discrimination against people with mental illness: what can psychiatrists do? Adv Psychiatr Treat. 2010;16:53–59.

    Article  Google Scholar 

  • Vega WA, Rodriguez MA, Ang A. Addressing stigma of depression in Latino primary care patients. Gen Hospital Psychiatry. 2010;32:182–91.

    Article  Google Scholar 

  • Halter MJ. Stigma & help seeking related to depression: a study of nursing students. J Psychosoc Nurs Ment Health Serv. 2004;42:42–51.

    PubMed  Article  Google Scholar 

  • Zhang Z, Sun K, Jatchavala C, Koh J, Chia Y, Bose J, et al. Overview of stigma against psychiatric illnesses and advancements of anti-stigma activities in six Asian societies. Int J Environ Res Public Health. 2020;17:280.

    Article  Google Scholar 

  • Clement S, Lassman F, Barley E, Evans‐Lacko S, Williams P, Yamaguchi S, et al. Mass media interventions for reducing mental health‐related stigma. Cochrane Database Syst Rev. 2013;23:CD009453.

  • Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med. 2021;27:225–8.

    PubMed  Article  Google Scholar 

  • Cai H, Bai W, Liu S, Liu H, Chen X, Qi H, et al. Attitudes toward COVID-19 vaccines in Chinese Adolescents. Front Med. 2021;8:691079.

    Article  Google Scholar 

  • Wang X, Gordon RM, Snyder EW. Comparing Chinese and US practitioners’ attitudes towards teletherapy during the COVID‐19 pandemic. Asia‐Pac Psychiatry. 2021;13:e12440.

    PubMed  Article  Google Scholar 

  • Lin Y, Hu Z, Zhao Q, Alias H, Danaee M, Wong LP. Understanding COVID-19 vaccine demand and hesitancy: a nationwide online survey in China. PLoS Neglected Tropical Dis. 2020;14:e0008961.

    Article  Google Scholar 

  • Reiter PL, Pennell ML, Katz ML. Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? Vaccine. 2020;38:6500–7.

    PubMed  PubMed Central  Article  Google Scholar 

  • Fried EI, Nesse RM. The impact of individual depressive symptoms on impairment of psychosocial functioning. PLoS ONE. 2014;9:e90311.

    PubMed  PubMed Central  Article  Google Scholar 

  • Epskamp S, Kruis J, Marsman M. Estimating psychopathological networks: be careful what you wish for. PLoS ONE. 2017;12:e0179891.

    PubMed  PubMed Central  Article  Google Scholar 

  • Tamminga CA, Ivleva EI, Keshavan MS, Pearlson GD, Clementz BA, Witte B, et al. Clinical phenotypes of psychosis in the bipolar-schizophrenia network on intermediate phenotypes (B-SNIP). Am J Psychiatry. 2013;170:1263–74.

    PubMed  Article  Google Scholar 

  • Boschloo L, van Borkulo CD, Rhemtulla M, Keyes KM, Borsboom D, Schoevers RA. The network structure of symptoms of the diagnostic and statistical manual of mental disorders. PLoS ONE. 2015;10:e0137621.

    PubMed  PubMed Central  Article  Google Scholar 

  • Cramer AO, Waldorp LJ, Van Der Maas HL, Borsboom D. Comorbidity: a network perspective. Behav Brain Sci. 2010;33:137–50.

    PubMed  Article  Google Scholar 

  • Fried EI, Nesse RM, Zivin K, Guille C, Sen S. Depression is more than the sum score of its parts: individual DSM symptoms have different risk factors. Psychol Med. 2014;44:2067–76.

    PubMed  Article  Google Scholar 

  • Wu W, Zhang Y, Wang P, Zhang L, Wang G, Lei G, et al. Psychological stress of medical staffs during outbreak of COVID‐19 and adjustment strategy. J Med Virol. 2020;92:1962–70.

    PubMed  PubMed Central  Article  Google Scholar 

  • Sun D, Yang D, Li Y, Zhou J, Wang W, Wang Q, et al. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect. 2020;148. https://doi.org/10.1017/S0950268820001090.

  • World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization; 1992.

  • Ma Y, Li T, Chen W, Chen J, Li M, Yang Z. Knowledge, attitudes and practices (KAP) toward seasonal influenza vaccine among young workers in South China. Hum Vacc Immunother. 2018;14:1283–93.

