Is population anxiety associated with COVID-19 related hospitalizations and deaths? A study protocol

Abstract

BACKGROUND The nocebo effect is any harmful reaction following a negative suggestion. Anxiety can be seen as a manifestation of a nocebo context. The psychological stress of the COVID-19 pandemic led some people to experience COVID-19 symptoms, which were not actually related to a COVID-19 infection. A fundamental goal during the COVID-19 pandemic is to limit the COVID-19 related demand on healthcare systems and to minimize COVID-19 related deaths. This exploratory study aims to determine to what extent the anxiety in the population is related to the number of covid-19 related hospitalizations and deaths. METHODS We will quantify the magnitude of the relationship between population anxiety and hospitalizations / deaths. Anxiety will be assessed using the results of the most frequently used anxiety measuring scale. Official websites of governments will be screened to determine hospitalizations and deaths. Studies will be included if they had at least 100 respondents, used a validated anxiety scale, reported on the general population of a country, and were conducted during the Covid-19 pandemic. A search strategy will take into account the limited resources for this study and will be used to search Pubmed, MedRXiv and PsychRXiv. Screening will take place at two levels: abstracts and titles, followed by full text reports. One researcher will extract data which will be double checked by a second researcher. We will perform weighted OLS regression to quantify the relationship of anxiety and covid-19 related hospitalizations / deaths. DISCUSSION Covid-19 related measures can carry a significant social cost and risk of unwanted effects; it is therefore important to assess the extent to which anxiety in the population is related to covid-19 related hospitalizations or deaths. If anxiety can be properly reduced in the population, health care will be safeguarded. Thus, any strategy that reduces anxiety can then be included in evidence-based decision making.