Association of Major Depressive Symptoms With Endorsement of COVID-19 Vaccine Misinformation Among US Adults

Abstract

IMPORTANCEMisinformation about COVID-19 vaccination may contribute substantially to vaccine hesitancy and resistance. OBJECTIVE To determine if depressive symptoms are associated with greater likelihood of believing vaccine-related misinformation. DESIGN, SETTING, AND PARTICIPANTS This survey study analyzed responses from 2 waves of a 50-state nonprobability internet survey conducted between May and July 2021, in which depressive symptoms were measured using the Patient Health Questionnaire 9-item (PHQ-9). Survey respondents were aged 18 and older. Population-reweighted multiple logistic regression was used to examine the association between moderate or greater depressive symptoms and endorsement of at least 1 item of vaccine misinformation, adjusted for sociodemographic features. The association between depressive symptoms in May and June, and new support for misinformation in the following wave was also examined. EXPOSURES Depressive symptoms. MAIN OUTCOMES AND MEASURESThe main outcome was endorsing any of 4 common vaccinerelated statements of misinformation. RESULTSAmong 15 464 survey respondents (9834 [63.6%] women and 5630 [36.4%] men; 722 Asian respondents [4.7%], 1494 Black respondents [9.7%], 1015 Hispanic respondents [6.6%], and 11 863 White respondents [76.7%]; mean [SD] age, 47.9 [17.5] years), 4164 respondents (26.9%) identified moderate or greater depressive symptoms on the PHQ-9, and 2964 respondents (19.2%) endorsed at least 1 vaccine-related statement of misinformation. Presence of depression was associated with increased likelihood of endorsing misinformation (crude odds ratio [OR], 2.33; 95% CI, 2.09-2.61; adjusted OR, 2.15; 95% CI, 1.91-2.43). Respondents endorsing at least 1 misinformation item were significantly less likely to be vaccinated (crude OR, 0.40; 95% CI, 0.36-0.45; adjusted OR, 0.45; 95% CI, 0.40-0.51) and more likely to report vaccine resistance (crude OR, 2.54; 95% CI, 2.21-2.91; adjusted OR, 2.68; 95% CI , 2.89-3.13). Among 2809 respondents who answered a subsequent survey in July, presence of depression in the first survey was associated with greater likelihood of endorsing more misinformation compared with the prior survey (crude OR, 1.98; 95% CI, 1.42-2.75; adjusted OR, 1.63; 95% CI, 1.14-2.33). CONCLUSIONS AND RELEVANCEThis survey study found that individuals with moderate or greater depressive symptoms were more likely to endorse vaccine-related misinformation, crosssectionally and at a subsequent survey wave. While this study design cannot address causation, the (continued) Key Points Question Are major depressive symptoms associated with increased risk of believing common misinformation about COVID-19 vaccines among US adults? Findings In this survey study including 15 464 US adults, people with moderate or greater major depressive symptoms on an initial survey were more likely to endorse at least 1 of 4 false statements about COVID-19 vaccines on a subsequent survey, and those who endorsed these statements were half as likely to be vaccinated.

Prevalence and factors associated with not receiving the booster dose of the COVID-19 vaccine in adults in Latin America and the Caribbean

“…This could give the impression that further measures against the pandemic are not necessary, since in parallel to this, many Latin American countries lifted some restriction measures [ 32 ]. In the case of people with depression, it is described that they are more likely to endorse false statements about COVID-19 and have half the likely to be vaccinated compared with those without depression, being proposed that a lack of positive interpretation bias or optimistic beliefs could conditionate those results mentioned above [ 33 ]. Additionally, there has been physical and mental exhaustion due to the restrictions related to the pandemic called “pandemic fatigue”, which causes people to decrease adherence to measures to prevent infection compared to the start of the pandemic [ 34 , 35 ].…”

Possible predictors of Covid-19 vaccine hesitancy in the psychiatric population – A scoping review

“…One of the most common findings in the studies considered for this review, is that patients with mental illnesses typically had lower vaccination rates or more vaccination hesitancy ( Eyllon et al, 2022 ; Huang et al, 2021 ; Jefsen et al, 2021 ; Bai et al, 2021 ; Perlis et al, 2022 ; Hao et al, 2021 ) confirming a numerous studies suggesting this (Wang et al, 2021). Specifically, individuals with severe mental illness, including schizophrenia, were least likely to accept vaccination ( Huang et al, 2021 ; Bai et al, 2021 ; Tzur Bitan et al, 2021 ; Raffard et al, 2022).…”

“… Perlis et al (2022) found that presence of depression was significantly associated with increased likelihood of endorsing misinformation, which was associated with decreased likelihood of vaccination willingness. Further, they found that respondents who endorsed at least one misinformation item were significantly less likely to be vaccinated, but also significantly less likely to have a vaccinated family member ( Perlis et al, 2022 ). These findings persisted even after adjustment for sociodemographic features, and self-reported ideology or political party affiliation.…”

“… More vaccine hesitancy across all psychiatric comorbidities except Alcohol Use Disorders Huang et al (2021) Cross-sectional study Wuhan, China N = 906 adult patients with mental disorders Outcome measures: self-administered questionnaire Main findings: Higher education, a good family financial status, believing that over 50% of vaccine recipients would be immune to COVID-19, not being worried about side-effects, being out-patients, having mental disorders other than psychosis significantly associated with vaccine uptake 2.psychotic disorders were least likely to take the vaccine Jefsen et al, 2021 Cross-sectional study Danish Population n = 992 patients from psychiatric services Outcome measures: questionnaire-based online surveys Main findings: Younger age and mental illness were associated with lower vaccination willingness; Reasons for vaccine hesitancy: safety concerns, vaccines not sufficiently tested, vaccination unnecessary, lack of trust in authorities Uvais (2021) Cross-sectional study Indian population N = 90 patients of an outpatient psychiatry department Outcome measures: Covid-19 related questionnaire Main findings: Patients with higher education had more intentions of vaccination; Islamic participants had significantly higher vaccine hesitancy; Significantly higher vaccine hesitancy in this population in comparison to other global populations. Bai et al, 2021 Cross-sectional study Chinese Population N = 1853 outpatients and inpatients associated with 6 psychiatric hospitals Outcome measures: survey containing items from the WHO Quality of Life Scale Brief version (WHOQOL-BREF), the Visual Analog Scale for Pain (VAS), Patient Health Questionnaire-2 (PHQ-2), Social Impact Scale (SIS) Main findings: Unemployed, severe mental illnesses, higher perceived vaccine stigma; living in community dwellings Perlis et al (2022) Cross-sectional study American Population N = 15, 464 respondents of which 4164 identified depressive symptoms Outcome measures: online survey Main findings: Depression and endorsing misinformation Diagnosis with depression was significantly associated with increased likelihood of endorsing misinformation after adjustment for sociodemog...…”

Predictors of Vaccine Hesitancy among Health Care Workers during the COVID-19 Pandemic

“…Consequently, individuals with these issues are less likely to engage in proactive, self-care behaviors. Individuals who endorse symptoms of depression appear susceptible to misinformation about COVID-19 vaccines [ 19 ], and a recent review of the relevant research to date found fear and anxiety were associated with COVID-19 hesitancy [ 20 ].…”