The Covid-19 vaccination rollout is underway with demand outpacing availability. With millions in line for the vaccine, experts offer advice to consider during the wait: prioritize your mental health.
In a recent peer-reviewed, preprint report, researchers argue stress, depression, loneliness, and poor health behaviors may impair the immune system’s response to vaccines. Poor mental health, it’s suggested, may be a risk factor for delayed immune response to the vaccine and can potentially shorten the duration of immunity.
This claim has not been tested in individuals vaccinated against Covid-19 but is based on 30 years of studies documenting the impact of psychological factors on the immune system’s vaccine response. The preprint is accepted for publication in Perspectives on Psychological Science.
Senior author Janice Kiecolt-Glaser is the director of the Institute for Behavioral Medicine Research at Ohio State University College of Medicine. She tells Inverse previous research, including studies conducted on how stress changes the body’s response to the hepatitis B vaccine, suggests “people who are more stressed and more anxious might take longer to respond to the vaccines” for coronavirus, too.
This is not to say people won’t be protected from the Covid-19 vaccines — they will be. Instead, it’s about protecting one’s mental health in an effort to maximize the vaccines’ effectiveness. Individuals can take concrete, meaningful steps to ensure their immune system is operating at peak performance before vaccination.
Mental health and immunity — After vaccination, the body launches an innate, general immune response to a potential biological threat. Part of this response involves the production of antibodies, and the continued production of antibodies indicates how effectively a vaccine protects you over time.
Poor mental health may influence the body’s immunological response, explains Fulvio D’Acquisto, a professor of immunology and the University of Roehampton. He was not involved in the new report. His work suggests the cellular composition of our immune system responds “to every positive and negative feeling or emotional experience” — like laughing, crying, or being in love.
“I’m going to be getting my vaccine next week and I’m going to be doing both of those things.”
But while there appears to be this link between the mind and immune system, scientists are still in the early stages of recognizing why it can play a role in the immune system’s response to a vaccine.
A potential explanation, explains Annelise Madison, are the neuroendocrine changes associated with chronic stress and depression. Madison is a Ph.D. candidate at the Ohio State University College of Medicine and a co-author of the report. Neuroendocrine describes cells that release hormones in response to the stimulation of the nervous system.
Kalil Alves de Lima, a post-doctoral researcher at Washington University who studies how the immune system affects mind and body and was not a part of the report, adds that in the past decade several "beautiful studies" have demonstrated reciprocal interactions between the immune and the central nervous systems. He tells Inverse it's fair to say poor mental health may negatively influence the body's reaction to the vaccine.
"For this unusual time that we are all experiencing, it is more important than ever to relieve any extra anxiety or stress," Alves de Lima says. "It will help us to keep not only our mental health, but it will certainly provide the extra boost that our immune system needs to mount the best possible response to beat Covid-19."
Studies suggest stress, depression, lack of social support, sedentariness, a bad diet, and poor sleep can “independently and synergistically promote a suboptimal immune response to the vaccine,” Madison tells Inverse. Poor mental health is one factor associated with a poorer immune response, she says.
“As you can imagine, these risk factors can start to compound and interact with one another,” Madison says. “For instance, a person with severe depression is likely to be sedentary, eat foods that are high in fat and sugar, and withdraw from their social circle, which all can hamper immune function.”
Mental health and vaccine effectiveness — The risk of the Covid-19 vaccine not working is low, Madison explains. Both the Pfizer and Moderna vaccines have an efficacy rate of about 95 percent. But efficacy is a measurement of performance in controlled circumstances, while effectiveness is what’s seen in real-world conditions.
The vaccine’s effectiveness might prove a bit lower — which is normal, expected, and nothing to be worried about.
“Individuals should be aware that their mental and physical health can impact their side effect profile, how long it takes to develop immunity, and how long the immunity lasts,” Madison says.
Future studies are necessary to confirm this in Covid-19 vaccine recipients. In the meantime, history can offer some insight. In Kiecolt-Glaser’s 1992 study on the hepatitis B vaccine, the jab was shown to be 90 percent effective against the disease, but the study participants “who were more stressed and anxious took significantly longer to develop a protective antibody response.”
It’s also a matter of how long the immune response lasts. In an evaluation of individuals receiving a pneumococcal pneumonia vaccine that Kiecolt-Glaser and colleagues published in 2000, they found groups classified as spousal caregivers and non-caregivers both responded initially, and equally, to the vaccine. But six months later, the non-caregivers were maintaining their protective level of antibodies, while the antibodies of the caregivers diminished.
What you can do — Minimizing stress during a pandemic, Madison acknowledges, is a hard ask. “An important consideration is that these risk factors for a suboptimal vaccine response are, ironically, more prevalent now during the pandemic than they were before the pandemic, she says.
And D’Acquisto, the immunology professor, is careful to note people who experience mental health issues are at no risk of the vaccine not working.
“What the study is really saying is that vaccination is not a ‘passive’ experience for the person that receives it,” D’Acquisto says.
In other words, there are actionable steps you can take to positively influence your mental health, and in turn, your immune response. Even relatively modest changes, the report argues, can help. These include:
- Getting a good night’s sleep before and after vaccination
- Vigorously exercising within 24 hours before the shot
“I’m going to be getting my vaccine next week,” Kiecolt-Glaser says, “and I’m going to be doing both of those things.”