Culture Plays Role in Sickness Behavior: Study
Fri, December 9, 2022

Culture Plays Role in Sickness Behavior: Study


The worst part of being sick is not always the coughing and the muscle aches. It could also be the fatigue, the foggy head, the lack of enthusiasm and sociability, the depressing effect, changes in diet, and the crankiness. This is what researchers refer to as sickness behavior. While the mental and physical sensations we associate with feeling sick are only natural biological responses to the inflammation, the severity and strength of these sensations may be affected by social norms.

The link between culture and sickness behavior

A team of social scientists recently discovered a link between a person’s culture and feeling sick. Their study, which was published in the peer-reviewed journal Frontiers in Behavioral Neuroscience, details that a person’s values may shape their internal views on what is a socially appropriate sickness. It is also associated with how people take action in dealing with their illness instead of spreading the disease to other people.  

The team explored the role of culture, ethnicity, and gender by surveying a national US sample involving 1,259 participants. They also used the SicknessQ instrument in measuring the participants’ recalled and self-reported sickness behavior. The SicknessQ instrument is a 10-item measure of perceived sickness behavior previously validated under experimentally-induced sickness behavior. Samples of these items include “My body feels sore,” “I wish to be alone,” “I feel tired,” and “I want to keep still.” Study participants were instructed to think of the recent times they had been sick with illnesses, such as common cold and influenza, to complete the SicknessQ instrument and determine how they felt.


How cultural and socioeconomic norms play a part

According to the team, the majority of the participants who work in fields, like medicine, would likely show up at work even if they are sick. They cited a 2017 study that complements their findings, wherein it was found that 91 to 93% of healthcare practitioners attended work while they were symptomatic for influenza-like illnesses.

The team believes that since sickness behavior has been intimately connected with acute-phase response and inflammation, it is reasonable to consider that those in the medical field felt that sickness behavior is a motivation to work. There is also a strong cultural norm in the hospital that they should continue to work unless they are extremely ill. Common reasons why they did not take heed on their biological cues and continued to work despite being ill are structural concerns like they didn’t want to burden their colleagues at work, had unsupportive supervisors, had staffing concerns, and had additional work.

Moreover, individuals who believe that their illness is a test from God or are reliant on their health on God are less likely to interrupt their normal activities or seek treatment despite being ill.



The study also found that the participants who were more likely to express being sick include those who (1) had symptoms of depression, (2) those who consider themselves as stoics or someone with a high tolerance for pain, and (3) earned less than the median household income in the US. Eric Shattuck, a biological anthropologist from the University of Texas at San Antonio’s Institute for Health Disparities Research, said via medical platform Medical Xpress that it is “ironic” how people would consider themselves as stoic and yet it shows the opposite effect when they are sick. They are the ones who own up being sick like a bragging right and would maintain the sickness longer than necessary.

Shattuck went on to say that regarding people with lower-income levels, it is probably because they don’t have the means to seek medical attention so their symptoms become severe and it makes them remember their sickness.

Familism or the degree to which one values close family ties was also linked with increased sickness behavior. This most especially applies to men. Shattuck explained that it could be because family support is seen as a social safety net and being sick enabled them to feel more cared for by their loved ones.

The authors noted that they plan to repeat the study with people who are actively sick and compare it with their current study, which focused on those who recall an illness. They said that their present findings should be interpreted “cautiously” considering the study limitations. For instance, medication, such as anti-inflammatories, may lead to a low SicknessQ score and is independent of any sociocultural factors.



Flu and flu shot: statistics

The Centers for Disease Control Prevention shared that from October 1, 2019, to February 22, 2020, there were 32,000,000 to 45,000,000 flu illnesses based on the in-season numbers of flu illnesses, hospitalizations, and medical visits in the United States. They also estimated a total of 14 million to 21 million flu medical visits, 310,000 to 560,000 flu hospitalizations, and 18,000 to 46,000 flu deaths. It noted that people with the flu can spread it to others up to 6 feet away and most experts believe that flu viruses spread mainly by droplets made when a sick person talks, sneezes, or coughs. These droplets can land in the noses and mouths of healthy individuals who are nearby or can be inhaled into their lungs. There are also some instances when flu is acquired by touching an object or surface that has the flu virus on it and touching their eyes, nose, or mouth.

Meanwhile, healthcare and pharmacy discount card provider SingleCare published that flu shots or vaccines help prevent the flu. The vaccine contains the deactivated flu virus, enabling the immune system to learn to fight the virus even before the body comes into contact with the harmful or live virus during the flu season. The flu shot reduces a person’s chances of getting the flu by 40 to 60%. This means that although one may still catch the flu, the vaccine can lessen the symptoms. In the 2017 to 2018 season, there were a total of 3 million doses of flu vaccine shipped.



It is recommended that as early as 6 months old, one should start getting a flu shot. The vaccine will protect the person against three to four flu strains. The most common reasons of US adults for not getting the flu shot during the 2018 flu season are that they do not trust the flu vaccine (48%), they do not feel the need to prevent the flu (40%), they think the flu vaccine is not effective and therefore not worth getting (26%), not enough time (11%), their doctor did not recommend it (8%), and it is not covered by their insurance (7%). This data was reported by the German database company Statista.

Understanding the cultural factors that affect people’s behavioral responses when they get sick is helpful as sickness behavior is one of the components of our overall immune response.