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.

Keywords: COVID-19; coronavirus; negative emotions; nocebo effect; psychological factors.

Figure 1.

The accepted model with direct and indirect paths. Certainty of being infected directly predicted the dependent variable. Anxiety mediated the effects of certainty. The model explained 27% of variance in perceived severity of COVID-like symptoms. Certainty: certainty of being infected; C-symptoms: COVID-like symptoms. ***p<0.001.