Experiencing COVID-19 symptoms without the disease: The role of nocebo in reporting of symptoms

Abstract

Background: A nocebo effect occurs when inactive factors lead to worsening of symptoms or reduce treatment outcomes. Believing that one is or has been infected with COVID-19 may act as a nocebo. However, not much is known about potential nocebo effects associated with the reporting of COVID-19 symptoms. Aim: An online survey investigated whether certainty of being infected with COVID-19, age, sex, cognitive, emotional and personality factors were associated with perceived severity of COVID-19 symptoms. Methods: Participants ( N=375) filled out an online survey containing 57 questions asking about symptoms resembling COVID-19, certainty of being infected with COVID-19, anxiety, stress and personality dimensions. Results: Certainty of being infected with COVID-19 and anxiety predicted 27% of the variance in reporting of COVID-like symptoms. The mediation analysis showed that both higher certainty of being infected and anxiety independently predicted increased reports of COVID-like symptom. Females had higher anxiety and stress levels, and reported more COVID-like symptoms than males did. Older age was not associated with reporting COVID-like symptoms. Conclusions: Believing to be infected with COVID-19, along with anxiety, can enhance the severity of COVID-like symptoms. Thus, the nocebo effect was due to both cognitive and emotional factors and was higher in females.

Epidemiology of SARS-CoV-2 Infection in Italy Using Real-World Data: Methodology and Cohort Description of the Second Phase of Web-Based EPICOVID19 Study

“…We also observed specific sex-differences in relation to the self-reported COVID-19-like symptoms, in which females tend to systematically over-report symptoms. Because no sex difference in the rate of positivity to the diagnostic or screening test has been observed, a possible explanation might reside in the fact that females were more worried about the health situation and tended to be more prone to the phenomenon of the 'nocebo effects' compared to males, as shown in other studies [44][45][46]. In line with available evidence, considering only participants with positive results from NPS and/or ST, males more often reported symptoms, such as fever and cough, known as predictors of worse outcomes [47], whereas females reported more frequently symptoms susceptible to subjective perception (headache, anosmia, dysgeusia, sore throat) and generally associated with less severe infections [48,49].…”

Epidemiology of SARS-CoV-2 infection in Italy using real-world data: methodology and cohort description of the second phase of web-based EPICOVID19 study

“…We also observed specific sex-differences in relation to the self-reported COVID-19like symptoms, in which females tend to systematically over-report symptoms. Because no sex difference in the rate of positivity to the diagnostic or screening test has been observed, a possible explanation might reside in the fact that females were more worried about the health situation and tended to be more prone to the phenomenon of the 'nocebo effects' compared to males, as shown in other studies [44][45][46]. In line with available evidence, considering only participants with positive results from NPS and/or ST, males more often reported symptoms, such as fever and cough, known as predictors of worse outcomes [47] whereas females reported more frequently symptoms susceptible to subjective perception (headache, anosmia, dysgeusia, sore throat) and generally associated with less severe infections [48,49].…”

Nocebo-Prone Behavior Associated with SARS-CoV-2 Vaccine Hesitancy in Healthcare Workers

“…In addition, the vicious cycle of negative expectations from treatment and resultant negative effects of treatment, i.e., nocebo effects, is fueled by negative media references [18,32], which for the case of pandemic are unprecedented in extent and intensity [33]. Therefore, one would expect that nocebo-prone individuals would have increased AE reporting post vaccination [34], which was not found. We believe that this is because nocebo-prone participants were more commonly unvaccinated, which did not allow us to highlight this association.…”