Research in The Lancet Regional Health Americas in August 2024 evaluates the effect of various COVID-19 vaccine rollout phases on “trends and prevalence” of anxiety and depression in US adults. The authors conducted a US population-based multi-intervention interrupted time series analysis through Deep Learning and autoregressive integrated moving average (ARIMA) approaches. They find “disparate effects” of the phased vaccine rollout and highlight the need for “careful planning” in future vaccine strategies.
Pandemic effects on mental health
The authors note that the COVID-19 pandemic “intensified pre-existing challenges” and “exacerbated health disparities” for many in the US. Research illustrates the pandemic’s “multifaceted impacts” on mental, with many people facing “compounded stressors and trauma” due to high COVID-19-related mortality and morbidity. A “marked increase in the prevalence of anxiety (25.5%) and depression (24.3%)” was observed.
Although the COVID-19 vaccine rollout, which began on 11th December 2020 in the US, was expected to provide a “sense of optimism for a return to normalcy”, the effect of the rollout and subsequent phases on mental health outcomes “remains unclear”. However, there is a “burgeoning body of research” into the psychological implications of COVID-19 vaccination. This research tends to consider adverse mental health symptoms post-vaccination; links are also drawn between mental health issues and vaccine hesitancy and trust in government and public health officials. Despite this, there is a “significant evidence gap with major public health implications” around the consequences of a phased COVID-19 vaccine rollout on mental health among US adults.
Public health guidelines on vaccine distribution may have influenced mental health outcomes in “several ways”. For example, the availability of the vaccine “might offer hope and relief” and enhance a “sense of control and optimism”. On the other hand, the phased distribution could “instigate stress due to concerns about its accessibility” and the unequal distribution “may exacerbate social and health inequalities”, thus “amplifying feelings of uncertainty, frustration, and resentment”.
“Because of the potential mixed psychological effect of phased COVID-19 vaccine rollout, we hypothesised that COVID-19 vaccine rollout phases would be associated with a change in the prevalence of anxiety and depression among US adults while controlling for the potential psychological effects associated with major pandemic-related events.”
The study
The study aimed to evaluate the association of specific phases of COVID-19 vaccine rollout with the prevalence of anxiety and depression among US adults at a population level. Secondary, de-identified data from the CDC’s Behavioural Risk Factor Surveillance System (BRFSS) was analysed. The BRFSS conducts surveys to collect data on risk behaviours, chronic health conditions, healthcare accessibility, and the use of preventive services among “noninstitutionalised US adults”.
The results of the main ARIMA model indicated a “modest uptrend” in the prevalence of anxiety and depression in US adults between 2019 and February 2023. Within this, the authors find it “noteworthy” that the estimated prevalence of anxiety and depression dropped after the prioritisation for educational/childcare workers on 2nd March 2021. This implies that this prioritisation “appeared to alleviate mental health burden” among US adults. Vaccine authorisation for children aged between 6 months and 5 years might have contributed to decreased anxiety/depressive symptoms in many people, including caregivers of this group.
The estimated anxiety and depression prevalence decreased after a booster rollout for all US adults on 21st November 2021, but Phase 1 and 2 of COVID-19 vaccine rollout were “not associated with a significant reduction”. The authors wonder if heterogeneity in vaccine distribution led to access disparities, which might have a “diluted effect on the overall mental health” or the “politicisation and persistent misinformation” around vaccine safety and efficacy had a “mixed influence” on mental health.
Another notable discovery is an apparent association between the Phase 1 vaccine rollout and “significant increases in the prevalence of anxiety and depression among Black/African Americans and other non-Hispanic people of colour”. Research suggests that “historical and ongoing systemic racism and discrimination across the healthcare systems and society” could contribute to mistrust and distrust.
“Given the heightened risk of COVID-19 complications without vaccination coupled with the stress of systemic racism and healthcare disparities, it is possible that more Black/African Americans and other non-Hispanic people of colour (e.g. Asian/Indigenous) experienced mental health problems following Phase 1 vaccine rollout.”
It also appears that “lower-income individuals experienced anxiety and depression” after Phase 1, which the authors suggest could be attributed to a “higher proportion of lower-income individuals from Black/Africa communities”, highlighting “socioeconomic inequalities”. However, they state that research is needed to determine a causal link.
Implications
“Overall, these findings provide crucial implications for phased disease prevention and intervention strategies in future vaccine administration.”
The authors highlight the need to ensure “sufficient vaccine supply and accessibility” to promote public mental health by “enhancing perceptions of public safety and reducing pandemic-related stress and fears”. They call on public health officials and the pharmaceutical industry to consider the role of “logistical efficiency and vaccine availability in supporting public mental health”.
Lead author and director of the University of Alabama at Birmingham Community Counselling Clinic, Dr Yusen Zhai, comments that the “empirical evidence” from the study underlines the “need for careful planning in future strategies”. This is particularly important for groups who experience a “combination of historical mistrust, ongoing discrimination, and the added pressures of economic hardship”.
“Concerns about the vaccine’s safety and effectiveness were more pronounced in these communities, partly due to past experiences of being mistreated or misled by health care providers and authorities. This scepticism was exacerbated by the fast-paced development and distribution of the vaccine, making it harder for people to feel confident about getting vaccinated.”
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