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

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
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.


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.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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