A $3.3 million grant from the National Institute of Mental Health (NIMH) will fund innovative new research to address high levels of COVID-19 vaccine hesitancy among individuals with symptoms of anxiety or depression.

Researchers from the CUNY Institute for Implementation Science in Population Health (CUNY ISPH) at the CUNY Graduate School of Public Health and Health Policy (CUNY SPH), the University of North Carolina Gillings School of Global Public Health (UNC Gillings), the Harvard T.H. Chan School of Public Health and Columbia University will leverage the infrastructure of the national CHASING COVID Cohort (C3) Study to tailor and test the effectiveness of a digital intervention to increase COVID-19 vaccination among U.S. adults experiencing mental health symptoms.

People with mental health disorders, including anxiety and depression, report greater vaccine hesitancy and lower COVID vaccination levels than the general population. They are also more likely to be impacted by COVID-19 vaccine misinformation and disinformation."

Angela Parcesepe, UNC Gillings Assistant Professor, one of the study's principal investigators

"In March 2021, about 40% of U.S. adults with symptoms of anxiety or depression were vaccinated compared to 53% of those without symptoms," says CUNY SPH Distinguished Professor Denis Nash, Executive Director of CUNY ISPH and the other principal investigator of the study. "Undervaccination is a key driver of the preventable outcomes of hospitalizations, deaths, and long COVID, and this is what has motivated our research team to conduct this study."

The team will conduct in-depth analyses of the C3 participant data to identify key vaccine and booster uptake determinants, including mis/disinformation, among people with depression or anxiety. This will inform the design of an intervention tailored to people experiencing mental health symptoms who may experience unique but modifiable barriers to staying up to date on vaccinations. The intervention will help participants recognize and protect themselves against vaccine mis/disinformation by using a narrative technique called "inoculation theory." The intervention will work the way some vaccines work: by exposing people to weakened forms of mis/disinformation, which can strengthen their ability to identify and resist mis/disinformation when they encounter it in the future.

The tailored intervention will build on one shown to be effective in a recent online trial led by Harvard Research Scientist Rachael Piltch-Loeb, a co-investigator on the newly-awarded grant. Her team found that "inoculating" people against COVID-19 vaccine misinformation significantly decreased COVID-19 vaccine hesitancy and increased resistance to vaccine misinformation among unvaccinated U.S. adults. However, the intervention was not specifically tailored to people experiencing mental health symptoms.

In the new study, the team will use a three-arm randomized controlled trial to compare a tailored intervention to the original untailored intervention and to conventional public health messaging around the importance of keeping up to date on COVID-19 vaccines.

"The premise of inoculation theory is to develop psychological resistance to misinformation," says Dr. Pilch-Loeb. "Therefore, we think that a tailored intervention that focuses on the particular psychological needs among those with depression and anxiety can have an added benefit."

"The COVID-19 pandemic both increased the rates of mental health problems, especially depression and anxiety, and worsened mental health disparities," says Dr. Milton Wainberg, a co-investigator on the study and Professor of Clinical Psychiatry at Columbia University. "Treating mental health problems will not be enough to improve suboptimal COVID-19 vaccination rates among people with mental health symptoms. Other strategies are needed."

Findings from this study will help inform the development and implementation of strategies to increase vaccination uptake and mitigate the impact of COVID-19 among people with anxiety and depression.