When Dr. Roy Perlis partnered with peers and colleagues to conduct an ongoing survey of Americans about COVID-19, the Harvard Medical School psychiatrist knew the team had to ask about mental health. Since the survey’s spring 2020 launch, the subject has appeared alongside questions about other aspects of respondents’ lives, including social media use, news consumption preferences, political affiliation, and socialization habits. As misinformation about COVID-19 surged and survey participants reported worse mental health, Perlis wondered: Could depression make people vulnerable to misinformation?

A hallmark of depression, negative cognitive bias typically makes someone more likely to remember the worst thoughts, feelings, and events — and to dwell on them. Faced with an onslaught of terrible news during a pandemic, Perlis thought that people with depression might experience more skepticism, disbelief, and distrust.

“If we talk about people wearing rose-colored glasses, some people with depression are wearing dark-colored glasses where the world looks like a darker place,” he told Mashable. “If you believe the world is a dangerous, scary place, if someone tells you that a vaccine is dangerous, or that a vaccine is part of a conspiracy, you might be more inclined to believe it.”

So Perlis and his fellow researchers designed a survey to explore this possibility, and their findings were recently published in the scientific journal JAMA Network Open. The team presented four common but false statements about vaccine misinformation and asked participants whether they believed them: “The COVID-19 vaccines will alter people’s DNA,” “The COVID-19 vaccines contain microchips that could track people,” “The COVID-19 vaccines contain the lung tissue of aborted fetuses,” and “The COVID-19 vaccines can cause infertility, making it more difficult to get pregnant.” (The 15,464 respondents were informed that the statements were incorrect once they’d completed the survey.)

To isolate the effect depression might have on people’s susceptibility to misinformation, the study took into account several factors, including social media use, news source preferences (think MSNBC, Fox News, CNN, or the Biden administration), race, ethnicity, age, gender, and political party affiliation. The researchers found that experiencing clinical depression was still strongly associated with an increased likelihood of endorsing misinformation. Those who did so were significantly less likely to be vaccinated and were more likely to express vaccine resistance. In an effort to determine whether the misinformation might actually cause depression, the researchers also surveyed a subgroup of participants about their beliefs a second time and found that depression preceded their misinformation beliefs.

“I think that depression does make people more susceptible to some of these ideas…” Perlis said. “To me, what our findings suggest is it’s yet another reason that we have to pay attention to depression and anxiety. If we could address the depression and anxiety, I think people’s receptivity to misinformation would diminish.”

“If we could address the depression and anxiety, I think people’s receptivity to misinformation would diminish.”

Efforts to tamp down misinformation typically don’t focus on mental health but instead emphasize the legitimate role of social media, polarization, and political identity. Until the last few years, researchers hadn’t explored the connection; even Perlis was surprised at how little had been written about it. But studies conducted during the pandemic point to the possibility that depression and anxiety can make some people vulnerable to misinformation. While Perlis and his fellow researchers can’t yet prove with certainty that depression causes susceptibility to misinformation, their findings make clear that it’s a mistake to dismiss mental health as insignificant in favor of factors like party affiliation and social media use.

Experts in misinformation and mental health may be hesitant to draw a line between the two, fearing that it’ll portray people who believe misinformation as mentally ill, or that it’ll contribute to negative stereotypes of people living with mental health conditions. Perlis is careful to note that endorsing falsehoods isn’t reflective of mental illness. Instead, poor mental health combined with other factors make it easier to fall prey to misinformation.

“There are lots of things that affect how receptive you are to misinformation and depression is part of it,” said Perlis, noting that news sources, social media use, personal networks, age, and gender also matter. But some of these risk factors can’t be easily changed. Depression, however, can be managed with treatment, said Perlis. In order to “really get a handle on misinformation and its effect on our society,” he believes we need to do a better job of diagnosing and treating depression.

For people who see themselves in Perlis’ findings, a first step might be talking to a primary care physician who can recommend various treatments, including cognitive behavioral therapy and antidepressant medication. Both have been found to improve depression symptoms. Perlis said he’d be particularly worried about someone who consistently feels “down” or “blue,” has difficulty functioning, or experiences suicidal feelings. He also recommends basic health strategies as a bulwark against depression, including exercise, quality sleep, socializing with friends and loved ones, and minimizing time spent on news consumption and social media as necessary. While those acts of self-care aren’t treatments for depression, Perlis said they can help manage its symptoms.

Depression, mindfulness, and misinformation

Dr. Zindel Segal, a clinical psychologist and distinguished professor of psychology in mood disorders at University of Toronto, said the study was well designed and that its findings make intuitive sense. Segal, who wasn’t involved in the research, said that in addition to being less trusting, people experiencing depression are more likely to engage in binary thinking, particularly as it relates to negative thoughts about themselves, like “I’m no good,” or “I’m helpless.” They may have difficulty tolerating the uncertainty of situations that are inherently difficult to predict, such as a pandemic.

“That tendency feeds unfortunately well into a misinformation perspective on COVID,” said Segal. “It makes the situation seem very cut and dry.” For example, falsehoods about government conspiracies might be easier to believe than complex explanations about how COVID vaccines work.

Segal said that behavioral therapy for depression involves helping a patient develop “metacognitive capacities,” or the ability to “stand back and observe their thoughts and what their thoughts are saying to them.” The mindfulness skill can help protect against depression when practiced regularly, said Segal, who is a co-founder of Mindfulness-Based Cognitive Therapy. MBCT is an eight-week treatment designed for people who experience chronic depression or frequent relapses. The goal is to teach patients how to note thoughts without getting pulled into their content — and the emotional roller coaster that can follow. Segal said that developing mindfulness skills is easier with training, and that they improve with regular practice. He recommends meditation apps, books, web-based or CD recordings, or classes. (Segal offers his own online courses and has published instructional books on mindfulness).

While MBCT hasn’t been tested on people with depression who also believe misinformation, it’s possible to see how basic mindfulness skills could create a buffer between a vulnerable person and the falsehoods they encounter. The ability to pause and identify the domino effect between receiving emotionally-charged misinformation and changes in mood that occur as a result is critical, regardless of whether or not someone is depressed.

“Whether we could tailor treatment to help make people more resilient to misinformation is a great question,” Perlis wrote in a follow-up email.

In general, there’s strong evidence that mindfulness-based interventions, including MBCT, are an effective treatment for depression. A meta-analysis of conducted by Dr. Simon Goldberg, an assistant professor in the department of counseling psychology and faculty at the Center for Healthy Minds at the University of Wisconsin, indicates that such programs are as effective as psycho- and behavioral therapies.

Goldberg told Mashable that those treatments, in addition to antidepressants, may reduce depression symptoms because they make negative thoughts about the self, other people, and the world less magnetic. Goldberg, who reviewed Perlis’ study and found it persuasive, said it’s plausible that mindfulness skills could influence people’s relationship with misinformation.

“Training in the ability to see our thoughts as merely thoughts, that could be a really powerful way to combat misinformation, potentially,” he said.

If you want to talk to someone or are experiencing suicidal thoughts, Crisis Text Line provides free, confidential support 24/7. Text CRISIS to 741741 to be connected to a crisis counselor. Contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday from 10:00 a.m. – 10:00 p.m. ET, or email info@nami.org. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources.