Depressed Individuals Are More Susceptible to COVID-19 Vaccine Misinformation

Roy H. Perlis, MD, MSc

Americans with depressive symptoms are more likely to endorse COVID-19 vaccine misinformation, according to results of a national survey that highlight the need to address susceptibility to false information among persons with depression.

The new findings from the study conducted by a team of US-based investigators also showed correlates between a person more likely being unvaccinated for COVID-19 and resistant to the practice when in endorsement to any 1 of the 4 COVID-19 vaccine misinformation statements presented to them.

Led by Roy H. Perlis, MD, MSc, of the Massachusetts General Hospital, investigators sought to determine the link between depressive symptoms and likelihood of believing COVID-19 vaccine-related misinformation—a public health behavior recognized even prior to the pandemic. During the pandemic, about one-fourth of US adults have consistently reported moderate or more severe depressive symptoms.

“While misinformation is increasingly well studied, most of this work has concentrated on how and why such misinformation spreads,” Perlis and colleagues wrote. “A general bias toward negativity in information selection, processing, and recall may exacerbate misinformation exposure. In the context of political misinformation, both anger and anxiety are associated with promoting beliefs in certain types of false stories.”

The team analyzed responses compiled from 2 waves of a national nonprobability internet survey conducted from May to July 2021. The survey, provided to more than 15,000 adults aged ≥18 years old, characterized association between depressive symptoms and endorsement of misinformation, as well as potential mediators or moderators of such associations.

Investigators measured depressive symptoms from surveyed adults via the Patient Health Questionnaire 9-item (PHQ-9), and conducted population-reweighted multiple logistic regression analysis to examine the link between moderate to severe depressive symptoms and endorsement of ≥1 item of vaccine information. They further adjusted for sociodemographic features in determining associations.

Of the 15,464 survey respondents, 63.6% were women and mean respondent age was 47.9 years. Respondents were predominately White (76.7%), followed by Black (9.7%), Hispanic (6.6%), then Asian (4.7%).

Similar to previous national assessments during COVID-19, one-quarter (26.9%) of respondents identified moderate or greater depressive symptoms on the PHQ-9. About one-fifth (19.2%) endorsed at least 1 vaccine-related statement of misinformation on the survey; such statements 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”
• “The COVID-19 vaccines can cause infertility, making it more difficult to get pregnant”

Respondents with presence of depressive symptoms were more than twice likely to endorse COVID-19 vaccine misinformation (odds ratio [OR], 2.33; 95% CI, 2.09 – 2.61). Respondents endorsing ≥1 misinformation item were significantly less likely to be vaccinated (OR, 0.40; 95% CI, 0.36 – 0.45) and significantly more likely to report resistance to vaccination (OR, 2.54; 95% CI, 2.21 – 2.91).

Among the 2800-plus respondents to answer a subsequent survey in July, the presence of depression in the first survey from May was linked to a greater likelihood of endorsing even more information in July compared with the prior survey (OR, 1.98; 95% CI, 1.42 – 2.75).

Each of these correlates remained statistically significant when investigators adjusted for respondent sociodemographic features, as well as self-reported ideology and political party information. Though the findings do not provide conclusion on causation, the assessment of second-wave survey respondents suggested to investigators that misinformation was unlikely to cause depression.

“In general, negative biases are apparent in information processing even in the absence of depression,” they wrote. “Individuals with major depressive symptoms often exhibit a more pronounced negativity bias, a form of attentional bias in which thoughts with negative valence receive greater focus.”

The team did note that individuals with depression may exhibit less willingness to trust institutions tasked with combating misinformation, such as the Centers for Disease Control and Prevention (CDC). “However, we found that incorporating terms for trust in these institutions in regression models did not change the main association with depression, which does not support a mediating association of trust in institutions,” they wrote.

Perlis and colleagues concluded that while their findings were “associative by necessity,” the results showing a link between depression and COVID-19 misinformation endorsement broadly suggest the significance of directly testing causation in future assessments—if only to derive strategies that could reduce the consequences of depression in individual’s perception of information.

“To date, efforts to combat the impact of misinformation on public health predominantly emphasize reduction in supply,” they wrote. “In parallel, it may be possible to develop interventions targeting negativity bias that reduce demand, or at least modulate the capacity of misinformation to impact health decision-making.”

The study, “Association of Major Depressive Symptoms With Endorsement of COVID-19 Vaccine Misinformation Among US Adults,” was published online in JAMA Network Open.