Psychological interventions as vaccine adjuvants: A systematic review

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

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

14 Citations (Scopus)
53 Downloads (Pure)


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.
Original languageEnglish
Pages (from-to)3255-3266
Number of pages12
Issue number25
Early online date6 May 2019
Publication statusPublished - 31 May 2019


  • Vaccinations
  • Antibodies
  • Psychological interventions


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