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Article

From Pandemic to Prevention: Insights from COVID-19 Vaccination Attitudes in Individuals with Schizophrenia

by
Felipe Soto-Pérez
1,2,3,*,
Andrea Lettieri
4,5,
Carmen Pita González
4,
Sonia Miguel Criado
4 and
Manuel A. Franco-Martín
1,2,6
1
Department of Personality, Assessment and Psychological Treatment, Avda. De la Merced 109, University of Salamanca, 37005 Salamanca, Spain
2
IBSAL—Biomedicine Institute of Salamanca, 37007 Salamanca, Spain
3
INICO—University Institute for Community Integration, University of Salamanca, 37005 Salamanca, Spain
4
Intras Foundation, 49024 Zamora, Spain
5
Department of Sociology and Social Work, University of Valladolid, Plaza de Santa Cruz 8, 47002 Valladolid, Spain
6
Mental Health and Psychiatry Service of Zamora, 49021 Zamora, Spain
*
Author to whom correspondence should be addressed.
COVID 2025, 5(6), 81; https://doi.org/10.3390/covid5060081
Submission received: 5 May 2025 / Revised: 23 May 2025 / Accepted: 26 May 2025 / Published: 29 May 2025
(This article belongs to the Section COVID Public Health and Epidemiology)
Review Reports Versions Notes

Abstract

Awareness about the attitudes towards the vaccination of persons with schizophrenia is essential, as this group has a greater likelihood of experiencing serious consequences if infected with COVID-19 or other infectious processes. For this reason, 141 persons with schizophrenia completed a survey addressing different aspects of receiving the vaccine for COVID-19. In general, the results are similar to those of people without a severe mental disorder. Persons with schizophrenia were willing to get vaccinated, perceived vaccination as being as safe and effective as the general population did, and reported that they usually followed preventive measures to avoid the spread of the virus. However, their concerns were frequently related to possible health problems or fears about the vaccination. There is no influence from sociodemographic variables, though limited social life, perceived risk in people in their immediate environment, and a negative self-assessment of their own health were associated with increased acceptance of vaccination. Thus, the present study provides useful information on this topic and encourages the development of programs and interventions that promote preventive actions for this group of people.

1. Introduction

People suffering from schizophrenia are at high risk of becoming infected and experiencing severe consequences due to COVID-19 [1,2,3,4,5,6], as the existing factors of this group can negatively influence the evolution of the infection [4,7,8,9,10,11,12,13,14]. In the general population, the mortality rate of hospitalized COVID-19 patients is less than 12%, while this rate increases to over 26% in persons with schizophrenia [12]. In addition, persons with a psychotic disorder have a persistently elevated risk of death following COVID-19 infection [5,15]. Research indicates that after age, schizophrenia has been shown to be the most significant variable in increasing the risk of dying from COVID-19 [1,2,9,12,16,17]. Moreover, people with schizophrenia remain hospitalized for longer periods and die at a younger age [2,8,17].
Factors of persons with schizophrenia that can increase the risk of death from COVID-19 include the negative influence of psychiatric treatments [5,15,17,18,19], an unhealthy lifestyle [11,17,20], and a weak immune system or reduced access to health services [5,10,11,21]. Furthermore, this strong association between death from COVID-19 and schizophrenia is still highly significant even in comparison to other comorbidities studied, such as obesity, diabetes, or heart disease [12]; smoking [22]; substance abuse [23]; or living in institutions [21,24,25]. In addition, persons with schizophrenia do not typically participate in preventive health care plans, and only a quarter of this group usually gets vaccinated against influenza and other common viruses [26,27,28,29,30].
Studies show that refusal and reluctance to get vaccinated against COVID-19 are reported by about 3% to 31% of the general population [31,32,33,34,35,36], with a significant influence of income level [37]; subsequent studies indicate a lower probability of vaccination in people with mental disorders [30]. Among others, these deviations were determined by the time and country in which the test was carried out. For example, rejection was higher at the beginning of the process and decreased as vaccination progressed. In Spain, the rejection rate was 3.4% [31]. Despite this, full vaccination in Spain reached 85.6% and, in the autonomous region of Castile and León, where the present study was carried out, vaccination reached 93.9% [38].
Refusal happened more frequently in young people, women, minorities, and in people with low educational and economic levels, limited knowledge about COVID-19, and distrust in the government [30,31,32,33,34,36,39,40,41,42]. Other studies have addressed the influence of conspiracy theories and poor relationships with healthcare professionals as situations that discourage vaccination [43,44,45,46,47].
Meanwhile, research on attitudes toward vaccination in persons with severe mental illnesses reports inconsistent results, as they differ in terms of methodology, instruments, population, diagnosis, and culture [42,48,49,50,51,52,53]. Arumuham et al. [48], developed a study in the UK that was carried out after vaccination had begun. Here, 63.4% of the participants had been diagnosed with schizophrenia. The results indicate that 55% of the participants had been vaccinated, and that the main reasons for not being vaccinated were due to the fear of side effects (21%), waiting to have access to the vaccine (20%), or they had not been contacted about getting vaccinated (8.9%). Raffard et al. [51] developed a study in France after vaccination had begun that involved people diagnosed with schizophrenia who were compared to a control group. The results indicated that fewer people with schizophrenia get vaccinated but that there is greater intent to get vaccinated in this group of people than in those who had not been vaccinated. In Greece, a study shows that the vaccination rate among people with mental disorders was 73.6%, the highest for infectious diseases [54]. The range of methods, health care settings, participants, instruments, and culture—which are important aspects shaping attitudes towards vaccination—means that these studies have only limited comparability and can only be approached from the perspective of discussions on the importance of vaccination.
Either way, vaccination studies indicate that people with schizophrenia have been vaccinated significantly less than the general population and that vaccination in this group decreases with increasing age [48,55,56]; even schizophrenia itself has been linked to vaccine refusal [57]. However, the results on the influence of gender are mixed, with some studies indicating that men are more likely to be unwilling to become vaccinated [55], or that women are more likely to be unwilling [56,58], or that there is no association with sex [48,51]. It has also been pointed out that vaccination in people with schizophrenia is associated with increased comorbidity [6,56]. In terms of barriers, studies indicate that difficulties in gaining access to vaccines are the primary barriers with respect to vaccination for this group.
Thus, the data highlight the importance of vaccination for people with schizophrenia, who face a high risk if they become infected and who do not usually benefit from preventive health policies [59]. In the case of vaccination campaigns, success is determined by several factors; in general, structural (e.g., information, access) and attitudinal barriers (e.g., emotions, beliefs, behavior when using a mask) must be overcome [60,61,62,63,64].
Based on the above, the present study aims to understand how people with schizophrenia living in the community feel about getting the vaccine for COVD-19. It will compare these feelings with those of the general population and see if there is an effect of psychopathology. Therefore, the information provided is intended to facilitate the implementation of actions aimed at persons with schizophrenia that promote access to disease prevention programs.

