Does Depression Make People More Vulnerable to COVID Vaccine Misinformation?

March 9, 2022

Ruta Nonacs, MD PhD

Individuals with depressive symptoms are twice as likely to endorse misinformation about COVID vaccines.

In recent analyses from the COVID States Project, Roy Perlis, MD MSc, Director of the Center for Quantitative Health at Mass General, and his colleagues have been looking at factors contributing to vaccine resistance, including vaccine-related misinformation. They have been particularly interested in understanding how depressive symptoms may impact decision-making. Specifically, they hypothesize that depressive symptoms may contribute to vaccine resistance. Because individuals with depressive symptoms often exhibit a more pronounced negativity bias, a form of attentional bias in which thoughts with negative valence receive greater attention, they considered the possibility that depressed individuals may be more likely to endorse misinformation eliciting negative affect and thus may be more likely to resist vaccination.

The COVID States Project

The COVID States Project online survey has been conducted approximately once every 6 weeks since April 2020, asking adults in all 50 US states and the District of Columbia about their attitudes and behaviors related to COVID-19. Between between May and July 2021, 15, 464 US adults in all 50 US states completed two waves of the survey. The participants were asked about whether they were or intended to be vaccinated and answered questions related to vaccine-specific misinformation.

Participants were asked to comment on the accuracy of four statements which were derived from misinformation prevalent on social media platforms in the Spring of 2021. Specific statements of misinformation included “The COVID-19 vaccines will alter people’s DNA,” “The COVID-19 vaccines contain microchips that could track people,” “The COVID-19 vaccines contain the lung tissue of aborted fetuses,” and “The COVID-19 vaccines can cause infertility, making it more difficult to get pregnant.”

Depressive symptoms were measured using the Patient Health Questionnaire 9-item (PHQ-9). Logistic regression was used to examine the association between moderate or severe depressive symptoms and the likelihood of endorsing at least one item of vaccine misinformation.

Depressive Symptoms and Vaccine Misinformation

In this cohort, 4164 (26.9%) of the respondents reported moderate or severe depressive symptoms on the PHQ-9, and 2964 respondents (19.2%) endorsed at least one vaccine-related statement of misinformation. Those reporting depressive symptoms were about twice as likely to endorse misinformation (adjusted OR, 2.15; 95% CI, 1.91-2.43).

Examining the subset of 2809 individuals who completed two consecutive waves of the survey approximately one month apart, the researchers also observed that respondents who reported depressive symptoms on the initial survey were more likely to endorse vaccine misinformation on the second survey than those with no depression (adjusted OR, 1.63; 95% CI, 1.14-2.33).

Vaccination rates were significantly lower in respondents endorsing at least one misinformation item (adjusted OR, 0.45; 95% CI, 0.40-0.51).

Targeting Depression: A New Way to Combat Misinformation?

This survey study including 15 ,464 US adults indicates that people with moderate or severe depressive symptoms were about twice as likely to endorse misinformation related to COVID-19 vaccines. Furthermore, those who endorsed these statements were about half as likely to be vaccinated.

Given the methodology used in this study, it is not possible to establish a causal relationship between depression and COVID vaccine misinformation. It is possible that depression distorts one’s cognitive abilities and impairs the accurate processing of information. However, it is also possible that behaviors related to depression may play a role. For example, those with depression may be more isolated and thus may be less likely to consult with and trust others, including medical professionals, and may be more likely to gather information from social media platforms. Because in a subset of participants who completed two consecutive surveys, the researchers observed that depressive symptoms preceded the endorsement of misinformation, it is less likely that misinformation caused the depression per se.

Nonetheless one of the most important findings of this study is that about 1 in 4 adults completing this survey reported moderate to severe depressive symptoms. Compared to pre-pandemic surveys, this represents a huge increase in the prevalence of clinically significant depressive symptoms. We have yet to fully understand the impact of pandemic-related depressive symptoms on adults in the United States. Of concern is the finding that depressive symptoms may be associated with increased morbidity and mortality in those with COVID.

If depression is, in fact, a risk factor for adopting COVID vaccine misinformation, it is possible that strategies targeting depressive symptoms and efforts to reduce the impact of depression on health decision-making may help to reduce the impact of misinformation on vaccine acceptance.