Is vaccine hesitancy related to mental health after the adjustment of the zero-COVID-19 strategy in the elderly? A mediation analysis in China

Figures & data

Table 1. Sample characteristics of participants (n = 658).

Characteristics		Number (%)	Mean (SD)
Gender
	male	329 (50.0)
	female	329 (50.0)
Age(continuous)			68.36 (6.29)
Age(years)
	60–74	551 (83.7)
	>75	107 (16.3)
Area of residence
	Eastern	256 (38.9)
	Midlands	237 (36.0)
	Western	165 (25.1)
Marital status
	Unmarried	10 (1.5)
	Married	578 (87.8)
	Divorced/widowed	70 (10.6)
Religious beliefs
	No	576 (87.5)
	Yes	82 (12.5)
Education level
	Less than high school education	409 (62.2)
	High school diploma	146 (22.2)
	College degree or more	103 (15.7)
Medical background
	I had medical background	26 (4.0)
	My family had medical background	144 (21.9)
	none	488 (74.2)
Health status
	Better	99 (15.1)
	Merely changed	336 (51.1)
	Worse	223 (33.9)
SARS-CoV-2 infection
	I got infected	123 (18.7)
	At least one of my family got infected	470 (71.4)
	Nobody got infected in my family	65 (9.9)
COVID-19 vaccination
	Unvaccinated	71 (10.8)
	Basic doses	277 (42.1)
	Booster doses	310 (47.1)
Frequency of influenza vaccination in the past 3 years
	Every year	179 (27.2)
	Once/twice vaccinated	236 (35.9)
	Never	243 (36.9)
COVID-19 vaccine hesitancy
	Yes	347 (52.7)
	No	311 (47.3)
Anxiety(continuous)			3.52 (4.64)
Anxiety
	None	483 (73.4)
	Mild	105 (16.0)
	Moderate	45 (6.8)
	Severe	25 (3.8)
Depression(continuous)			3.82 (5.43)
Depression
	None	476 (72.3)
	Mild	109 (16.6)
	Moderate	31 (4.7)
	Moderately severe	23 (3.5)
	Severe	19 (2.9)
Benefit-finding(continuous)			5.70 (1.13)
Health consciousness			6.15 (1.26)
Family value			6.02 (1.25)
Meaning in life			4.78 (2.08)
Social connectedness			6.12 (1.25)
Fear(continuous)			17.77 (8.85)
5C scale
Confidence			5.51 (1.50)
Complacency			3.21 (1.47)
Constraint			2.69 (1.61)
Calculation			4.85 (2.09)
Collective responsibility			5.30 (1.58)

Standard Deviation (SD).

Table 2. Correlations between variables of interest (n = 658).

	Gender	Area of residence	Religious beliefs	Education level	Health status	COVID-19 vaccination	Influenza vaccination	COVID-19 vaccine hesitancy	Anxiety	Depression	Benefit-finding	Fear
Gender	1
Area of residence	−.143**	1
Religious beliefs	.092*	−.124**	1
Education level	−.023	−.458**	.084*	1
Health status	.040	−.069	−.006	.036	1
COVID-19 vaccination	−.123**	.103**	−.117**	−.009	−.008	1
Influenza vaccination	.091*	−.476**	.030	.243**	.065	−.322**	1
COVID-19 vaccine hesitancy	−.033	.240**	−.090*	−.196**	−.117**	.221**	−.150**	1
Anxiety	−.004	−.224**	−.104**	.095*	−.066	.043	.273**	.194**	1
Depression	.115**	−.476**	.083*	.213**	.082*	−.134**	.386**	−.126**	.811**	1
Benefit-finding	.103**	−.312**	.145**	.201**	.135**	−.084*	.201**	−.168**	−.017	−0.07	1
Fear	.104**	−.351**	.151**	.219**	.157**	−.070	.217**	−.226**	.613**	.577**	.209**	1

Table shows the Spearman’s correlation coefficient, *P < .05 **P < .01.