2. Materials and Methods

2.1. Study Design and Participants

A cross-sectional study was performed using opportunity sampling of a self-administered survey. Inclusion criteria for the study were (a) having a diagnosis of schizophrenia; (b) receiving care from a mental health provider and social services; and (c) participating voluntarily and consensually in the study. Conversely, the following subjects were excluded: (a) legally incapacitated persons; (b) persons who refused to participate in the study; and (c) persons whose psychopathological state impeded the comprehension or application of the survey. The study was approved by the Clinical Research Ethics Committee of the Zamora Health Area (Reg. No.: 531). A total of 141 people completed the survey (Table 1).

2.2. Data Collection Process

Data were collected through a self-administered survey (see Supplementary File), either on paper or digitally depending on the participant’s skills or preferences. Day centers for people with schizophrenia in the provinces of Zamora and Valladolid (Spain) were visited and contacted, and the questionnaire and inclusion/exclusion criteria were sent out. Data were collected between December 2020 and February 2021 and in Qualtrics.

2.3. Instruments

Data were collected using a questionnaire on attitudes towards vaccination against COVID-19 previously applied in the general population [31,39,52,65]. This questionnaire (see Supplementary File) included six items that addressed socio-demographic data and 61 items that referred to the willingness and motivation to get vaccinated. Questions that addressed specific characteristics of the group were also added (Table 2). The questions in the survey have both closed-ended (e.g., “In the common flu vaccination campaign of last year 2019, did you get vaccinated?”) and Likert-type responses (e.g., What would you say is your probability of being infected with the new coronavirus?). A previous pilot test was conducted among 20 participants with schizophrenia who confirmed the simplicity, readability, and usability of the survey. The instrument was hosted and applied on the Qualtrics platform.

2.4. Data Analysis

Data were analyzed using SPSS version 28, with missing data being excluded from the analysis (9 to 21 depending on the variable). The overall hypothesis was that vaccination acceptance was a variable that depended on predictors that emerged from the literature (e.g., age and sex, clinical variables, attitudinal variables, beliefs in vaccine effectiveness, perceived risk of infection, specific paranoid thinking, and compliance with protective measures, among others). The results of the Kolmogorov–Smirnov test and Levene’s test pointed to the use of non-parametric statistics. Then, descriptive statistics and frequency of responses were collected. The next step was calculating the chi-squared (χ2) statistic for some variables that would predict acceptability (e.g., beliefs in vaccine effectiveness, mandatory vaccination, vaccination delay, specific paranoid thinking, among others). We then calculated the Spearman’s rank correlation for variables that are associated with the acceptance of vaccination (e.g., health status, social isolation, contact with older relatives, doubts about the existence of the virus, among others). Results above p ≤ 0.05 were included in an ordinal regression model to explain the variable “vaccination acceptance”, with a particular focus on the association of psychopathological aspects. The significance of the results was established using Cohen’s d [66]. Finally, the Bonferroni–Holm post hoc model [67] was used to adjust the p-values due to the multiple comparisons that were made; this adjustment was noted for each significant result as adj-p.

3. Results

Table 3 shows that 56.03% (79) of participants would get vaccinated and 88.7% (125) perceive vaccination as effective, while the main reasons for not getting vaccinated were related to health risks (36%). The results of the χ2 test revealed significant differences in vaccination acceptance and in the belief about whether vaccines were effective or not (χ2(2, 141) = 19.484, p = 0.000; adj-p = 0.000). Thus, thinking that vaccines were effective favored vaccination, though 35.46% (50) of the participants were hesitant about vaccination. Among them, 36% (18), noted that vaccines were effective, yet they were not committed to getting vaccinated. Moreover, compulsory vaccination was associated with acceptance, while voluntariness was associated with hesitancy (χ2(2, 131) = 11.609; p = 0.003; adj-p = 0.024).
The sex variable did not establish a distinction in the acceptance or refusal of vaccination (χ2(2, 128) = 1.429, p = 0.489), although women tended to be more hesitant about vaccination (41.7% vs. 31.3% of men). Likewise, age did not establish significant distinctions in the acceptance or refusal of vaccination (χ2(8, 126) = 4.347, p = 0.825). However, a direct association was observed whereby older respondents had greater acceptance of vaccination. Thus, 53% of those under 60 years of age accepted vaccination, while 66.7% of those over 60 years of age did so. Level of education did not establish significant distinctions regarding vaccination either (χ2(12, 126) = 11.046, p = 0.525), but the tendency observed showed that the higher the level of education, the less hesitation and the greater the refusal to be vaccinated. Therefore, the level of education seemed to increase extreme decisions and decrease hesitancy.
Receiving injectable medication did not significantly affect acceptance or refusal of vaccination (χ2(2, 128) = 0.368; p = 0.832). Having received the 2019 influenza vaccine was associated with vaccination acceptance but was non-significant (χ2(2, 141) = 4.743; p = 0.093). Here, n = 86 who had been vaccinated against influenza were more likely to accept vaccination against COVID-19 (67.19%), and n = 42 who had not been vaccinated were more likely to be hesitant (32.8%). The intention to get vaccinated against influenza for the 2021 campaign had no significant effect.
Some elements of risk perception (susceptibility, vulnerability, and severe consequences if infected or probability, high-risk environment, potential infection) favored vaccination, including not having experienced COVID-19. A non-significant trend was detected between the association of the perceived likelihood of infection with an increased willingness to be vaccinated (χ2(14, 141) = 23.354; p = 0.055). According to the data, the average scores related to fear result in increased hesitancy (n = 53; 41.09%), whereas higher scores for fear increase willingness to get vaccinated (n = 79; 61.2%). The perception of being in a poor state of health (n = 83; 64.3%) had a moderate and direct effect on the willingness to get vaccinated (rs = 0.408, p = 0.000, N = 129; adj-p = 0.000). On the other hand, severe allergies were not significantly associated with willingness to get vaccinated (n = 55; 42.6%), and the estimate of disease severity if infected by COVID-19 did not establish significant differences in willingness to get vaccinated either. The degree of closeness to people who had been infected had different effects. When they belonged to the respondent’s immediate surroundings, 55% tended to want to get vaccinated. If they had a close relationship with said person, rates increased to 60%. In the case of living with older relatives, the association became weak but significant (rs = 0.233, p = 0.008, N = 127; adj-p = 0.04)
A total of 81.6% (n = 115) of persons with schizophrenia followed the recommendations of health authorities to prevent the spread of the coronavirus; 85.4% practiced social distancing (n = 111), and 86.9% wore face masks outdoors (n =113). Preventive behaviors were significantly associated with vaccination acceptance, specifically, these included wearing a face mask outdoors (χ2(7, 130) = 0.231 α = 0.008; adj-p = 0.04) and following recommendations on social isolation (rs = 0.252, ρ = 0.004, N = 130; adj-p = 0.028). Hand hygiene, whenever possible, did not show a significant trend (χ2(2, 130) = 0.167; α = 0.058). Similarly, a high percentage of people who were hesitant to get vaccinated always wore a face mask (n = 35; 70%), washed their hands (n = 32; 64%), and practiced social distancing (n = 27; 54%).
There was no significant association between the attitude towards vaccination and receiving information from professionals (rs = 0.076, ρ = 0.388, N = 126) or having a good relationship with one’s doctor (rs = 0.147, p = 0.093, N = 131). Doubts about the existence of the coronavirus and vaccination showed a slightly positive association (rs = 0.222, ρ = 0.010, N = 126; adj-p = 0.04) with 32% of those who were hesitant to get vaccinated (n = 16), and 51.9% people who would get vaccinated (n = 41) questioned the existence of the pandemic.
Thinking that “there might be something dodgy in the vaccine” no showed significant association with vaccination (rs = −0.202, p = 0.121, N = 130) and no significant differences in the decision to vaccinate (χ2(4, 130) = 12.124; p = 0.016; adj-p = 0.096). Nevertheless, descriptively, those who did not think the vaccine might contain something strange were more likely to get vaccinated (76.7%). This perception was not associated with differences in the reasons for not getting vaccinated (χ2(14, 130) = 25.985, p = 0.026; adj-p = 0.105). Respondents who believed that the vaccine might pose a health risk were less likely to believe that something “strange” could be in the vaccine (20.3%).
Persons with schizophrenia typically have limited social lives [68,69]. Here, 28.2% (n = 37) acknowledged this to be true. This variable was directly associated with vaccination (rs = 0.250, p = 0.004, N = 131).
Finally, an ordinal regression model was applied in order to explain the variables associated with vaccination (sex, age, education, and risk perception), following the existing literature on the subject [26]. However, the results of the present study did not demonstrate a significant relationship (χ2 = 16,286; p > 0.05). Consequently, adopting a position in accordance with models emphasizing the significance of psychopathological factors in decision-making, we proceeded to introduce variables associated with paranoid thoughts and restricted social life. This model was found to be statistically significant (χ2 = 49.036; p = 0.008), with an explanatory power of 35% of the variance (Nagelkerke R2 = 0.350). Firstly, symptoms consistent with paranoia (β = −3.020, SD = 0.8588, p < 0.001, OR = 20.493, 95%CI [3.807–1120.320]) and, secondly, a restricted social life (β = −1.515, SE = 0.6122, p = 0.13 OR = 0.220, 95%CI [0.066–0.730]) were found to be associated with difficulties in accepting vaccination.

