{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T11:02:50Z","timestamp":1793790170044,"version":"4.6.1"},"reference-count":48,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Friedrich-Baur-Stiftung","award":["18\/21"],"award-info":[{"award-number":["18\/21"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Vaccines against COVID-19 and influenza are highly recommended for the chronically ill. They often suffer from co-morbid mental health issues. This cross-sectional observational study analyzes the associations between depression (PHQ-9) and anxiety (OASIS) with vaccination readiness (5C) against COVID-19 and influenza in chronically ill adults in primary care in Germany. Sociodemographic data, social activity (LSNS), patient activation measure (PAM), and the doctor\/patient relationship (PRA) are examined as well. Descriptive statistics and linear mixed-effects regression models are calculated. We compare data from n = 795 study participants. The symptoms of depression are negatively associated with confidence in COVID-19 vaccines (p = 0.010) and positively associated with constraints to get vaccinated against COVID-19 (p = 0.041). There are no significant associations between symptoms of depression and vaccination readiness against influenza. Self-reported symptoms of a generalized anxiety disorder seem not to be associated with vaccination readiness. To address confidence in COVID-19 vaccines among the chronically ill, targeted educational interventions should be elaborated to consider mental health issues like depression. As general practitioners play a key role in the development of a good doctor\/patient relationship, they should be trained in patient-centered communication. Furthermore, a standardized implementation of digital vaccination management systems might improve immunization rates in primary care.<\/jats:p>","DOI":"10.3390\/vaccines11121795","type":"journal-article","created":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T09:39:12Z","timestamp":1701337152000},"page":"1795","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Psychological Determinants of Vaccination Readiness against COVID-19 and Seasonal Influenza of the Chronically Ill in Primary Care in Germany\u2014A Cross-Sectional Survey"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3174-5297","authenticated-orcid":false,"given":"Linda","family":"Sanftenberg","sequence":"first","affiliation":[{"name":"Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Keppeler","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Heithorst","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Dreischulte","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1596-5908","authenticated-orcid":false,"given":"Marco","family":"Roos","sequence":"additional","affiliation":[{"name":"General Practice, Medical Faculty, University of Augsburg, 86356 Neus\u00e4\u00df, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3504-5837","authenticated-orcid":false,"given":"Philipp","family":"Sckopke","sequence":"additional","affiliation":[{"name":"Department of Psychology, LMU Munich, 80802 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"B\u00fchner","sequence":"additional","affiliation":[{"name":"Department of Psychology, LMU Munich, 80802 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Gensichen","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,30]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023, November 27). Noncommunicable Diseases. Available online: www.who.int\/news-room\/fact-sheets\/detail\/noncommunicable-diseases."},{"key":"ref_2","first-page":"3","article-title":"Beschluss und Wissenschaftliche Begr\u00fcndung der St\u00e4ndigen Impfkommission (STIKO) f\u00fcr die Aktualisierung der Influenza-Impfempfehlung f\u00fcr Personen im Alter von \u2265 60 Jahren","volume":"1","author":"Michaelis","year":"2021","journal-title":"Epidemiol. Bull."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/S2215-0366(20)30564-2","article-title":"COVID-19 vaccination for people with severe mental illness: Why, what, and how?","volume":"8","author":"Mazereel","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"ref_4","unstructured":"World Health Organization (2023, November 27). Coronavirus Disease (COVID-19): Vaccines and Vaccine Safety. Available online: www.who.int\/news-room\/questions-and-answers\/item\/coronavirus-disease-(covid-19)-vaccines."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6681","DOI":"10.1016\/j.vaccine.2016.11.015","article-title":"Vaccination of special populations: Protecting the vulnerable","volume":"34","author":"Doherty","year":"2016","journal-title":"Vaccine"},{"key":"ref_6","first-page":"71","article-title":"Council recommendation of 22 December 2009 on seasonal influenza vaccination","volume":"348","author":"Carlgren","year":"2009","journal-title":"Off. J. Eur. Union"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.humimm.2022.08.004","article-title":"Immunogenicity, effectiveness, safety and psychological impact of COVID-19 mRNA vaccines","volume":"83","author":"Alesci","year":"2022","journal-title":"Hum. