A Systematic Review and Meta-Analysis of Psychological Interventions for Reducing Distress During Vaccine Injections.

BACKGROUND

Vaccine injections are associated with distress across the lifespan. Within a series of updated systematic reviews, we evaluated the effectiveness of psychological interventions, namely various forms of distraction and memory reframing, for reducing distress in vaccine recipients.

DESIGN/

METHODS

Overarching sources of guidance were GRADE and Cochrane. A search strategy was conducted in 5 databases for randomized and quasi-randomized trials in English. Trials were separated into infant (0 to 12 mo) and older individuals (>12 mo) and examined in separate meta-analyses using intervention subgroups. Using a random-effects model, standardized mean differences (SMDs) and 95% CIs were calculated to assess the effectiveness of reducing distress (the critical outcome), with SMDs <0.2 considered trivial. Summary statements for preferred interventions were derived from evidence certainty and effect magnitude.

RESULTS

Fifty-seven studies were included, focusing on infants, children, and adolescents. For infants, distraction through a toy (SMD=-3.68, low certainty) and singing (SMD=-0.60, low certainty) were preferred interventions, followed by auditory intervention with a device (SMD=-1.39, very low certainty) and video/movie (SMD=-1.67, very low certainty). For older individuals, preferred interventions were distraction via music (SMD=-0.38, moderate certainty), followed by digital activity/game (SMD=-0.74, low certainty), and virtual reality (SMD=-0.51, low certainty). Breathing with a toy (SMD=-0.82, very low certainty), nondigital activity/game (SMD=-0.86, very low certainty), toy (SMD=-1.37, very low certainty), and video/movie (SMD=-1.03, very low certainty) followed. The least preferred were verbal distraction (SMD=-0.27, very low certainty) and nonassisted (other) breathing interventions (SMD=-0.08, very low certainty). Memory reframing resulted in little to no difference in distress (SMD=-0.16, low certainty).

CONCLUSIONS

The choice of distraction methods to reduce distress should consider both the strength of the evidence and the preferences of vaccine recipients and their support persons.