Understanding vaccine hesitancy among transitional-aged youth with mental health concerns

A recent CAMH youth-led qualitative study of attitudes and beliefs among transitional-aged youth (aged 16-29) with mental health concerns has found that lived experience of mental illness impacts their decision-making about whether to get a COVID-19 vaccine. The article, entitled Understanding attitudes and beliefs regarding COVID-19 vaccines among transitional-aged youth with mental health concerns: a youth-led qualitative study, has been published in the journal BMJ Open.

In order to ensure the findings resonated with the study’s target population, the study took a youth-led approach. The researchers conducted interviews with 46 young people with mental health concerns as well as six family members between September 2021 and August 2022, a period when COVID-19 vaccines were widely available and 73 per cent of the population had received at least one shot. The research team included Youth Engagement Specialists from CAMH’s Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, plus an advisory committee of eight lived experience Youth Advisors.

The study found that the main reason for vaccine hesitancy in this population was lack of trust in the vaccine itself, in healthcare providers, and in government.

The CAMH team involved in the study also created a variety of public education resources intended to reduce vaccine hesitancy among young people with mental illness, including a resources aimed both for youth and clinicians.

The study found that the main reason for vaccine hesitancy in this population was lack of trust in the vaccine itself, in healthcare providers, and in government. The study also found lived experience of mental illness played a role in whether transitional-aged youth decided to get a COVID-19 vaccine.

Key Recommendations include:

• Address Trust Concerns: Better understand and address youth’s trust concerns regarding vaccines, healthcare providers, the healthcare system, and government policy makers to improve vaccine acceptance. Participants who were vaccine hesitant often cited decreased trust in institutions and relied increasingly on information from their social networks, increasing the risk of mis/disinformation exposure.

• Acknowledge Historical Harms: Acknowledge and rectify historical and ongoing harms perpetrated by healthcare systems and governments against racialized communities to boost vaccine confidence and uptake. Participants expressed concerns over the lack of acknowledgement of previous harms when encouraging and enforcing vaccination, emphasizing the need for governments and healthcare organizations to demonstrate
trustworthiness.

• Impact of Mental Health: Understand the impact of acute mental health concerns, such as psychosis, on vaccine decisions, and develop strategies to reduce susceptibility to mis/disinformation and needle phobia. Providing plain language vaccine information, support from trusted loved ones, and specialized vaccine clinics with low-stimulation setups and personalized approaches can help address these issues.

• Encourage Open Conversations: Encourage open, non-judgmental conversations about vaccines by normalizing hesitancy and feelings of doubt. Health care providers should reduce stigma and provide clear, evidence-based, and accessible information to foster informed decision-making.

Previous research has shown that people with mental illness, including youth, have a 65 per cent higher risk of contracting COVID-19, and that people between 18 and 34 are seven times more likely to be vaccine-hesitant than people over 65.

“These statistics suggest that youth with mental health concerns may have even higher rates of vaccine hesitancy,” says Senior Author Alexxa Abi-Jaoudé, Communications Coordinator, CAMH Education. “The insights into attitudes towards vaccines gleaned from this study are highly relevant to not just ongoing vaccination efforts for new COVID-19 strains, but for other transmissible diseases and future pandemics as well. Our youth-led work here illustrates the need for youth-specific public health and clinical resources to encourage vaccination in this population, and that the lived experience of youth must be embedded in the development of those
resources.”

The study also found that different kinds of mental illness can have positive or negative effects on vaccine hesitancy. While previous research has shown young people with anxiety may be more likely to engage in risk-reducing behaviours like getting a vaccine, some participants in the study with lived experience of acute psychosis said they had negative views of vaccination that improved after the episode of psychosis had passed.

“When I was in that state of mind, I was like, ‘This is going to be bad for my body, they are putting toxins in me,” said one study participant. “After I was put on medication and came back to being aware of what reality is, I was like ‘This is stupid, I should just get vaccinated. It’s not really an infringement on people’s rights or anything. It’s about public safety.”

Aloha Narajos is a Youth Engagement Specialist who was part of the Youth Engagement Initiative engaged in the co-creation of the study and the public education resources related to the study. She remarked:

“When speaking with youth about vaccine hesitancy what came across clearly is that scare tactics don’t work. In addition, the use of scientific jargon can be harmful to youth’s understanding of vaccines and making informed decisions. Rather than using language where it seems as if folks don’t have a choice or confusing them with technical language, instead provide all the right and applicable information so youth can make a well informed decision on their own accord.

“The young people also talked about how social media had influenced their decisions and their knowledge of vaccines. I think because in most cases, social media is a huge part in a young person’s life; it’s one of the big ways they’re able to connect with others in their lives, and to get information. This could be leveraged as an important tool to combat vaccine hesitancy if delivered in a clear, simple way from an organization they trust.”