ArticlePloS one2023
Mental distress, COVID19 vaccine distrust and vaccine hesitancy in South Africa: A causal mediation regression analysis.
Article in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- [Associated factors with vaccine hesitancy in sub-Saharan Africa: a literature review].The Pan African medical journal · 2026Pooled it
- The impact of pediatric influenza and COVID-19 hospitalization on parental attitudes toward vaccination.Human vaccines & immunotherapeutics · 2026Observational
- Willingness to accept the HBV vaccine and related factors: Administering the vaccination attitudes examination scale to Urban Vietnamese adults.PLOS global public health · 2026Article
- Mental health issues, coping mechanisms, and COVID-19 vaccine acceptance among chronically ill patients in tertiary health facilities in Central Region, Ghana.Discover mental health · 2025Article
- Anxiety and fear of COVID-19 as potential mechanisms to explain vaccine hesitancy among adults.Frontiers in psychiatry · 2024Article
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Authors and funding
3 authors.
Funding
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Abstract
aimWithin the context of increasing mental distress noted since the beginning of the COVID19 pandemic, the study aims at analysing the relationship between mental health, vaccine distrust and vaccine hesitancy in South Africa. SUBJECT AND
methodsThe study uses nationally representative panel data of 3241 individuals interviewed prior to and during the COVID19 pandemic. The study uses a range of regression techniques including logit, mediation and gradient-boosted causal mediation models to identify the causal relationship while accounting for selection bias.
resultsThe results of multivariate logit regression reveal that vaccine distrust is the most important predictor of vaccine hesitancy [Coeff: 3.420, CI 3.122, 3.717]. Mental distress is not found to be a significant driver in a fully specified logit model, pointing to the need to analyse the pathways through which mental distress impacts vaccine hesitancy. The mediation regression undertaken for this purpose finds that the mental distress has a positive and significant association with vaccine distrust [Coeff: 0.027, CI: 0.0029, 0.052]. The increased vaccine distrust in turn results in increased vaccine hesitancy [Coeff: 0.661, CI: 0.611, 0.711]. The results of mediation regression therefore indicate strong and significant mediation effects, whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust. These results are robust to the gradient boosted causal mediation model which establishes strong and significant indirect effects [Coeff: 0.015, CI: 0.01, 0.019], whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust.
conclusionThe study concludes that mental health impacts on vaccine intention through the mediating role of vaccine distrust. The findings indicate that individuals at high risk of depression are more concerned regarding the safety of vaccines, which in turn feeds into vaccine hesitancy. Therefore, depressive symptoms impact on vaccine hesitancy through the mediating factor of vaccine distrust.
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