Childhood Trauma May Influence COVID Vaccine Hesitancy

Unwillingness or refusal to get the COVID-19 vaccine—also known as vaccine hesitancy—may be linked to traumatic events during childhood, such as physical, verbal, and sexual abuse, drug misuse, or neglect in the family home, according to a new study.

Researchers found vaccine hesitancy was three times higher in people who had experienced four or more types of adverse childhood experiences (ACEs) compared to those who hadn’t experienced any trauma as a child. 

“Adverse childhood experiences are strongly linked to poorer mental well-being and have been associated with lower levels of trust, including in health services,” Karen Hughes, lead researcher and professor of public health at Bangor University, told Verywell in an email. “People who have suffered abuse, neglect or other forms of adversity as children may find it more difficult to trust state systems provided for their protection and help, particularly if they have previously had bad experiences with such systems.” 

The researchers analyzed responses from a national cross-sectional telephone survey of adults living in Wales between December 2020 and March 2021, a time when restrictions like masking and social distancing were in effect to help curb the spread of COVID-19 infection.

Over 6,000 people were contacted, but only 2,285 responses were included. The final analysis used participants that answered all of the questions and met all eligibility criteria. 

Participants were asked about nine different types of adverse childhood experiences before the age of 18 which included: physical, verbal, and sexual abuse; parental separation; exposure to domestic violence; and living with a household member with mental illness, alcohol abuse, drug misuse, or who was in prison. 

Approximately half (52%) of the participants reported having no experiences of any childhood trauma, but around 21% said they experienced one type, 17% reported having two or three, and 10% reported four or more. 

Those who had experienced higher counts of trauma as a child generally had low trust in the United Kingdom's National Health Service (NHS) COVID-19 information, felt unfairly restricted by the government, and were more supportive of removing social distancing and face-covering requirements. The study was published in the BMJ Open.

Ernestine Cabady Briggs-King, PhD, an associate professor in psychiatry and behavioral sciences at Duke University who was not a part of the study, told Verywell having experiences of trauma at a young age violates an individual's trust early on and can lead them to have a negative view of other people, institutions, and public health systems. 

“If you’ve had more experience with trauma it teaches you things about the world or teaches you things about people in it,” Briggs-King said. “For example, with sexual abuse, it involves someone that you’re supposed to trust but they violate your trust. Because of this, you will have difficulty trusting other people and often have different perceptions of what’s safe and what’s not.” 

Childhood Trauma and Trust

Are there specific childhood traumas that have a larger impact on someone's ability to trust health information related to COVID-19 and vaccines? According to Hughes, many traumas are co-related and often occur together.

However, she says more studies and research are needed to determine if one childhood trauma has more of an impact than another. 

“There is a wide body of research indicating that the more adverse childhood experiences people suffer, the greater the impact on health,” she said. “However, this may be something we look into in more detail in the future.” 

Susan Yoon, PhD, associate professor and researcher with expertise in childhood trauma and child maltreatment at The Ohio State University, told Verywell in an email that while there is no robust evidence that suggests certain forms of childhood trauma have more salient effects than others on health trust or behaviors, prior research has consistently found that the greater number of traumas or ACEs a child faces is associated with worse health outcomes. 

However, Briggs-King believes based on existing research, sexual abuse and domestic violence could be more prominent in someone’s ability to believe and rely on information especially when it comes to health. 

“Sexual abuse is probably one of the most synergistic types of trauma or adversity," Briggs-King said. "When mixed with domestic violence, physical abuse or substance use it can lead to depression, anxiety and behavioral problems moving forward. This also goes back to a violation of trust in people and information.” 

How Do We Reduce Vaccine Hesitancy?

Hughes and Yoon say one way to reduce distrust in health information or vaccines is for healthcare professionals and providers to be trauma-informed. Professionals who have a better understanding of how childhood adversity can affect people can better help them when discussing vaccines and other medical or health issues.

“What can appear routine to a health professional may be a difficult leap of faith especially for those who have poorer experiences of trusting even within family settings,” Hughes said. “In particular with the vaccine message, there is a danger for some people that simply repeating the same message multiple times in more or less the same way might come across a bit like shouting—the result might be to push people further away rather than convince them of the benefits.” 

Briggs-King adds that understanding other factors including cultural considerations, history of maltreatment within the health care system, and other health disparities is important too—along with having more diversity and representation in the medical field.

“We have to make sure systems are equitable and inclusive," Briggs-King said. "We also have to make sure folks have access to information because there’s a lot of stuff that goes on social media that may not have accurate information. It’s key to have doctors that represent various communities that are available to talk to people about some of their concerns and answer their questions.” 

Yoon said potential strategies to reduce vaccine hesitancy and lack of trust in the government response to COVID-19 among people with a history of childhood trauma may include creating a space where individuals affected by trauma can share their concerns, validating these concerns and feelings, building rapport and trusting relationship with them, and collaborating with other health/mental health professionals (social workers, therapists) who may have existing trusting relationships with them to discuss COVID information.

As a note, while the study suggests higher levels of ACEs are linked with higher vaccine hesitancy, it is by no means the case for all people with vaccine hesitancy. Hughes said many people have other reasons to feel hesitant about getting vaccinated. 

More Research to Follow

The response rate for the study was only around 36% and the findings relied on personal recall. Women were also overrepresented and people from ethnic minority backgrounds were underrepresented. 

According to Hughes, they did not find any relationship between trust in NHS COVID-19 information and demographic factors. However, vaccine hesitancy as well as being in favor of ending current restrictions were related to socio-demographics with younger age groups. 

Briggs-King said despite the lack of representation in the study, she believes the findings can be relevant and applicable to people around the globe. But more studies will be needed that factors in housing, poverty levels, unemployment, and other health inequities and disparities. 

“This study gives us an understanding and clues around what we, as medical professionals, can do to address concerns about vaccine hesitancy in a different way other than saying, here are the rules,” Briggs-King said. “Understanding the source of some of these concerns can help us address them with information and let people make more informed decisions.”

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