COVID-19 vaccine development should have been the “light at the end of the tunnel.” However, antivaccinations attitudes and hesitation are common,1 even among older adults. Such hesitancy has been positively associated with depression, potentially due to concerns about vaccine side-effects.2 We tested the association between depression and vaccine side-effects in older adults, and hypothesized that, like physical illness,3 depression should increase with each additional side-effect.
This survey was conducted via iPanel (a probability based panel, see4 for additional details) to obtain good representation of vaccinated Israeli older adults (N = 939, mean age 68.9 ± 3.43 [range 65–85]; 59.9% females, 46.9% academic education; 75% married). At time of study (January 25th-February 4th, 2021), respondents were 28.15 ± 9.47 days after the first Pfizer vaccine [BNT162b2mRNA]. Participants completed web-based questionnaires comprising demographics, self-rated health, COVID-19 vaccination side-effects and depressive symptoms. Respondents provided informed consent to procedures approved by the last author's university institutional review board. The extent of suffering from side-effects (reported by the FDA1 and the Israeli Ministry of Health2 ) was examined (1-not at all to 5-very severely). We computed the number of side-effects endorsed as severe/very severe. Depressive symptoms were assessed by the PHQ-9 questionnaire (α = 0.84), the clinical cut-off score was ≥10.5 A single item indexing self-rated health was used (1-not healthy to 5-very healthy).6
Vaccination side-effects were rare (see Supplementary file). Prevalence of clinical depressive symptom levels was 11%. Clinical depression was logistically regressed on vaccination side-effects. Those with one severe side-effect were twice as likely to report clinical depressive symptom levels (OR = 2.30 [95% CI = 1.26–4.18], Wald = 7.48; df = 1, p <0.0001); those with 2 severe side-effects, 4.76 times more likely (OR = 4.76 [95% CI = 2.31–9.80]; Wald = 18.195; df = 1, p <0.0001), those with 3+ severe side-effects were 7.34 times more likely to report clinical depressive symptoms (OR = 7.19 [95% CI = 3.58–14.42]; Wald = 30.85; df = 1, p <0.0001). Controlling for relevant variables (demographics, days since vaccination, and self-rated health) yielded similar results (see Supplementary file).
Although severe vaccination side effects were rare, they positively linked with depressive symptoms. The large scale of global vaccination suggests a potentially important mental health burden for those with side-effects. Depressive symptoms, if untreated, may be detrimental to older adults’ physical and mental health.3
Limitations of this study include narrowly focusing on Pfizer's vaccination and older adults within a narrow age range, potentially mitigating generalizability to other vaccines and ages. Additionally, the directionality of the depression–side-effects link could not be discerned from our cross-sectional data. High depression levels in older adults during COVID-19.7 may lead to side-effects8; likewise, side-effects may lead to depression.8 Future studies measuring these variables across time points may enable discerning causality provided suitable models are applied.9 Experimental studies may also be revealing, e.g., comparing vaccination side-effects in a group of older adults whose depression rate was experimentally lowered (e.g., via an intervention) to a control group.
The current data suggest that reported side-effects may be useful in identifying depression in older adults. Presenting vaccinated older adults with accurate information regarding depressive symptoms and treatment centers, should be helpful. Psycho-educational interventions emphasizing that vaccination side-effects neither challenge vaccine safety nor efficacy, may aid in reducing potential depressive symptoms.
Disclosure
No disclosures to report.
Footnotes
This research was supported by an internal grant awarded to MB by his university.
The data have not been previously presented orally or by poster at scientific meetings.
Supplementary material associated with this article can be found, in the online version, at https://doi.org/10.1016/j.jagp.2021.09.010.
Appendix. SUPPLEMENTARY MATERIALS
References
- 1.Berry SD, Johnson KS, Myles L, et al. Lessons learned from frontline skilled nursing facility staff regarding COVID-19 vaccine hesitancy. J Am Geriatr Soc. 2021;69:1140–1146. doi: 10.1111/jgs.17136. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Palgi Y, Bergman YS, Ben-David B, et al. No psychological vaccination: vaccine hesitancy is associated with negative psychiatric outcomes among Israelis who received COVID-19 vaccination. J Affect Disord. 2021;287:352–353. doi: 10.1016/j.jad.2021.03.064. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Agustini B, Lotfaliany M, Woods RL, et al. Patterns of association between depressive symptoms and chronic medical morbidities in older adults. J Am Geriatr Soc. 2020;68:1834–1841. doi: 10.1111/jgs.16468. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Ben-Ezra M, Hamama-Raz Y, Goodwin R, et al. Association between mental health trajectories and somatic symptoms following a second lockdown in Israel: a longitudinal study. BMJ open. 2021;11(9) doi: 10.1136/bmjopen-2021-050480. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Gen Intern Med. 2001;16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38:21–37. [PubMed] [Google Scholar]
- 7.Callow DD, Arnold-Nedimala NA, Jordan LS, et al. The mental health benefits of physical activity in older adults survive the COVID-19 pandemic. Am J Geriat Psychiat. 2020 doi: 10.1016/j.jagp.2020.06.024. https://www.ajgponline.org/article/S1064-7481(20)30400-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Madison AA, Shrout MR, Renna ME, et al. Psychological and behavioral predictors of vaccine efficacy: considerations for COVID-19. Perspect Psychol Sci. 2021;16:191–203. doi: 10.1177/1745691621989243. https://doi.org/10.1177%2F1745691621989243. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Jindra C, Li C, Tsang RSM, Bauermeister S, Gallacher J, et al. Depression and memory function – evidence from crosslagged panel models with unit fixed effects in ELSA and HRS. Psychol Med. 2020:1–9. doi: 10.1017/S0033291720003037. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.