Association of Covid-19 vaccination uptake with recorded self-harm, neurodevelopmental disorders and mental health conditions during the Covid-19 pandemic: A nationwide e-cohort study in Wales, UK

Abstract

Background: Understanding COVID-19 vaccine uptake among individuals who self-harm or with mental health conditions is critical to addressing health inequalities and guiding public health strategies/pandemic preparedness. Evidence on temporal trends and sociodemographic factors shaping vaccine uptake within these populations remains limited.Methods: We linked Wales Immunisation System data to demographic and healthcare records for 2.2 million individuals. Using modified Poisson regressions and growth models, we explored the association between self-harm, neurodevelopmental disorders, mental health conditions, and vaccine uptake from 8 December 2020 to 8 December 2023. Models were adjusted for age, sex, deprivation, ethnicity, and physical comorbidities.Findings: Attention Deficit Hyperactivity Disorder (ADHD), conduct disorder, drug use, and, to a lesser extent, self-harm were associated with lower incidence of vaccination. Conversely, those with autism spectrum disorder, or learning difficulty had slightly higher incidence of vaccination. Individuals with severe mental illness (SMI: schizophrenia, bipolar disorder and other psychotic disorders) exhibited a steeper initial increase and earlier peak in uptake, but their final coverage was lower. Belonging to an ethnic minority group and, to a lesser extent, being male, younger, or leaving in highly deprived areas were also associated with reduced uptake.Interpretation: Disparities in vaccine uptake exist among individuals with self-harm and mental health conditions, driven by intersecting health and social factors. Tailored interventions, effective communication, and trust-building strategies are critical to reducing these inequities. Underserved groups including those with SMI, ADHD, and self-harm, should be prioritised in future vaccination campaigns to improve equity