4. Discussion

A total of 141 persons with schizophrenia completed a survey about vaccination. The results showed that persons with schizophrenia had a positive attitude towards COVID-19 vaccination, as reported in other studies [51,68]; this is a key aspect: attitudes are similar to those of the general population [6,59]. However, our results were slightly lower than in other vaccination campaigns, such as for influenza [27], and were higher than results about mental disorders in general [50], with hesitancy being lower in the same group [49]. As noted in previous research [6,26], the perception of vaccine effectiveness was associated with a stronger willingness to get vaccinated, although there was a group of hesitant respondents who, despite recognizing the effectiveness of the vaccine, lacked the motivation to get vaccinated; this group is interesting to study because it may be driven by fear or anxiety, for example.
It appears that socio-demographic variables (e.g., sex, age, level of education, or household members) usually associated with the acceptance of vaccination in the general population [31,32,33,34,35,36,40,41,69], and in other groups of mental disorders [53,55,56], do not necessarily align in individuals with schizophrenia; in particular, with respect to the impact of the sex variable [48,51]. Thus, a subsequent analysis of this result is imperative to establish the reliability and generalizability of the finding, particularly in light of the observed behavioral differences among the collective.
Some of our results contradict publications analyzing vaccination in persons with mental disorders [26,27], and specifically for COVID-19 vaccination [49,50,52,53], but the studies are not about the same group of diagnosis of participants. In those studies, the presence of persons with schizophrenia is lower than in this one, and comparisons are complex considering the moment of the vaccination campaign, its general acceptance in each country, and the instruments.
About the influence of psychopathological state, our results are not conclusive. In terms of negative symptoms (e.g., having a limited social life), our conclusion is the same as that of Raffard et al. [51], in terms of a direct association between social isolation and vaccination acceptance, but our results contradict the findings regarding a sense of loneliness indicated by Yen et al. [58], where this feeling is indirectly related to accepting vaccination. In this context, it is important to consider that social restriction during the COVID-19 pandemic was a preventive and recommended behavior.
Concerning positive symptomatology (paranoid thoughts or grandiosity), we are in accordance with Danenberg et al. [50] in not identifying any influence caused by the patient’s psychopathological state. But, ignoring the Bonferroni–Holms correction, and in descriptive terms, we detect an influence of specific paranoid thoughts related with the refusal of vaccination. It is important to highlight that this paranoid content does not represent a concern about potential harm to health but rather a persecutory and controlling concern. Raffard et al. [51], who assessed persons with schizophrenia, also described this type of thinking. However, Lin et al. [70] has highlighted that the observed symptoms of disorganization are associated with non-vaccination; on the other hand, Yen et al. [58] identified self-stigma as the factor most associated with rejection. Both are important factors to consider in future studies but were not assessed in our study. We agree with Barker et al. [6,59], who conclude that schizophrenia itself does not increase the likelihood of non-vaccination. However, some individuals diagnosed with schizophrenia may be less inclined to receive the vaccination due to specific characteristics (e.g., non-compliance with treatment, specific symptoms, and/or unusual or idiosyncratic thoughts)
In general, participants reported following health instructions, although other studies have noted the opposite [71] or suggest that this group would have difficulty understanding prevention measures [72]. However, we agree with Maguire et al. [27] that preventative behaviors in epidemics would not pose a challenge for all of them. In this case, it seems that the pandemic has generated a countertrend in terms of adherence to psychiatric treatment. Studies report that COVID-19 preventive behavior in persons with schizophrenia, (e.g., using a face mask) ranges from 34% [73] to 54.9% [27] and is associated with the level of knowledge about the pandemic. However, in our study, self-reported face mask use was 86.9%, and this preventive behavior was associated with higher vaccination rates. Thus, persons with schizophrenia reported following specific preventive measures (facemasks, social distancing), and those who adopted such measures expressed reparadothe desire to get vaccinated. A correlation was not found concerning hand hygiene.
The results of the present study were consistent with the findings of Ren et al. [74] regarding the influence of risk perception related to susceptibility, understood as poor health self-assessment. But we do not agree with the results of Raffard et al. [51] concerning self-assessment of one’s health status; these researchers did not describe such a relationship. A perceived risk of contracting COVID-19 did not lead to a substantial willingness to get vaccinated, which is consistent with the findings of Danenberg et al. [50] but not with those of Maguire et al. [27]. Here, the significance of risk perception was affected by the Bonferroni–Holm correction. Finally, having a vulnerable family member (old person) at home was related to a significant desire to get vaccinated.

