People who remain hesitant to get a COVID-19 vaccine may feel that way because of an association with traumatic events in childhood that undermine trust, including domestic violence, substance abuse in the home, or neglect, a new study suggests.
The study results, published online in the journal BMJ Open, Prof. are especially significant, the authors say, because of how common childhood trauma is, with up to 10% of people in some countries reporting multiple traumas.
The authors write that hesitancy or refusal to get the vaccine increased with the number of traumas reported.
For example, hesitancy was 3 times higher among people who had experienced four or more types of childhood trauma than those who did not report any traumatic events.
Mark A. Bellis, PhD, with Bangor University in the United Kingdom, one of the study authors, says while their work suggests that higher levels of trauma are linked with higher vaccine hesitancy, it is by no means the only reason people choose not to get vaccinated.
However, he said, the association they found may have key messages for doctors and other health care professionals.
"For clinicians, simply being ‘trauma-informed’ can help," Bellis says. "Understanding how such childhood adversity can affect people may help them when discussing vaccines, and in understanding resistance to what is a complex medical issue and one that requires considerable trust.”
What may appear routine to a doctor “may be a difficult leap of faith, especially for those who have poorer experiences of trusting even within family settings,” he says
More Trauma, Less Trust
The study authors used responses to a telephone survey of adults in the U.K. taken between December 2020 and March 2021, when COVID-19 restrictions were in force. Out of 6,763 people contacted, 2,285 met all criteria and answered all the questions and were included in the final analysis.
The survey asked about nine types of childhood experiences before the age of 18, including: parents who separate; physical, verbal, and sexual abuse; exposure to domestic violence; and living with someone who has mental illness, misuses alcohol and/or drugs, or who was incarcerated.
It also included personal details and long-term health information.
About half of the respondents said they hadn't experienced any childhood trauma. Of those who did, one in five said they had experienced one type, 17% reported two to three types, and 10% reported four or more.
According to the authors, prevalenceof these childhood experiences was consistent with other population surveys, including those conducted face to face.
They also investigated levels of trust and preference for different health regulations.
People with more childhood trauma were more likely to have low trust in government COVID-19 information.
"Other sociodemographics and a history of either chronic disease or COVID-19 infection were not significantly associated with low trust," the authors point out.
People reporting higher amounts of trauma were also more likely to say they felt they were unfairly restricted by the government. People with four or more experiences were twice as likely to say they felt unfairly restricted and wanted rules such as mandatory masking to stop.
Additionally, people with four or more types of trauma were almost twice as likely to ignore the pandemic restrictions as those who hadn't experienced any.
Loss of Control
"Past traumatic experiences can predispose someone to avoid things that remind them of that trauma,” Consuelo Cagande, MD, senior associate program director at Children's Hospital of Philadelphia, says. “This avoidance protects them from re-experiencing the negative symptoms and behaviors that come with it. Whether this results into hesitancy of something that would benefit their health is not well known,"
She pointed out a limitation the authors mention that is common when using childhood experiences as a link to possible negative behavior in the future is that people self-report them and may misremember or misreport them.
Cagande said that fearing loss of control may be another factor at play in having to follow restrictions, such as quarantining and masking, social distancing, or mandated vaccinations.
She said it's important to understand a person's reason for hesitancy to vaccines and work with the person with the help of their community, to help them trust and feel safe.