    Article  Google Scholar 

  • Kroenke K, Spitzer RL, Williams, JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care. 2003; 41:1284–92.

  • Liu ZW, Yu Y, Hu M, Liu HM, Zhou L, Xiao SY. PHQ-9 and PHQ-2 for screening depression in Chinese rural elderly. PLoS ONE. 2016;11:e0151042.

    PubMed  PubMed Central  Article  Google Scholar 

  • Gladman D, Nash P, Goto H, Birt JA, Lin C-Y, Orbai A-M, et al. Fatigue numeric rating scale validity, discrimination and responder definition in patients with psoriatic arthritis. RMD open. 2020;6:e000928.

    PubMed  PubMed Central  Article  Google Scholar 

  • Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63:S240–252.

    Article  Google Scholar 

  • Wang L, Zhang J, Wang J, Tao T, Fan C, Gao W. Validity and reliability of the Chinese version of the self-regulatory fatigue scale in young adults. Chin Ment Health J. 2015;12:290–4.

  • Fife BL, Wright ER. The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer. J Health Soc Behav. 2000; 41:50–67.

  • Pan A-W, Chung L, Fife BL, Hsiung P-C. Evaluation of the psychometrics of the Social Impact Scale: a measure of stigmatization. Int J Rehabilitation Res. 2007;30:235–8.

    Article  Google Scholar 

  • R Core Team. R: A language and environment for statistical computing. https://www.R-project.org/ (2020).

  • Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: a tutorial paper. Behav Res Methods. 2018;50:195–212.

    PubMed  Article  Google Scholar 

  • Beard C, Millner AJ, Forgeard MJ, Fried EI, Hsu KJ, Treadway MT, et al. Network analysis of depression and anxiety symptom relationships in a psychiatric sample. Psychological Med. 2016;46:3359–69.

    Article  Google Scholar 

  • Epskamp S, Cramer AOJ, Waldorp LJ, Schmittmann VD, Borsboom D. qgraph: Network visualizations of relationships in psychometric data. J Stat Softw. 2012;11–18.

  • Dodd RH, et al. Willingness to vaccinate against COVID-19 in Australia. Lancet Infect Dis. 2021;21:318–9.

    PubMed  Article  Google Scholar 

  • Bell S, Clarke R, Mounier-Jack S, Walker JL, Paterson P. Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England. Vaccine. 2020;38:7789–98.

    PubMed  PubMed Central  Article  Google Scholar 

  • Maguire PA, Reay RE, Looi JC. Nothing to sneeze at–uptake of protective measures against an influenza pandemic by people with schizophrenia: willingness and perceived barriers. Australas Psychiatry. 2019;27:171–8.

    PubMed  Article  Google Scholar 

  • Muruganandam P, Neelamegam S, Menon V, Alexander J, Chaturvedi SK. COVID-19 and severe mental illness: impact on patients and its relation with their awareness about COVID-19. Psychiatry Res. 2020;291:113265.

    PubMed  PubMed Central  Article  Google Scholar 

  • Brown C, Keene AR, Hooper CR, O’Brien A. Isolation of patients in psychiatric hospitals in the context of the COVID-19 pandemic: an ethical, legal, and practical challenge. Int J Law Psychiatry. 2020;71:101572.

    PubMed  PubMed Central  Article  Google Scholar 

  • Mazereel V, Van Assche K, Detraux J, De Hert M. COVID-19 vaccination for people with severe mental illness: why, what, and how? Lancet Psychiatry. 2021;8:445–450

  • Coulombe J, Moodie EE, Shortreed SM, Renoux C. Can the risk of severe depression-related outcomes be reduced by tailoring the antidepressant therapy to patient characteristics? Am J Epidemiol. 2021;190:210–1219.

  • Young JE, Rygh JL, Weinberger AD, Beck AT. Cognitive therapy for depression. 2014.

  • Barlow DH. Clinical handbook of psychological disorders: a step-by-step treatment manual. Guilford Publications; 2021. p. 257–316.

  • James TT, Kutty VR. Assessment of internalized stigma among patients with mental disorders in Thiruvananthapuram district, Kerala, India. Asia Pac J Public Health. 2015;27:439–49.

    PubMed  Article  Google Scholar 

  • Segalovich J, Doron A, Behrbalk P, Kurs R, Romem P. Internalization of stigma and self-esteem as it affects the capacity for intimacy among patients with schizophrenia. Arch Psychiatr Nurs. 2013;27:231–4.

