31 Jan People Sick With Contagious Respiratory Viruses Often Conceal Illness for Personal or Professional Reasons, Regardless of Effects on Others
MedicalResearch.com Interview with:
Wilson N. Merrell
Department of Psychology
University of Michigan
MedicalResearch.com: What is the background for this study?
Response: From the common cold to COVID-19, people get sick all the time. Because our social worlds don’t pause just because we are feeling ill, we often still need to navigate in-person events ranging from work and school to first dates and family dinners even while we’re feeling under the weather. In these kinds of social situations, do we always tell others when we’re feeling sick, or are there times when we may want to downplay our illness? After all, we tend to react negatively to, find less attractive, and steer clear of people who are sick with infectious illness. To the extent that we want to avoid these negative social outcomes while sick, it therefore makes sense that we may take steps to cover up our sickness in social situations. Given that this concealment could serve individual social goals (like allowing you to connect with others) at the cost of broader harms to public health (through the spread of infectious disease), we found this behavior both theoretically novel and practically timely.
MedicalResearch.com: What are the main findings?
Response: In our studies, we indeed find that concealment is a common behavioral strategy that people take while they are sick. About 75% of our participants (including 61% of healthcare employees) told us that they had concealed illness at least once in the past, or held intentions to conceal at some point in the future. People largely told us about concealing respiratory illnesses like a common cold or the flu.
Crucially, we found a difference between how people believe they would act when sick and how sick people actually act. Healthy people forecasted that they would be unlikely to hide harmful illnesses—those that spread easily and have severe symptoms—but actively sick people reported high levels of concealment regardless of how harmful their illness was to others. This suggests that sick people and healthy people evaluate the consequences of concealment in different ways, with sick people being relatively insensitive to how spreadable and severe their illness may be for others.
MedicalResearch.com: What should readers take away from your report?
Response: One thing readers can take away from our report is the variety of ways people conceal their illness. In one of our studies, we asked college students how often and accurately they completed the university’s mandatory symptom screening tool when they were feeling sick. This was an app-based tool required for all students to complete any time they entered campus buildings. 41% of students reported misuse of this screener in attempts to conceal their illness when they weren’t feeling well. This suggests that solutions to the problem of disease concealment may need to rely on more than just individual good-will.
A second take away involved why people said they hid their illness from others. Most people reported concealing for social reasons—because they wanted to go out to a party or had an appointment they had waited a long time for. Conversely, a very small percentage of people blamed explicit institutional policies (like a written attendance policy in a class or a lack of paid time off) for their concealment decisions. That is, it seems like the motivations for concealment that people self-reported to us were driven by a desire to fulfill personal goals, as opposed to strict external pressures they were facing. This could mean that interventions targeted towards specific institutional policies may be less effective in curbing disease concealment, but more work definitely needs to be done in this area specifically (see below!
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: All of the participants in our studies came from the United States, and we recognize that some of the concealment patterns we observed may vary based on cultural context. To understand this cross-cultural variation, we are currently collecting data from a range of countries to measure the prevalence and predictors of disease concealment. We are particularly interested in how cultural dimensions (like how strictly norms surrounding infectious illness are enforced within a society) and ecological dimensions (like how prevalent pathogens are in a given country) at the country level relate to concealment decisions.
Wilson N. Merrell, Soyeon Choi, Joshua M. Ackerman. When and Why People Conceal Infectious Disease. Psychological Science, 2024; DOI: 10.1177/09567976231221990
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Last Updated on January 31, 2024 by Marie Benz MD FAAD