Study data published in JAMA Network Open suggest that depressive symptoms may be associated with engagement in COVID-19 vaccine-related misinformation. In an online survey conducted among US adults, respondents with depression were significantly more likely to endorse misinformation-driven statements about vaccines. Further, survey participants who endorsed misinformation were significantly less likely to report receiving a COVID-19 vaccine.

This study analyzed responses from 2 waves of the COVID-19 States Project survey, an ongoing internet survey that measures participants’ opinions on myriad aspects of public policy. The waves of interest were conducted between April and July of 2021. The survey applies nonprobability sampling to achieve balanced participant ratios by age, sex, race/ethnicity, and state of residence.

Vaccine-related misinformation was measured by asking participants to endorse the accuracy of specific statements, including the following: “The COVID-19 vaccines will alter people’s DNA”; “The COVID-19 vaccines contain microchips”; and “The COVID-19 vaccines can cause infertility.” Depression symptoms were measured using the Patient Health Questionnaire 9-item (PHQ-9); a PHQ-9 score of 10 or higher was considered indicative of depression. Multiple logistic regression was used to examine the relationship between depressive symptoms and misinformation. Models were adjusted for sociodemographic features.

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The study cohort comprised 15,646 respondents of mean age 47.9 ± 17.5 years, among whom 9834 (63.6%) were women; 5630 (36.4%) were men; 11,863 (76.7%) identified as White; and 1,494 (9.7%) identified as Black. A total of 4,164 (26.9%) participants had moderate or greater depressive symptoms per the PHQ-9. Overall, 2964 (19.2%) individuals endorsed at least 1 vaccine-related statement of misinformation.

In regression models, the presence of depression was associated with significantly greater odds of endorsing 1 or more statements of misinformation (adjusted odds ratio [aOR], 2.15; 95% CI, 1.91-2.43). Participants who indicated agreement with misinformation were significantly less likely to be vaccinated (aOR, 0.45; 95% CI, 0.40-0.51) and reported more vaccine resistance (aOR, 2.68; 95% CI, 2.89-3.13) than participants who did not endorse misinformation.

A total of 2,809 respondents participated in both survey waves. Presence of depression on the first survey was associated with greater likelihood of endorsing more statements of misinformation on the subsequent survey (aOR, 1.63; 95% CI, 1.14-2.33).

Results from this study outline a potential association between depression symptoms and susceptibility to vaccine-related misinformation. The cross-sectional study design prevents assertion of causality. Further study is necessary to understand the relationship between these variables and assess means of intervention.

“To date, efforts to combat the impact of misinformation on public health predominantly emphasize reduction in supply,” investigators noted. “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.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Perlis RH, Ognyanova K, Santillana M, et al. Association of major depressive symptoms with endorsement of COVID-19 vaccine misinformation among US adults. JAMA Netw Open. 2022;5(1):e2145697. doi:10.1001/jamanetworkopen.2021.45697