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

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To identify the key insights or developments described in this article

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JAMA Network Open

Published Online: January 21, 2022

Original Investigation

Article Information and Disclosures

Roy H. Perlis, MD, MSc^1,2;

Katherine Ognyanova, PhD³;

Mauricio Santillana, PhD^2,4;

Jennifer Lin, BA⁵;

James Druckman, PhD⁵;

David Lazer, PhD⁶;

Jon Green, PhD⁶;

Matthew Simonson, PhD⁶;

Matthew A. Baum, PhD⁷;

John Della Volpe, BA⁷

Author Affiliations

¹Massachusetts General Hospital, Boston
²Harvard Medical School, Boston, Massachusetts
³Rutgers University, New Brunswick, New Jersey
⁴Boston Children’s Hospital, Boston, Massachusetts
⁵Northwestern University, Evanston, Illinois
⁶Northeastern University, Boston, Massachusetts
⁷Harvard University, Cambridge, Massachusetts

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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.

Meaning These findings suggest another potential benefit of public health efforts to address depressive symptoms, namely reducing susceptibility to misinformation.

Abstract

Importance Misinformation 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 Measures The main outcome was endorsing any of 4 common vaccine-related statements of misinformation.

Results Among 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 Relevance This survey study found that individuals with moderate or greater depressive symptoms were more likely to endorse vaccine-related misinformation, cross-sectionally and at a subsequent survey wave. While this study design cannot address causation, the association between depression and spread and impact of misinformation merits further investigation.

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Article Information

Accepted for Publication: December 2, 2021.

Published: January 21, 2022. doi:10.1001/jamanetworkopen.2021.45697

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Perlis RH et al. JAMA Network Open.

Corresponding Author: Roy H. Perlis, MD, MSc, Massachusetts General Hospital, 185 Cambridge St, Sixth Floor, Boston, MA 02114 (rperlis@mgh.harvard.edu).

Author Contributions: Dr Perlis had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Perlis, Lazer, Della Volpe.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Perlis.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Perlis, Santillana.

Obtained funding: Ognyanova, Druckman, Lazer, Baum.

Administrative, technical, or material support: Ognyanova, Lin, Druckman, Lazer, Simonson, Della Volpe.

Supervision: Perlis, Lazer.

Conflict of Interest Disclosures: Dr Perlis reported receiving personal fees from Burrage Capital, Genomind, RID Ventures, Belle Artificial Intelligence, and Takeda and owning equity in Psy Therapeutics and Belle Artificial Intelligence outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by the National Science Foundation (SES-2029292 and SES-2029792; Drs Baum and Ognyanova), the National Institute of Mental Health (R01MH116270 and 1R56MH115187; Dr Perlis), and Northeastern University, Harvard Kennedy School of Government, and Rutgers University.

Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: Dr Perlis is an associated editor of JAMA Network Open, but he was not involved in any of the decisions regarding review of the manuscript or its acceptance.

References

Swire-Thompson B , Lazer D . Public health and online misinformation: challenges and recommendations. Annu Rev Public Health. 2020;41:433-451. doi:10.1146/annurev-publhealth-040119-094127 PubMed Google Scholar Crossref

Loomba S , de Figueiredo A , Piatek SJ , de Graaf K , Larson HJ . Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA. Nat Hum Behav. 2021;5(3):337-348. doi:10.1038/s41562-021-01056-1 PubMed Google Scholar Crossref

Romer D , Jamieson KH . Conspiracy theories as barriers to controlling the spread of COVID-19 in the U.S. Soc Sci Med. 2020;263:113356. doi:10.1016/j.socscimed.2020.113356 PubMed Google Scholar

Druckman JN , Ognyanova K , Baum MA , et al. The role of race, religion, and partisanship in misperceptions about COVID-19. Group Processes Intergroup Relations. 2021;24(4):638-657. doi:10.1177/1368430220985912 Google Scholar Crossref

Vosoughi S , Roy D , Aral S . The spread of true and false news online. Science. 2018;359(6380):1146-1151. doi:10.1126/science.aap9559 PubMed Google Scholar Crossref

Knobloch-Westerwick S , Mothes C , Polavin N. Confirmation bias, ingroup bias, and negativity bias in selective exposure to political information. Commun Res. 2020;47(1):104-124. doi:10.1177/0093650217719596 Google Scholar Crossref

Rozin P , Royzman EB . Negativity bias, negativity dominance, and contagion. Pers Soc Psychol Rev. 2001;5(4):296-320. doi:10.1207/S15327957PSPR0504_2 Google Scholar Crossref

Weeks BE . Emotions, partisanship, and misperceptions: how anger and anxiety moderate the effect of partisan bias on susceptibility to political misinformation: emotions and misperceptions. J Commun. 2015;65(4):699-719. doi:10.1111/jcom.12164 Google Scholar Crossref

Perlis RH , Santillana M , Ognyanova K , et al. Factors associated with self-reported symptoms of depression among adults with and without a previous COVID-19 diagnosis. JAMA Netw Open. 2021;4(6):e2116612. doi:10.1001/jamanetworkopen.2021.16612 PubMed Google Scholar

National Center for Health Statistics. Anxiety and depression: Household Pulse Survey. Accessed December 13, 2021. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm

The COVID States Project. Accessed December 14, 2021. https://covidstates.org/

Kroenke K , Spitzer RL . The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32(9):509-515. doi:10.3928/0048-5713-20020901-06 Google Scholar Crossref

Kube T , Schwarting R , Rozenkrantz L , Glombiewski JA , Rief W . Distorted cognitive processes in major depression: a predictive processing perspective. Biol Psychiatry. 2020;87(5):388-398. doi:10.1016/j.biopsych.2019.07.017 PubMed Google Scholar Crossref

Everaert J , Podina IR , Koster EHW . A comprehensive meta-analysis of interpretation biases in depression. Clin Psychol Rev. 2017;58:33-48. doi:10.1016/j.cpr.2017.09.005 PubMed Google Scholar Crossref

Korn CW , Sharot T , Walter H , Heekeren HR , Dolan RJ . Depression is related to an absence of optimistically biased belief updating about future life events. Psychol Med. 2014;44(3):579-592. doi:10.1017/S0033291713001074 PubMed Google Scholar Crossref

Castro VM , Gunning FM , McCoy TH , Perlis RH . Mood disorders and outcomes of COVID-19 hospitalizations. Am J Psychiatry. 2021;178(6):541-547. doi:10.1176/appi.ajp.2020.20060842 PubMed Google Scholar Crossref

Lin LY , Sidani JE , Shensa A , et al. Association between social media use and depression among U.S. young adults. Depress Anxiety. 2016;33(4):323-331. doi:10.1002/da.22466 Google Scholar Crossref

Kross E , Verduyn P , Demiralp E , et al. Facebook use predicts declines in subjective well-being in young adults. PLoS One. 2013;8(8):e69841. doi:10.1371/journal.pone.0069841 PubMed Google Scholar

Sagioglou C , Greitemeyer T. Facebook’s emotional consequences: why Facebook causes a decrease in mood and why people still use it. Comput Human Behav. 2014;35:359-363. doi:10.1016/j.chb.2014.03.003 Google Scholar Crossref

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