Nocebo-Prone Behavior Associated with SARS-CoV-2 Vaccine Hesitancy in Healthcare Workers

Among healthcare workers (HCWs), SARS‐CoV‐2 vaccine hesitancy may be linked to a higher susceptibility to nocebo effects, i.e., adverse events (AEs) experienced after medical treat‐ ments due to negative expectations. To investigate this hypothesis a cross‐sectional survey was per‐ formed with a self‐completed questionnaire that included a tool (Q‐No) for the identification of nocebo‐prone individuals. A total of 1309 HCWs (67.2%women; 43.4% physicians; 28.4% nurses; 11∙5% administrative staff; 16∙6% other personnel) completed the questionnaires, among whom 237 (18.1%) had declined vaccination. Q‐No scores were ≥15 in 325 participants (24.8%) suggesting nocebo‐prone behavior. In a multivariate logistic regression model with Q‐No score, age, gender, and occupation as independent variables, estimated odds ratios (ORs) of vaccination were 0.43 (i.e., less likely, p < 0.001) in participants with Q‐No score ≥15 vs. Q‐No score < 15, 0.58 in females vs. males (p = 0.013), and 4.7 (i.e., more likely) in physicians vs. other HCWs (p < 0.001), independent of age, which was not significantly associated with OR of vaccination. At least one adverse effect (AE) was reported by 67.5% of vaccinees, mostly local pain and flu‐like symptoms. In a multivariate lo‐ gistic regression model, with Q‐No score, age, gender, and occupation as independent variables, esti‐ mated ORs of AE reporting were 2.0 in females vs. males (p < 0.001) and 1.47 in physicians vs. other HCWs (p = 0.017) independently of age and Q‐No score, which were not significantly associated with OR of AE. These findings suggest that nocebo‐prone behaviorin HCWs is associated with SARS‐CoV‐2 vac‐ cination hesitancy indicating a potential benefit of a campaign focused on nocebo‐prone people.