4.1. Practical Implications: From Pandemic to Prevention

As noted above, people with schizophrenia often overcome all barriers to accessing public health prevention campaigns, but there is a subgroup that does not. While the acceptance rate of vaccination is similar to that of the general population, it is important to focus on the groups that differ. This group appears to be associated firstly with positive symptomatology (paranoid thoughts) and secondly with the pole of negative symptomatology (social isolation). It is important to note that other studies have highlighted the necessity of paying close attention to symptoms related to disorganization. Consequently, the results indicate potential interventions to enhance vaccine uptake, with the primary intervention being the development of acceptance/rejection profiles, and this profiling can be useful for other types of preventive actions.
It seems that among those who refuse vaccination, there are at least three distinct profiles: those who are reluctant due to fear or anxiety; those who are hesitant due to symptoms; and those who are unvaccinated for ideological or personal reasons. Interventions should therefore be targeted to each profile.
First of all, the overall intervention needs to announce the possibility of vaccination in advance, carrying out information campaigns and highlighting effectiveness. At the same time, it is important to point out elements that trigger a perception of risk related to susceptibility, for example, by informing people about the vulnerability of the group to COVID-19 disease. It is important to point out that persons who follow preventive behaviors, have a poor social life, or are living with elder relatives are more susceptible to accepting the vaccine. In the second step, after profiling acceptance/rejection, specific actions should be developed, for example, for those people with specific paranoid beliefs about the vaccine and those with grandiose ideas about the possibility that they are immune. In this regard, it is important to distinguish whether pandemic denial is an effect of ideology or a delusional element [75]. On the other hand, in relation to those who acknowledge the efficacy of the vaccine but still reject it, those who have specific concerns about the vaccine and its adverse effects should be identified. Finally, it should be remembered that this was an exploratory study but that for a topic as important as vaccination in a vulnerable group, the importance of avoiding Type II errors should be considered [76,77].

4.2. Limitations and Future Research

The findings of this study should be interpreted with caution given that an instrument originally developed for the general population was applied to a specific clinical subgroup—individuals diagnosed with schizophrenia. Moreover, it is essential to acknowledge that the study evaluates vaccination intention rather than observed vaccination behavior. It is important to consider that the surveyed group, which is part of a community care model, appears to adhere more consistently to preventive health measures than other samples. This is evidenced, for instance, by the higher rate of influenza vaccination in this group compared to other studies [26,27,28,29,30].
In addition to the above, the limitations of the present study are mainly the opportunity sampling, size of the participant sample, lack of control over the participants who completed the survey autonomously, and unavailability of information on the people who refused to take part in the survey. In addition, the results come from a cross-sectional survey, with all its biases. Moreover, assessment of risk perception and psychopathology was not carried out using standardized values, so they only reflected the subjective participant’s opinion. But this is an exploratory study that allows us to orient future research hypotheses. Thus, in the future and in relation to the acceptance of preventive action as vaccination, group-specific instruments should be used that address, among other things, the influence of specific paranoid thoughts regarding the vaccine, as well as elements of grandiosity and feelings of excessive security regarding one’s own ability to protect oneself from infection. In addition, further work should be carried out concerning preventative behaviors in people with schizophrenia.

5. Conclusions

The responses of 141 people with schizophrenia about their attitudes towards vaccination against COVID-19 showed that they were willing to get vaccinated, perceived vaccination to be effective, and followed the preventive behaviors. The main causes of vaccination refusal were fears and health risks, very similar to the concerns of the general population. In contrast, the influence of age, sex, or educational level was absent. Regardless, in order to encourage vaccination or in the context of prevention campaigns, people should be informed over a period of time about the impact on vulnerable people close to them and their own health status. Despite the extensive knowledge of their vulnerabilities, persons with schizophrenia do not typically participate in preventive health care plans, and policies to combat this inequality have not yet been adopted.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/covid5060081/s1. Supplementary File: Personal Attitudes Toward COVID-19 Vaccination. Survey, datasets generated and/or analyzed during the current study, and specific COVID-related references are available in the Opens Science Framework (OSF) repository, https://doi.org/10.17605/OSF.IO/TZGXY accessed on 2 May 2025.

Author Contributions

Conceptualization, F.S.-P. and A.L.; methodology, F.S.-P. and A.L.; formal analysis, S.M.C., A.L. and F.S.-P.; investigation, C.P.G.; resources, F.S.-P., A.L. and M.A.F.-M.; data curation, F.S.-P.; writing—original draft preparation, F.S.-P.; writing—review and editing, A.L.; supervision and project administration, funding acquisition, F.S.-P. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding. The revision of the translation was financed by the Department of Personality, Assessment and Psychological Treatment of the University of Salamanca.

Institutional Review Board Statement

Clinical Research Ethics Committee of the Zamora Health Area (Reg. No.: 531).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

