Health policies can impact citizens’ psychological needs and mental health: Evidence from covid-safe health certifications

Health certification tools, like the COVID-Safe Ticket (CST), are common in public health policies, yet their psychological impact is underexplored. This longitudinal study tested whether the CST's introduction and removal affected basic psychological needs and mental health, whether effects differed by vaccination status, and whether perceived meaning of the CST (safety-enhancing vs polarizing) explained outcomes. Across nine waves (March 2020-March 2022) in Belgium, 1349 participants (12% unvaccinated) reported on basic psychological needs and mental health, and, during CST implementation, on CST perceptions. Multilevel analyses showed that the implementation of CST increased relatedness frustration only among unvaccinated persons, while autonomy differences between vaccinated and unvaccinated were amplified. Unvaccinated participants viewed the CST as more polarizing and less safety-enhancing, explaining differences in need experiences linked to mental health. Health certification tools undermined autonomy and relatedness among unvaccinated individuals. Framing such measures as promoting public safety may better preserve psychological needs and social cohesion.