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Psychological interventions as vaccine adjuvants: A systematic review

Vedhara, Kavita; Ayling, Kieren; Sunger, Kanchan; Caldwell, Deborah M.; Halliday, Vanessa; Fairclough, Lucy; Avery, Anthony; Robles, Luke; Garibaldi, Jonathan; Welton, Nicky J.; Royal, Simon


Kavita Vedhara

Kieren Ayling

Kanchan Sunger

Deborah M. Caldwell

Vanessa Halliday

Lucy Fairclough

Anthony Avery

Luke Robles

Jonathan Garibaldi

Nicky J. Welton

Simon Royal


Objectives: The effectiveness of vaccines is known to be altered by a range of psychological factors. We conducted a systematic review to evaluate the effects of psychological interventions on the ability of vaccines to protect against disease, as measured by antibody responses.

Methods: Electronic databases (EMBASE, Medline, PsychINFO, CINAHL) were searched from their inception to 6th February 2018.

Results: The search yielded 9 eligible trials conducted with 1603 participants and four broad categories of intervention: meditation/mindfulness (n=3), massage (n=3), expressive writing (n=2) and cognitive behavioural stress management (n=1). Some evidence of benefit on the antibody response to vaccination was observed in 6/9 of all trials and in 4/7 of randomised controlled trials. However, effects on antibody levels were often mixed, with only 3 of 6 trials showing benefit demonstrating an improvement in all antibody outcomes and at all time points assessed. Trials demonstrating benefit also provided direct or indirect evidence of adequate adherence with the intervention; and in 50% of these trials, there was also evidence that the intervention was effective in changing the mediating psychological constructs targeted by the intervention.

Conclusions: This literature is characterised by considerable heterogeneity in terms of intervention type, vaccine type, age of participants and the temporal relationship between vaccination and intervention. We conclude that there is early evidence to suggest that psychological interventions may enhance the antibody response to vaccination. However, the effects are inconsistent, with the greatest likelihood of benefit seen in trials evidencing adequate adherence with the intervention. Future work would benefit from rigorous intervention development that focuses on achieving adequate adherence and large well-controlled randomised trials with a focus on an agreed set of outcomes.

Journal Article Type Article
Publication Date May 31, 2019
Print ISSN 0264-410X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 37
Issue 25
Pages 3255-3266
APA6 Citation Vedhara, K., Ayling, K., Sunger, K., Caldwell, D. M., Halliday, V., Fairclough, L., …Royal, S. (2019). Psychological interventions as vaccine adjuvants: A systematic review. Vaccine, 37(25), 3255-3266. doi:10.1016/j.vaccine.2019.04.091
Keywords Vaccinations; Antibodies; Psychological interventions
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