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

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.

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.

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).

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.