https://doi.org/10.17605/OSF.IO/TZGXY accessed on 2 May 2025.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Fond, G.; Nemani, K.; Etchecopar-Etchart, D.; Loundou, A.; Goff, D.C.; Lee, S.W.; Lancon, C.; Auquier, P.; Baumstarck, K.; Llorca, P.-M.; 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, 1208–1217. [Google Scholar] [CrossRef]
  2. Toubasi, A.A.; AbuAnzeh, R.B.; Tawileh, H.B.A.; Aldebei, R.H.; Alryalat, S.A.S. A Meta-Analysis: The Mortality and Severity of COVID-19 among Patients with Mental Disorders. Psychiatry Res. 2021, 299, 113856. [Google Scholar] [CrossRef]
  3. Yang, H.; Chen, W.; Hu, Y.; Chen, Y.; Zeng, Y.; Sun, Y.; Ying, Z.; He, J.; Qu, Y.; Lu, D. Pre-Pandemic Psychiatric Disorders and Risk of COVID-19: A UK Biobank Cohort Analysis. Lancet Healthy Longev. 2020, 1, e69–e79. [Google Scholar] [CrossRef]
  4. De Hert, M.; Mazereel, V.; Stroobants, M.; De Picker, L.; Van Assche, K.; Detraux, J. COVID-19-Related Mortality Risk in People With Severe Mental Illness: A Systematic and Critical Review. Front. Psychiatry 2022, 12, 798554. [Google Scholar] [CrossRef] [PubMed]
  5. Gibbs, A.; Maripuu, M.; Öhlund, L.; Widerström, M.; Nilsson, N.; Werneke, U. COVID-19-Associated Mortality in Individuals with Serious Mental Disorders in Sweden during the First Two Years of the Pandemic—A Population-Based Register Study. BMC Psychiatry 2024, 24, 189. [Google Scholar] [CrossRef] [PubMed]
  6. Barker, M.M.; Kõiv, K.; Magnúsdóttir, I.; Milbourn, H.; Wang, B.; Du, X.; Murphy, G.; Herweijer, E.; Gísladóttir, E.U.; Li, H.; et al. Mental Illness and COVID-19 Vaccination: A Multinational Investigation of Observational & Register-Based Data. Nat. Commun. 2024, 15, 8124. [Google Scholar] [CrossRef] [PubMed]
  7. Lee, S.W.; Yang, J.M.; Moon, S.Y.; Yoo, I.K.; Ha, E.K.; Kim, S.Y.; Park, U.M.; Choi, S.; Lee, S.-H.; Ahn, Y.M. Association between Mental Illness and COVID-19 Susceptibility and Clinical Outcomes in South Korea: A Nationwide Cohort Study. Lancet Psychiatry 2020, 7, 1025–1031. [Google Scholar] [CrossRef]
  8. Lega, I.; Nisticò, L.; Palmieri, L.; Caroppo, E.; Noce, C.L.; Donfrancesco, C.; Vanacore, N.; Scattoni, M.L.; Picardi, A.; Gigantesco, A. Psychiatric Disorders among Hospitalized Patients Deceased with COVID-19 in Italy. J. EClinicalMedicine 2021, 35, 100854. [Google Scholar] [CrossRef]
  9. Li, L.; Li, F.; Fortunati, F.; Krystal, J.H. Association of a Prior Psychiatric Diagnosis with Mortality among Hospitalized Patients with Coronavirus Disease 2019 (COVID-19) Infection. JAMA Netw. Open 2020, 3, e2023282. [Google Scholar] [CrossRef]
  10. Maripuu, M.; Bendix, M.; Öhlund, L.; Widerström, M.; Werneke, U. Death Associated With Coronavirus (COVID-19) Infection in Individuals With Severe Mental Disorders in Sweden During the Early Months of the Outbreak—An Exploratory Cross-Sectional Analysis of a Population-Based Register Study. Front. Psychiatry 2021, 11, 609579. [Google Scholar] [CrossRef]
  11. 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, 275–276. [Google Scholar] [CrossRef] [PubMed]
  12. Nemani, K.; Li, C.; Olfson, M.; Blessing, E.M.; Razavian, N.; Chen, J.; Petkova, E.; Goff, D.C. Association of Psychiatric Disorders With Mortality Among Patients With COVID-19. JAMA Psychiatry 2021, 78, 380–386. [Google Scholar] [CrossRef]
  13. Taquet, M.; Luciano, S.; Geddes, J.R.; Harrison, P.J. Bidirectional Associations between COVID-19 and Psychiatric Disorder: Retrospective Cohort Studies of 62 354 COVID-19 Cases in the USA. J. Lancet Psychiatry 2021, 8, 130–140. [Google Scholar] [CrossRef] [PubMed]
  14. Wang, Q.Q.; Xu, R.; Volkow, N.D. Increased Risk of COVID-19 Infection and Mortality in People with Mental Disorders: Analysis from Electronic Health Records in the United States. World Psychiatry 2020, 20, 124–130. [Google Scholar] [CrossRef]
  15. Formánek, T.; Potočár, L.; Wolfova, K.; Melicharová, H.; Mladá, K.; Wiedemann, A.; Chen, D.; Mohr, P.; Winkler, P.; Jones, P.B.; et al. Deaths with COVID-19 and from All-Causes Following First-Ever SARS-CoV-2 Infection in Individuals with Preexisting Mental Disorders: A National Cohort Study from Czechia. PLoS Med. 2024, 21, e1004422. [Google Scholar] [CrossRef] [PubMed]
  16. Pardamean, E.; Roan, W.; Iskandar, K.T.A.; Prayangga, R.; Hariyanto, T.I. Mortality from Coronavirus Disease 2019 (COVID-19) in Patients with Schizophrenia: A Systematic Review, Meta-Analysis and Meta-Regression. Gen. Hosp. Psychiatry 2022, 75, 61–67. [Google Scholar] [CrossRef]
  17. Costa, D.F.B.; Rossignoli, P.; Pontarolli, D.R.S.; Junior, P.C.; Assolari, C.L.; Nasr, A.M.L.F.; de Carvalho, D.S.; Gadelha, A.; Massuda, R. Increased COVID-19 Mortality in Patients with Schizophrenia: A Retrospective Study in Brazil. Schizophr. Res. 2024, 271, 200–205. [Google Scholar] [CrossRef]
  18. Fond, G.; Pauly, V.; Orleans, V.; Antonini, F.; Fabre, C.; Sanz, M.; Klay, S.; Jimeno, M.-T.; Leone, M.; Lancon, C.; et al. Increased In-Hospital Mortality from COVID-19 in Patients with Schizophrenia. L’Encephale 2020, 47, 89–95. [Google Scholar] [CrossRef]
  19. Govind, R.; de Freitas, D.F.; Pritchard, M.; Hayes, R.D.; MacCabe, J. Clozapine Treatment and Risk of COVID-19 Infection: Retrospective Cohort Study. Br. J. Psychiatry 2020, 219, 368–374. [Google Scholar] [CrossRef]
  20. Kavoor, A.R. COVID-19 in People with Mental Illness: Challenges and Vulnerabilities. Asian J. Psychiatry 2020, 51, 102051. [Google Scholar] [CrossRef]
  21. Seminog, O.O.; Goldacre, M.J. Risk of Pneumonia and Pneumococcal Disease in People with Severe Mental Illness: English Record Linkage Studies. Thorax 2013, 68, 171–176. [Google Scholar] [CrossRef] [PubMed]
  22. Leung, J.M.; Yang, C.X.; Tam, A.; Shaipanich, T.; Hackett, T.-L.; Singhera, G.K.; Dorscheid, D.R.; Sin, D.D. ACE-2 Expression in the Small Airway Epithelia of Smokers and COPD Patients: Implications for COVID-19. Eur. Respir. J. 2020, 55, 2000688. [Google Scholar] [CrossRef]
