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 run in five databases for randomized and quasi-randomized trials in English. Trials were separated into infant (0–12 months) and older individuals (>12 months) and examined in separate meta-analyses using intervention subgroups. Using a random effects model, standardized mean differences (SMD) and 95% confidence intervals were calculated to assess effectiveness on reducing distress (critical outcome) with <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 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), non-digital 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 non-assisted (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: Choice of distraction methods to reduce distress should consider both evidence strength and preferences of vaccine recipients and their support persons.