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S0140-6736(07)61415-9","article-title":"Depression, chronic diseases, and decrements in health: Results from the World Health Surveys","volume":"370","author":"Moussavi","year":"2007","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1001\/archpsyc.1996.01830100035005","article-title":"Comorbid Anxiety Disorder and the Functioning and Well-being of Chronically Ill Patients of General Medical Providers","volume":"53","author":"Sherbourne","year":"1996","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1002\/wps.20806","article-title":"Increased risk of COVID-19 infection and mortality in people with mental disorders: Analysis from electronic health records in the United States","volume":"20","author":"Wang","year":"2021","journal-title":"World Psychiatry"},{"key":"ref_11","unstructured":"(2023, November 27). Deutsche Gesellschaft f\u00fcr Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V.: COVID-19-Impfstrategie: Warum Menschen mit Schweren Psychischen Erkrankungen zur Risikogruppe Geh\u00f6ren [Press Release]. Berlin 2020. Available online: www.dgppn.de\/presse\/stellungnahmen\/stellungnahmen-2020\/covid19-impfstrategie.html."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Pandolfo, G., Genovese, G., Iannuzzo, F., Bruno, A., Pioggia, G., and Gangemi, S. (2022). COVID-19 Vaccination and Mental Disorders, What Has Been Accomplished and Future Direction. Brain Sci., 12.","DOI":"10.3390\/brainsci12020292"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"114329","DOI":"10.1016\/j.psychres.2021.114329","article-title":"Associations between psychiatric morbidity and COVID-19 vaccine hesitancy: An analysis of electronic health records and patient survey","volume":"307","author":"Eyllon","year":"2022","journal-title":"Psychiatry Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Sekizawa, Y., Hashimoto, S., Denda, K., Ochi, S., and So, M. (2022). Association between COVID-19 vaccine hesitancy and generalized trust, depression, generalized anxiety, and fear of COVID-19. BMC Public Health, 22.","DOI":"10.1186\/s12889-021-12479-w"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3825","DOI":"10.1016\/j.vaccine.2022.04.091","article-title":"Measuring parents\u2019 readiness to vaccinate themselves and their children against COVID-19","volume":"40","author":"Rees","year":"2022","journal-title":"Vaccine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jad.2011.12.037","article-title":"Does depression lead to influenza?\u2014A systematic literature analysis","volume":"138","author":"Gharbawy","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"eAO5830","DOI":"10.31744\/einstein_journal\/2021AO5830","article-title":"Influenza vaccination coverage in elderly and high-risk adults: Characterization of associated factors","volume":"19","author":"Meneghini","year":"2021","journal-title":"Einstein"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/01.mlr.0000196965.54871.d5","article-title":"Psychological distress as a barrier to preventive care in community-dwelling elderly in the United States","volume":"44","author":"Thorpe","year":"2006","journal-title":"Med. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1001\/archinte.160.14.2101","article-title":"Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence","volume":"160","author":"DiMatteo","year":"2000","journal-title":"Arch. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Betsch, C., Schmid, P., Heinemeier, D., Korn, L., Holtmann, C., and B\u00f6hm, R. (2018). Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PLoS ONE, 13.","DOI":"10.31234\/osf.io\/ytb7w"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.medmal.2016.02.002","article-title":"The impact of the web and social networks on vaccination. New challenges and opportunities offered to fight against vaccine hesitancy","volume":"46","author":"Stahl","year":"2016","journal-title":"Med. Mal. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5048","DOI":"10.1080\/21645515.2021.2004837","article-title":"The influence of social network on COVID-19 vaccine hesitancy among healthcare workers: A cross-sectional survey in Chongqing, China","volume":"17","author":"Xu","year":"2021","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1111\/j.1475-6773.2006.00669.x","article-title":"Do Increases in Patient Activation Result in Improved Self-Management Behaviors?","volume":"42","author":"Hibbard","year":"2007","journal-title":"Health Serv. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1370\/afm.2679","article-title":"Primary Care\u2019s Historic Role in Vaccination and Potential Role in COVID-19 Immunization Programs","volume":"19","author":"Wilkinson","year":"2021","journal-title":"Ann. Fam. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.3122\/jabfm.2022.220126R1","article-title":"Trust Takes Two\u2026","volume":"35","author":"Williamson","year":"2022","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2855","DOI":"10.2147\/PPA.S433331","article-title":"Comparison of SARS-CoV-2 Vaccination Skepticism, Reasons, and Concerns between Mass Vaccination Centers and General Practices in Germany 2021","volume":"17","author":"Schrimpf","year":"2023","journal-title":"Patient Prefer. Adherence"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jad.2008.03.014","article-title":"Validation of a brief measure of anxiety-related severity and impairment: The Overall Anxiety Severity and Impairment Scale (OASIS)","volume":"112","author":"Norman","year":"2009","journal-title":"J. Affect. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1093\/geront\/46.4.503","article-title":"Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations","volume":"46","author":"Lubben","year":"2006","journal-title":"Gerontologist"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Brenk-Franz, K.H.J., Herrmann, W.J., Freund, T., Szecsenyi, J., Djalali, S., Steurer-Stey, C., S\u00f6nnichsen, A., Tiesler, F., Storch, M., and Schneider, N. (2013). Validation of the German Version of the Patient Activation Measure 13 (PAM13-D) in an International Multicentre Study of Primary Care Patients. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0074786"},{"key":"ref_31","first-page":"103","article-title":"Qualit\u00e4t der Arzt-Patienten-Beziehung\u2014Evaluation der deutschen Version des Patient Reactions Assessment Instruments (PRA-D)","volume":"92","author":"Hunold","year":"2016","journal-title":"ZFA Z. F\u00fcr Allg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Gerretsen, P., Kim, J., Caravaggio, F., Quilty, L., Sanches, M., Wells, S., Brown, E.E., Agic, B., Pollock, B.G., and Graff-Guerrero, A. (2021). Individual determinants of COVID-19 vaccine hesitancy. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0258462"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2190716","DOI":"10.1080\/21645515.2023.2190716","article-title":"Vaccine hesitancy within the Muslim community: Islamic faith and public health perspectives","volume":"19","author":"Alsuwaidi","year":"2023","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101454","DOI":"10.1016\/j.eclinm.2022.101454","article-title":"Social media and attitudes towards a COVID-19 vaccination: A systematic review of the literature","volume":"48","author":"Cascini","year":"2022","journal-title":"EClinicalMedicine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"103854","DOI":"10.1016\/j.ijnurstu.2020.103854","article-title":"Editor\u2019s Choice: Influenza vaccine uptake, COVID-19 vaccination intention and vaccine hesitancy among nurses: A survey","volume":"114","author":"Kwok","year":"2021","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0277-9536(96)00221-3","article-title":"Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)","volume":"44","author":"Charles","year":"1997","journal-title":"Soc. Sci. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.vaccine.2020.12.014","article-title":"Assessing the impact of shared decision making processes on influenza vaccination rates in adult patients in outpatient care: A systematic review and meta-analysis","volume":"39","author":"Sanftenberg","year":"2021","journal-title":"Vaccine"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"K\u00fchne, F., Sanftenberg, L., Dreischulte, T., and Gensichen, J. (2020). Shared Decision Making Enhances Pneumococcal Vaccination Rates in Adult Patients in Outpatient Care. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17239146"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1017\/neu.2021.15","article-title":"COVID-19 vaccine willingness amongst patients with mental illness compared with the general population","volume":"33","author":"Jefsen","year":"2021","journal-title":"Acta Neuropsychiatr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1001\/jamapsychiatry.2020.4396","article-title":"Maximizing the Uptake of a COVID-19 Vaccine in People With Severe Mental Illness: A Public Health Priority","volume":"78","author":"Warren","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"194","DOI":"10.5993\/AJHB.40.2.4","article-title":"Barriers to Self-management of Serious Mental Illness and Diabetes","volume":"40","author":"Blixen","year":"2016","journal-title":"Am. J. Health Behav."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"9714","DOI":"10.3390\/ijerph120809714","article-title":"Relationship between Health Literacy, Health-Related Behaviors and Health Status: A Survey of Elderly Chinese","volume":"12","author":"Liu","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"439","DOI":"10.3200\/JRLP.139.5.439-457","article-title":"The General Self-Efficacy Scale: Multicultural Validation Studies","volume":"139","author":"Luszczynska","year":"2005","journal-title":"J. Psychol."},{"key":"ref_44","first-page":"645","article-title":"A systematic review on strategies for increasing vaccination rates against seasonal influenza in patients with chronic diseases in primary care","volume":"116","author":"Sanftenberg","year":"2019","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_45","first-page":"CD00394","article-title":"Patient reminder and patient recall systems to improve immunization rates","volume":"20","author":"Jacobson","year":"2005","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_46","first-page":"499","article-title":"Studies on Factors Influencing Influenza Vaccination Rates in Patients with Chronic Obstructive Pulmonary Disease","volume":"75","author":"Fischer","year":"2021","journal-title":"Pneumologie"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"107724","DOI":"10.1016\/j.intimp.2021.107724","article-title":"COVID-19 vaccine hesitancy and related fears and anxiety","volume":"97","author":"Bendau","year":"2021","journal-title":"Int. Immunopharmacol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1017\/dmp.2021.311","article-title":"COVID-19 Vaccine Hesitancy Among Patients With Epilepsy or Other Chronic Conditions","volume":"16","author":"Barzegar","year":"2022","journal-title":"Disaster Med. Public Health Prep."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/11\/12\/1795\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:35:04Z","timestamp":1760132104000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/11\/12\/1795"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,30]]},"references-count":48,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["vaccines11121795"],"URL":"https:\/\/doi.org\/10.3390\/vaccines11121795","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,30]]}}}