  23. Wang, Q.Q.; Kaelber, D.C.; Xu, R.; Volkow, N.D. COVID-19 Risk and Outcomes in Patients with Substance Use Disorders: Analyses from Electronic Health Records in the United States. Mol. Psychiatry 2021, 26, 30–39. [Google Scholar] [CrossRef]
  24. Bretón, E.F.; Miguel, G.S. Covid-19 y Salud Mental. Rev. Española De Salud Pública 2020, 94, 1–5. [Google Scholar]
  25. Ji, H.; Liu, L.; Huang, T.; Zhu, Y. Nosocomial Infections in Psychiatric Hospitals during the COVID-19 Outbreak. Eur. J. Psychiatry 2020, 34, 177–179. [Google Scholar] [CrossRef]
  26. Lorenz, R.A.; Norris, M.M.; Norton, L.C.; Westrick, S.C. Factors Associated with Influenza Vaccination Decisions among Patients with Mental Illness. Int. J. Psychiatry Med. 2013, 46, 1–13. [Google Scholar] [CrossRef] [PubMed]
  27. Maguire, P.A.; Reay, R.E.; Looi, J.C. Nothing to Sneeze at–Uptake of Protective Measures against an Influenza Pandemic by People with Schizophrenia: Willingness and Perceived Barriers. Australas. Psychiatry 2019, 27, 171–178. [Google Scholar] [CrossRef] [PubMed]
  28. Miles, L.W.; Williams, N.; Luthy, K.E.; Eden, L. Adult Vaccination Rates in the Mentally Ill Population: An Outpatient Improvement Project. J. Am. Psychiatr. Nurses Assoc. 2020, 26, 172–180. [Google Scholar] [CrossRef] [PubMed]
  29. Warren, N.; Kisely, S.; Siskind, D. Maximizing the Uptake of a COVID-19 Vaccine in People With Severe Mental Illness: A Public Health Priority. JAMA Psychiatry 2020, 78, 589–590. [Google Scholar] [CrossRef]
  30. Owen-Smith, A.; Stewart, C.; Coleman, K.J.; Cromwell, L.; Barton, L.; Simon, G. Influenza and COVID-19 Vaccine Uptake Among Individuals With Versus Without Diagnosed Psychiatric Disorders. Psychiatr. Serv. 2025, 76, 169–176. [Google Scholar] [CrossRef]
  31. Lobera Serrano, J.; Cabrera Álvarez, P. Evolución de la Percepción Social de Aspectos Científicos de La COVID-19 [Evolution of Social Perceptions of Scientific Aspects of COVID-19]; (Julio 2020–Enero 2021); Fundación Española para la Ciencia y la Tecnología: Madrid, Spain, 2021. [Google Scholar]
  32. Enticott, J.; Gill, J.S.; Bacon, S.L.; Lavoie, K.L.; Epstein, D.S.; Dawadi, S.; Teede, H.J.; Boyle, J. Attitudes towards Vaccines and Intention to Vaccinate against COVID-19: A Cross-Sectional Analysis—Implications for Public Health Communications in Australia. BMJ Open 2022, 12, e057127. [Google Scholar] [CrossRef] [PubMed]
  33. Paul, E.; Steptoe, A.; Fancourt, D. Attitudes towards Vaccines and Intention to Vaccinate against COVID-19: Implications for Public Health Communications. Lancet Reg. Health-Eur. 2021, 1, 100012. [Google Scholar] [CrossRef] [PubMed]
  34. Barello, S.; Palamenghi, L.; Graffigna, G. Looking inside the ‘Black Box’ of Vaccine Hesitancy: Unlocking the Effect of Psychological Attitudes and Beliefs on COVID-19 Vaccine Acceptance and Implications for Public Health Communication. Psychol. Med. 2021, 53, 1120–1121. [Google Scholar] [CrossRef]
  35. Coustasse, A.; Kimble, C.; Maxik, K. COVID-19 and Vaccine Hesitancy: A Challenge the United States Must Overcome. J. Ambul. Care Manag. 2021, 44, 71–75. [Google Scholar] [CrossRef]
  36. Salali, G.D.; Uysal, M.S. COVID-19 Vaccine Hesitancy Is Associated with Beliefs on the Origin of the Novel Coronavirus in the UK and Turkey. Psychol. Med. 2020, online ahead of print. 1–3. [Google Scholar] [CrossRef]
  37. Gonzalez-Jaramillo, N.; Abbühl, D.; Roa-Díaz, Z.M.; Kobler-Betancourt, C.; Frahsa, A. COVID-19 Vaccine Acceptance in the General Population and under-Resourced Communities from High-Income Countries: Realist Review. BMJ Open 2024, 14, e084560. [Google Scholar] [CrossRef] [PubMed]
  38. Ministerio de Sanidad Cuadro de Mando Resumen de Datos de Vacunación. Available online: https://www.sanidad.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/pbiVacunacion.htm (accessed on 21 June 2022).
  39. Lazarus, J.V.; Ratzan, S.C.; Palayew, A.; Gostin, L.O.; Larson, H.J.; Rabin, K.; Kimball, S.; El-Mohandes, A. A Global Survey of Potential Acceptance of a COVID-19 Vaccine. Nat. Med. 2021, 27, 225–228. [Google Scholar] [CrossRef]
  40. Razai, M.S.; Chaudhry, U.A.R.; Doerholt, K.; Bauld, L.; Majeed, A. Covid-19 Vaccination Hesitancy. BMJ 2021, 373, n1138. [Google Scholar] [CrossRef]
  41. Salomoni, M.G.; Di Valerio, Z.; Gabrielli, E.; Montalti, M.; Tedesco, D.; Guaraldi, F.; Gori, D. Hesitant or Not Hesitant? A Systematic Review on Global COVID-19 Vaccine Acceptance in Different Populations. Vaccines 2021, 9, 873. [Google Scholar] [CrossRef]
  42. Begum, T.; Efstathiou, N.; Bailey, C.; Guo, P. Cultural and Social Attitudes towards COVID-19 Vaccination and Factors Associated with Vaccine Acceptance in Adults across the Globe: A Systematic Review. Vaccine 2024, 42, 125993. [Google Scholar] [CrossRef]
  43. Freeman, D.; Loe, B.S.; Chadwick, A.; Vaccari, C.; Waite, F.; Rosebrock, L.; Jenner, L.; Petit, A.; Lewandowsky, S.; Vanderslott, S.; et al. COVID-19 Vaccine Hesitancy in the UK: The Oxford Coronavirus Explanations, Attitudes, and Narratives Survey (Oceans) II. Psychol. Med. 2020, 52, 3127–3141. [Google Scholar] [CrossRef] [PubMed]
  44. Freeman, D.; Waite, F.; Rosebrock, L.; Petit, A.; Causier, C.; East, A.; Jenner, L.; Teale, A.-L.; Carr, L.; Mulhall, S. Coronavirus Conspiracy Beliefs, Mistrust, and Compliance with Government Guidelines in England. Psychol. Med. 2022, 52, 251–263. [Google Scholar] [CrossRef]
  45. Murphy, J.; Vallières, F.; Bentall, R.P.; Shevlin, M.; McBride, O.; Hartman, T.K.; McKay, R.; Bennett, K.; Mason, L.; Gibson-Miller, J.; et al. Psychological Characteristics Associated with COVID-19 Vaccine Hesitancy and Resistance in Ireland and the United Kingdom. Nat. Commun. 2021, 12, 29. [Google Scholar] [CrossRef]