    PubMed  Article  Google Scholar 

  • Lagger N, Amering M, Sibitz I, Gmeiner A, Schrank B. Stability and mutual prospective relationships of stereotyped beliefs about mental illness, hope and depressive symptoms among people with schizophrenia spectrum disorders. Psychiatry Res. 2018;268:484–9.

    PubMed  Article  Google Scholar 

  • Parcesepe AM, Cabassa LJ. Public stigma of mental illness in the United States: a systematic literature review. Adm Policy Ment Health Ment Health Serv Res. 2013;40:384–99.

    Article  Google Scholar 

  • Hipes C, Lucas J, Phelan JC, White RC. The stigma of mental illness in the labor market. Soc Sci Res. 2016;56:16–25.

    PubMed  Article  Google Scholar 

  • Ben C, Chio FH, Mak WW, Corrigan PW, Chan KK. Internalization process of stigma of people with mental illness across cultures: a meta-analytic structural equation modeling approach. Clin Psychol Rev. 2021;87:102029.

    Article  Google Scholar 

  • Ben J, Cormack D, Harris R, Paradies Y. Racism and health service utilisation: a systematic review and meta-analysis. PLoS ONE. 2017;12:e0189900.

    PubMed  PubMed Central  Article  Google Scholar 

  • Crawley LM, Ahn DK, Winkleby MA. Perceived medical discrimination and cancer screening behaviors of racial and ethnic minority adults. Cancer Epidemiol Biomark Prev. 2008;17:1937–44.

    Article  Google Scholar 

  • Harris R, Cormack D, Tobias M, Yeh L-C, Talamaivao N, Minster J, et al. Self-reported experience of racial discrimination and health care use in New Zealand: results from the 2006/07 New Zealand Health Survey. Am J Public Health. 2012;102:1012–9.

    PubMed  PubMed Central  Article  Google Scholar 

  • Henderson C, Evans-Lacko S, Thornicroft G. Mental illness stigma, help seeking, and public health programs. Am J Public Health. 2013;103:777–80.

    PubMed  PubMed Central  Article  Google Scholar 

  • Williams DR, Lawrence JA, Davis BA, Vu C. Understanding how discrimination can affect health. Health Serv Res. 2019;54:1374–88.

    PubMed  PubMed Central  Article  Google Scholar 

  • Diaz AD, Baweja R. The role of neurotropism in psychiatric patients with COVID-19. Eur Arch Psychiatry Clin Neurosci. 2021;271:385–6.

    PubMed  Article  Google Scholar 

  • Xin M, Luo S, She R, Yu Y, Li L, Wang S, et al. Negative cognitive and psychological correlates of mandatory quarantine during the initial COVID-19 outbreak in China. Am Psychologist. 2020;75:607.

    Article  Google Scholar 

  • Casagrande SS, Gary TL, LaVeist TA, Gaskin DJ, Cooper LA. Perceived discrimination and adherence to medical care in a racially integrated community. J Gen Intern Med. 2007;22:389–95.

    PubMed  PubMed Central  Article  Google Scholar 

  • Wamala S, Merlo J, Boström G, Hogstedt C. Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. J Epidemiol Community Health. 2007;61:409–15.

    PubMed  PubMed Central  Article  Google Scholar 

  • Corrigan P, Michaels PJ, Morris S. Do the effects of antistigma programs persist over time? Findings from a meta-analysis. Psychiatr Serv. 2015;66:543–6.

    PubMed  Article  Google Scholar 

  • Corrigan PW, Nieweglowski K. How does familiarity impact the stigma of mental illness? Clin Psychol Rev. 2019;70:40–50.

    PubMed  Article  Google Scholar 

  • Lien Y-Y, Lin H-S, Lien Y-J, Tsai C-H, Wu T-T, Li H, et al. Challenging mental illness stigma in healthcare professionals and students: a systematic review and network meta-analysis. Psychol Health. 2021;36:669–84.

    PubMed  Article  Google Scholar 

  • Xu Z, Huang F, Koesters M, Ruesch N. Challenging mental health related stigma in China: systematic review and meta-analysis. II. Interventions among people with mental illness. Psychiatry Res. 2017;255:457–64.

    PubMed  Article  Google Scholar