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

  1. Frederik Feys
  2. Abdallah Naser

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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.

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  1. ScreenIT

    SciScore for 10.1101/2020.07.16.20155457: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strength and weaknesses: Our research efforts will be the first to investigate world population anxiety and the relation with convid-19 related burden on public health. We will examine the impact of anxiety across all available evidence. Therefore, we will use an extensive and systematic search for eligible studies. Data extraction will be checked independently by a second researcher. We will cater upon the open science framework. All study processes will be transparent, analysis will be shared, and data will be publicly available. One possible limitation of the study is that we will use reported study data only, which may not be an accurate representation of actual study conduct: reporting can be poor but study conduct can be good, and vice versa. Secondly, we are evaluating only results from one commonly used anxiety measurement scale, albeit across a comprehensive set of studies. Thirdly, by the nature of the current epidemic, we will likely include many preliminary research findings through preprint, which lessens the robustness of findings. Fourth, This study will be observational. So it does not allow statements about directionality or causality. As studies represent data at the population level, it will not be valid to make statements about the individual chances of people being hospitalized or dying from anxiety. Fifth, precision of findings is likely to be limited as countries register hospitalizations and deaths related to Covid-19 in different ways. Also cross-sect...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.07.16.20155457v1 on medRxiv