  46. Sallam, M. COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates. Vaccines 2021, 9, 160. [Google Scholar] [CrossRef] [PubMed]
  47. Taubert, F.; Meyer-Hoeven, G.; Schmid, P.; Gerdes, P.; Betsch, C. Conspiracy Narratives and Vaccine Hesitancy: A Scoping Review of Prevalence, Impact, and Interventions. BMC Public Health 2024, 24, 3325. [Google Scholar] [CrossRef]
  48. Arumuham, A.; O’Brien, O.; Ahmad, Z.; Nikbin, K.; Howes, O.D. Low COVID-19 Vaccination Rates in People with Severe Mental Illness and Reasons for This: An out-Patient Study. Acta Psychiatr. Scand. 2022, 145, 416–418. [Google Scholar] [CrossRef]
  49. Bai, W.; Cai, H.; Jin, Y.; Zhang, Q.; Cheung, T.; Su, Z.; Tang, Y.-L.; Ng, C.H.; Xiang, Y.-T. COVID-19 Vaccine Hesitancy in Community-Dwelling and Hospitalized Patients with Severe Mental Illness. Psychol. Med. 2023, 53, 4288–4290. [Google Scholar] [CrossRef] [PubMed]
  50. Danenberg, R.; Shemesh, S.; Tzur Bitan, D.; Maoz, H.; Saker, T.; Dror, C.; Hertzberg, L.; Bloch, Y. Attitudes of Patients with Severe Mental Illness towards COVID-19 Vaccinations: A Preliminary Report from a Public Psychiatric Hospital. J. Psychiatr. Res. 2021, 143, 16–20. [Google Scholar] [CrossRef] [PubMed]
  51. Raffard, S.; Bayard, S.; Eisenblaetter, M.; Attal, J.; Andrieu, C.; Chereau, I.; Fond, G.; Leignier, S.; Mallet, J.; Tattard, P.; et al. Attitudes towards Vaccines, Intent to Vaccinate and the Relationship with COVID-19 Vaccination Rates in Individuals with Schizophrenia. Vaccines 2022, 10, 1228. [Google Scholar] [CrossRef]
  52. Santos Requejo, L.; Cuevas Badallo, A.; Torres González, O.; Rivière Gómez, J.; López Navarro, I. Encuesta Sobre la Actitud ante la Vacunación de los Colectivos USAL. Divulgación de Resultados Preliminares [Survey on the Attitude Towards Vaccination of the USAL Collective. Dissemination of Preliminary Results]. Available online: https://expercitec.usal.es/wp-content/uploads/2021/02/Resultados-preliminares-encuesta-COVID-19-Definitivo.pdf (accessed on 25 May 2021).
  53. Uvais, N. Factors Associated With COVID-19 Vaccination Uptake Among Community-Dwelling Patients With Severe Mental Illness: A Cross-Sectional Study. Prim. Care Companion CNS Disord. 2022, 24, 41191. [Google Scholar] [CrossRef] [PubMed]
  54. Kantidakis, E.E.; Symvoulakis, E.K.; Basta, M.; Chourdaki, E.; Dimitriou, H. Vaccination Coverage of Persons Using Hospital Outpatient Mental Health Services at Heraklion, Crete, Greece: A Cross-Sectional Study during Pandemic. Psychiatry 2024, 35, 282–292. [Google Scholar] [CrossRef]
  55. Tzur Bitan, D. Patients with Schizophrenia Are Under-vaccinated for COVID-19: A Report from Israel. World Psychiatry 2021, 20, 300–301. [Google Scholar] [CrossRef] [PubMed]
  56. Tzur Bitan, D.; Kridin, K.; Cohen, A.D.; Weinstein, O. COVID-19 Hospitalisation, Mortality, Vaccination, and Postvaccination Trends among People with Schizophrenia in Israel: A Longitudinal Cohort Study. The lancet. Psychiatry 2021, 8, 901–908. [Google Scholar] [CrossRef] [PubMed]
  57. Farcas, A.; Christi, P.; Fagen, J.; Iftene, F. Possible Predictors of Covid-19 Vaccine Hesitancy in the Psychiatric Population—A Scoping Review. Psychiatry Res. Commun. 2022, 2, 100075. [Google Scholar] [CrossRef]
  58. Yen, C.-F.; Tsai, C.-S.; Lin, C.-W.; Hsiao, R.C.; Wang, P.-W. Predictors of the Fear of COVID-19 in Individuals with Schizophrenia: A Prospective Study. Int. J. Med. Sci. 2025, 22, 1916–1923. [Google Scholar] [CrossRef]
  59. Hall, T.M.; Attwell, K.; Morgan, V.A.; Hincks, S.; Waterreus, A. Exploring Barriers to the COVID-19 Vaccine in People with Psychoses in Western Australia. Prev. Med. Rep. 2025, 52, 103025. [Google Scholar] [CrossRef] [PubMed]
  60. Fisk, R.J. Barriers to Vaccination for Coronavirus Disease 2019 (COVID-19) Control: Experience from the United States. Glob. Health J. 2021, 5, 51–55. [Google Scholar] [CrossRef]
  61. Luz, P.M.; Johnson, R.E.; Brown, H.E. Workplace Availability, Risk Group and Perceived Barriers Predictive of 2016–17 Influenza Vaccine Uptake in the United States: A Cross-Sectional Study. Vaccine 2017, 35, 5890–5896. [Google Scholar] [CrossRef]
  62. MacDonald, N.E. Vaccine Hesitancy: Definition, Scope and Determinants. Vaccine 2015, 33, 4161–4164. [Google Scholar] [CrossRef]
  63. Schmid, P.; Rauber, D.; Betsch, C.; Lidolt, G.; Denker, M.-L. Barriers of Influenza Vaccination Intention and Behavior—A Systematic Review of Influenza Vaccine Hesitancy, 2005–2016. PLoS ONE 2017, 12, e0170550. [Google Scholar] [CrossRef]
  64. Zheng, H.; Jiang, S.; Wu, Q. Factors Influencing COVID-19 Vaccination Intention: The Roles of Vaccine Knowledge, Vaccine Risk Perception, and Doctor-Patient Communication. Patient Educ. Couns. 2022, 105, 277–283. [Google Scholar] [CrossRef] [PubMed]
  65. Instituto de Salud Carlos III. Monitorización del Comportamiento y las Actitudes de la Población Relacionadas con la COVID-19 en España [Monitoring of Population Behaviour and Attitudes Related to COVID-19 In Spain]; (COSMO-SPAIN): Estudio OMS 2021; Centro Nacional de Epidemiología: Madrid, Spain, 2021. [Google Scholar]
  66. Cohen, J. Statistical Power Analysis for the Social Sciences; Routledge: New York, NY, USA, 2013. [Google Scholar]
  67. Holm, S. A Simple Sequentially Rejective Multiple Test Procedure. Scand. J. Stat. 1979, 6, 65–70. [Google Scholar]
  68. Lim, M.H.; Gleeson, J.F. Social Connectedness Across the Psychosis Spectrum: Current Issues and Future Directions for Interventions in Loneliness. Front. Psychiatry 2014, 5, 154. [Google Scholar] [CrossRef]
  69. Sweet, D.; Byng, R.; Webber, M.; Enki, D.G.; Porter, I.; Larsen, J.; Huxley, P.; Pinfold, V. Personal Well-Being Networks, Social Capital and Severe Mental Illness: Exploratory Study. Br. J. Psychiatry 2018, 212, 308–317. [Google Scholar] [CrossRef]
