9 The Likelihood to Disclose Symptoms of Sickness During the COVID-19 Pandemic Increases with Age Across Adulthood
Authors: Egbert Anna R , Cankurtaran Sadiye , Ouzturk Sirinnaz 
Published: December 2023

Objective:Compliance with safety precautions plays significant role in containing pandemic. On a personal level, one critical precaution is to disclose sickness status to people who one comes into direct contact with. Yet, factors governing this personal decision remain uncertain. This study examined age-related differences across adulthood in (i) the likelihood to disclose symptoms of sickness (LDSS) during COVID-19 pandemic, (ii) the level of COVID-19-associated anxiety (CAA), and (iii) the relationship between LDSS and CAA.Participants and Methods:Data were obtained from a large-scale survey “Measuring Worldwide COVID-19 Attitudes and Beliefs” (Fetzer et al., 2020). Retained data included sociodemographic characteristics, number of chronic conditions and self-rated quality of health for USA sample (n=11,445) which we stratified by age into five groups (18-29 years old n=2065; 30-39 n=3765; 40-49 n=2463; 50-59 n=1760; 60+ n=1392). Disclosure of sickness was measured with statement: “in the past week if I had exhibited symptoms of sickness, I would have immediately informed the people around me”, where participants self-rated it on the scale from 0–“does not apply at all to me” to 100– “applies very much to me”. We computed LDSS score with thresholds: ≤50–unlikely/uncertain, >50–likely, 100–certain to disclose. CAA symptoms were measured with the following statements which participants self-rated on a scale from 1–“does not apply at all” to 5– “strongly applies”: I am nervous when I think about current circumstances; I am calm and relaxed; I am worried about my health; I am worried about the health of my family members; I am stressed about leaving my house. ANOVA w/Bonferroni post-hoc tests compared LDSS and CAA between the age groups. Multivariate regression (accounting for: gender, education, self-rated health, number of chronic conditions) examined LDSS–CAA relationship.Results:Age groups were comparable in gender (∼40% males), education (∼17 years of education), and relationship status (∼65% married/cohabitating). Most participants rated own health as good and reported one chronic condition. LDSS was increasing with aging, F(df=4)=35.552 (p<0.001), with 72% youngest vs. 85% oldest adults indicating certainty about disclosing sickness status. Anxiety about own health was increasing with age, F(df=4)=7.319 (p<0.001), while anxiety about health of family members was decreasing with age, F(df=4)=25.398 (p<0.001). Middle-aged adults showed the highest anxiety related to thinking about the current circumstances, F(df=4)=10.476 (p<0.001), and feeling stressed about leaving own house, F(df=4)=6.368 (p<0.001). LDSS was positively related to anxiety about health of family members and/or feeling stressed about leaving own house in young and middle-aged adults (B=0.042, p=0.001, CI95%=0.017–0.068), but not related to any CAA symptoms in adults aged 60+.Conclusions:This study suggests that people can become more likely to disclose sickness status as they age and can be prone to different CAA symptoms across life stages. The results further indicate that distinct CAA symptoms can play a role in LDSS in young and middle adulthood, but may loose significance in older age. Acknowledgement of these diverse mechanisms can inform clinical practice dedicated to individuals with illness anxiety, as well as can help develop age-targeted campaigns that promote compliance with the safety precautions.