Figure 1. Mediation effect of COVID-19 vaccine hesitancy between demographics and anxiety symptoms.

Note. RMSEA (Root mean square error of approximation) is an index used to evaluate model misfit. CFI (Comparative Fit Index) is used to measure the consistency between the model and the original data. SRMR (standardized root mean square residual) value measures the residual mean between observed variables and predictor variables in the model. RMSEA ≤ 0.05, CFI ≥ 0.95 and SRMR ≤ 0.08 represent an excellent fitting model.

Figure 2. Mediation effect of COVID-19 vaccine hesitancy between demographics and depression symptoms.

Figure 3. Mediation effect of COVID-19 vaccine hesitancy between demographics and benefit-finding.

Figure 4. Mediation effect of COVID-19 vaccine hesitancy between demographics and fear.

Table 3. Mediation effect of COVID-19 vaccine hesitancy between demographics and mental health.

		X→M	M→Y	X→Y	Sobel Test	RIT	RID
Anxiety	Area of residence	B = 0.171***	B = −0.086*	B = 0.196***	B = −0.127*	0.091	0.100
	Education Level	B = −0.103^*	B = −0.086*	B = 0.012	B = 0.148**	0.176	0.214
	Health Status	B = −0.100^**	B = −0.086*	B = 0.092*	B = 0.118*	0.141	0.164
	COVID-19 Vaccination	B = 0.223^***	B = −0.086*	B = 0.023	B = −0.249**	0.695	2.276
Depression	Area of residence	B = 0.171***	B = −0.135***	B = 0.215***	B = −0.023*	0.118	0.134
	Education Level	B = −0.103^*	B = −0.135***	B = 0.004	B = 0.014*	0.218	0.278
	Health Status	B = −0.100^**	B = −0.135***	B = 0.092*	B = 0.013*	0.179	0.218
	COVID-19 Vaccination	B = 0.223^***	B = −0.135***	B = 0.047	B = −0.030**	1.016	60.846
Benefit-Finding	Area of residence	B = 0.171***	B = 0.239^***	B = −0.169^***	B = 0.813^***	0.317	0.241
	Education Level	B = −0.103^*	B = 0.239^***	B = −0.009^***	B = −0.577^***	0.548	0.354
	Health Status	B = −0.100^**	B = 0.239^*	B = −0.042	B = −0.396^***	0.584	1.406
	COVID-19 Vaccination	B = 0.223^***	B = 0.239^***	B = 0.089^*	B = 0.794^***	0.983	58.29

RIT = Ratio of indirect effect to total effect; RID = Ratio of indirect effect to direct effect. X refers to the independent variables included in this mediation model, including geography, education level, health status, and COVID-19 vaccination; M represents the mediating variable COVID-19 vaccine hesitancy; and Y is the dependent variable in the mediation model, including anxiety, depression, and benefit-finding. The effect of X on Y in the mediation model is divided into two parts: one is the direct effect, the direct effect of X on Y, and the other is the indirect effect, the effect of X on Y through M.

Table 4. Total score of 5C and score of each dimension in participants (n = 658).

Dimensions	Median (IQR)	Vaccine Hesitancy		Wilcoxon test (Mann-Whitney)
		Yes (n = 347)	No (n = 311)	Z-value	P-value
Confidence	5.83 (2.33)	5.00 (2.00)	7.00 (1.00)	14.69	<.001
Complacency	3.25 (1.75)	3.50 (1.50)	2.50 (2.00)	7.03	<.001
Constraint	2.67 (2.67)	3.00 (2.33)	1.67 (2.00)	7.77	<.001
Calculation	5.33 (3.67)	5.00 (2.67)	5.33 (4.00)	0.47	.644
Collective responsibility	5.50 (3.00)	5.00 (2.00)	6.50 (2.00)	8.85	<.001

IQR (Inter Quartile Range) = High quartile(Q3) – low quartile(Q1).

Data availability statement

Data will be made available on request.