  70. Hao, F.; Wang, B.; Tan, W.; Husain, S.F.; McIntyre, R.S.; Tang, X.; Zhang, L.; Han, X.; Jiang, L.; Chew, N.W.S.; et al. Attitudes toward COVID-19 Vaccination and Willingness to Pay: Comparison of People with and without Mental Disorders in China. BJPsych Open 2021, 7, e146. [Google Scholar] [CrossRef] [PubMed]
  71. Tessier, A.; Boyer, L.; Husky, M.; Baylé, F.; Llorca, P.-M.; Misdrahi, D. Medication Adherence in Schizophrenia: The Role of Insight, Therapeutic Alliance and Perceived Trauma Associated with Psychiatric Care. J. Psychiatry Res. 2017, 257, 315–321. [Google Scholar] [CrossRef] [PubMed]
  72. Brown, E.; Gray, R.; Monaco, S.L.; O’Donoghue, B.; Nelson, B.; Thompson, A.; Francey, S.; McGorry, P. The Potential Impact of COVID-19 on Psychosis: A Rapid Review of Contemporary Epidemic and Pandemic Research. J. Schizophr. Res. 2020, 222, 79–87. [Google Scholar] [CrossRef]
  73. Jung, H.-R.; Park, C.; Kim, M.; Jhon, M.; Kim, J.-W.; Ryu, S.; Lee, J.-Y.; Kim, J.-M.; Park, K.-H.; Jung, S.-I. Factors Associated with Mask Wearing among Psychiatric Inpatients during the COVID-19 Pandemic. J. Schizophr. Res. 2021, 228, 235–236. [Google Scholar] [CrossRef]
  74. Ren, X.; Shen, F.; Gui, Y.; Wang, W.; Xing, B.; Huang, W. The Attitudes of Psychiatric Patients towards COVID-19 Vaccination in China: A Cross-Sectional Study. BMC Psychiatry 2021, 21, 475. [Google Scholar] [CrossRef]
  75. Mosconi, G.; Barello, S.; Bertuccio, P.; Fiorentino, M.; Vecchi, T.; Odone, A. Individual Voices, Collective Health: A Person-Centered Cross-Sectional Study to Identify Psychological Drivers of Vaccination Attitudes. Humanit. Soc. Sci. Commun. 2025, 12, 568. [Google Scholar] [CrossRef]
  76. Armstrong, R.A. When to Use the Bonferroni Correction. Ophthalmic Physiol. Opt. 2014, 34, 502–508. [Google Scholar] [CrossRef] [PubMed]
  77. Streiner, D.L.; Norman, G.R. Correction for Multiple Testing: Is There a Resolution? Chest 2011, 140, 16–18. [Google Scholar] [CrossRef] [PubMed]
Table 1. Socio-demographic data of participants and the corresponding percentages.
Table 1. Socio-demographic data of participants and the corresponding percentages.
VariableResponsesn (%)
SexMale80 (62.5%)
Female48 (37.5%)
Missing *13 (9.2%)
Age
  Range 21–74
  X = 50.05 years
  SD = 11.168		21–3519 (13.5%)
36–4828 (19.9%)
49–6060 (42.6%)
61–7318 (12.8%)
74 and above1 (0.7%)
Missing *15 (10.5%)
EducationPrimary education64 (45.5%)
Compulsory secondary education14 (9.9%)
Upper secondary education11 (7.8%)
Intermediate vocational training15 (10.6%)
Bachelor’s degree16 (11.3%)
Higher vocational training5 (3.6%)
Master’s degree3 (2.1%)
Missing *13 (9.2%)
HouseholdPrivate flat15 (10.6%)
Shared flat17 (12.1%)
Family flat70 (49.7%)
Supported housing26 (18.4%)
Missing *13 (9.2%)
Note *: missing data have been labelled as “Missing Completely at Random” (MCAR) and have been deleted on a listwise basis.
Table 2. Main dimensions and examples of survey questions.
Table 2. Main dimensions and examples of survey questions.
Dimension (Questions)Example Question
Attitude towards vaccination (2)If a vaccine to prevent COVID-19 were available tomorrow, would you take it?
Relationship with vaccines (2)In the 2019 common flu vaccination campaign, did you get vaccinated?
Decision delay (1)I would not get the first vaccine; I would rather get the second or the third one that comes out.
Compulsory nature of the vaccines (1)Do you think that vaccination against COVID-19 should be compulsory for the whole population?
Reasons for not getting vaccinated (1)What are the reasons you would refuse to get vaccinated against COVID-19?
Perceived risk of COVID-19 infection (9) How likely do you think it is that you will become infected with the coronavirus?
Additional questions focusing on specific aspects of the target group
Specific phobia (1)I dislike syringes.
Paranoia (2)There might be something dodgy in the vaccine (a tracking chip, something that modifies my genes…).
Nature of the relationship with professionals (2)I have a good relationship with my doctor.
Social life (1)I don’t have much of a social life or friends.
Table 3. Willingness to get vaccinated and perception of vaccine safety.
Table 3. Willingness to get vaccinated and perception of vaccine safety.
Question (n)Answern (%)
Willingness to get vaccinated
(141)		Yes79 (56.03%)
Hesitant50 (35.46%)
No12 (8.51%)
Effectiveness of the vaccine (141)They are effective125 (88.7%)
Unclear16 (11.3%)
Hesitancy on the effectiveness of the vaccine (16)Side effects11 (7.8%)
Driven by economic interests4 (2.8%)
Harmful to the immune system1 (0.7%)
Safety of the vaccines
(131)		They are safe64 (45.4%)
Doubts about safety30 (21.3%)
They are not safe47 (33.3%)
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Soto-Pérez, F.; Lettieri, A.; González, C.P.; Miguel Criado, S.; Franco-Martín, M.A. From Pandemic to Prevention: Insights from COVID-19 Vaccination Attitudes in Individuals with Schizophrenia. COVID 2025, 5, 81. https://doi.org/10.3390/covid5060081

AMA Style

Soto-Pérez F, Lettieri A, González CP, Miguel Criado S, Franco-Martín MA. From Pandemic to Prevention: Insights from COVID-19 Vaccination Attitudes in Individuals with Schizophrenia. COVID. 2025; 5(6):81. https://doi.org/10.3390/covid5060081

Chicago/Turabian Style

Soto-Pérez, Felipe, Andrea Lettieri, Carmen Pita González, Sonia Miguel Criado, and Manuel A. Franco-Martín. 2025. "From Pandemic to Prevention: Insights from COVID-19 Vaccination Attitudes in Individuals with Schizophrenia" COVID 5, no. 6: 81. https://doi.org/10.3390/covid5060081

APA Style

Soto-Pérez, F., Lettieri, A., González, C. P., Miguel Criado, S., & Franco-Martín, M. A. (2025). From Pandemic to Prevention: Insights from COVID-19 Vaccination Attitudes in Individuals with Schizophrenia. COVID, 5(6), 81. https://doi.org/10.3390/covid5060081

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