The nocebo phenomenon in the COVID-19 pandemic: a nocebodemic effect

ABSTRACT

Introduction

The COVID-19 pandemic had remarkable effects on psychological distress. The main stressors were prolonged quarantine and social isolation, fear of infection and death, stigmatization, infodemic, financial difficulties, and job loss. These negative stressors, which affect mental and physical health, make people more vulnerable to nocebo-related risk behaviors. We aimed to summarize data on nocebo behaviors, such as the negative psychological consequences of the COVID-19 pandemic in terms of how people perceive and interpret medical services and treatments.

Areas covered

Limited data were found from randomized controlled trials with SARS-CoV-2 vaccines and from surveys on healthy people, healthcare workers, and patients with chronic pain disorders.

Expert opinion

Studies have shown nocebo effects among participants in SARS-CoV-2 vaccines trials, among patients with chronic pain, and among healthcare workers. These effects were widely amplified during the pandemic era, prefiguring a ‘nocebodemic effect’ to describe the massive negative interpretation of health services and medical treatments. Greater awareness of these findings could reduce the impact of the ‘nocebodemic effect’ and increase public trust in science.

KEYWORDS:

• COVID-19 pandemic
• experimental studies
• nocebodemic effect
• nocebo effect
• SARS-CoV-2 vaccine randomized clinical trials

Article highlights

• Data from clinical trials and cross-sectional surveys suggest that the COVID-19 pandemic amplified nocebo effects.

• We propose the term ‘nocebodemic effect’ to describe this phenomenon triggered by the COVID-19 pandemic.

• ‘Nocebodemic effect’ traumatizes public health and medical treatment outcomes.

• To address this negative effect, the possible determinants should be clarified.

• A large-scale campaign to explain the ‘nocebodemic effect’ is needed to protect people’s trust in science and improve treatment outcomes.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

M Amanzio conceived the content of this perspective article, wrote the manuscript and structured the figure and the table. GE Cipriani wrote and edited the manuscript and revised table. DD Mitsikostas discussed the content of the article and suggested several additions to the text. All authors contributed to the article and approved the submitted version of the article.

Additional information

Funding

This paper was not funded.