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Macleod-Hall CIA, Munafò MR, Dyer ML. Confirmation of COVID-19 infection status and reporting of Long COVID symptoms in a population-based birth cohort: No evidence of a nocebo effect. J Health Psychol 2024; 29:581-594. [PMID: 38269448 PMCID: PMC11144352 DOI: 10.1177/13591053241228711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Some patients with COVID-19 develop symptoms after the acute infection, known as 'Long COVID'. We examined whether or not confirmation of COVID-19 infection status could act as a nocebo, using data from questionnaires distributed to the Avon Longitudinal Study of Parents and Children cohort. We examined associations between confirmation of COVID-19 infection status (confirmed by a positive test vs unconfirmed) and reporting of Long COVID symptoms. We explored the roles of sex and anxiety as potential moderators. There was no clear evidence of a strong association between confirmation of COVID-19 infection status and the Long COVID composite score, physical or psychological symptoms or duration of symptoms. There was no clear evidence of moderation by sex or anxiety. We therefore found no evidence of a nocebo effect. Our data suggest that this psychological mechanism does not play a role in the medical symptomatology experienced by patients with Long COVID.
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Affiliation(s)
| | - Marcus R Munafò
- University of Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, UK
| | - Maddy L Dyer
- University of Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
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2
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Seroprevalence and socioeconomic impact of the first SARS-CoV-2 infection wave in a small town in Navarre, Spain. Sci Rep 2023; 13:3862. [PMID: 36890175 PMCID: PMC9992915 DOI: 10.1038/s41598-023-30542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023] Open
Abstract
The characterization of the antibody response to SARS-CoV-2 and its determinants are key for the understanding of COVID-19. The identification of vulnerable populations to the infection and to its socioeconomic impact is indispensable for inclusive policies. We conducted an age-stratified cross-sectional community-based seroprevalence survey between June 12th and 19th 2020-during the easing of lockdown-in Cizur, Spain. We quantified IgG, IgM and IgA levels against SARS-CoV-2 spike and its receptor-binding domain in a sample of 728 randomly selected, voluntarily registered inhabitants. We estimated a 7.9% seroprevalence in the general population, with the lowest seroprevalence among children under ten (n = 3/142, 2.1%) and the highest among adolescents (11-20 years old, n = 18/159, 11.3%). We found a heterogeneous immune-response profile across participants regarding isotype/antigen-specific seropositivity, although levels generally correlated. Those with technical education level were the most financially affected. Fifty-five percent had visited a supermarket and 43% a sanitary centre since mid-February 2020. When comparing by gender, men had left the household more frequently. In conclusion, few days after strict lockdown, the burden of SARS-CoV-2 infection was the lowest in children under 10. The findings also suggest that a wider isotype-antigen panel confers higher sensitivity. Finally, the economic impact biases should be considered when designing public health measures.
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Akintola T, Chung J, Atlas L. The Effects of Expectations and Worries on the Experience of COVID-19 Symptoms. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.26.23284911. [PMID: 36789412 PMCID: PMC9928146 DOI: 10.1101/2023.01.26.23284911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction The COVID-19 pandemic has been shown to have profound effects on both mental and physical health. Distress and widespread uncertainty about global events and personal risk are associated with increased worry and negative expectations that impact physical health. Thus, the current pandemic poses a possibility for the experience of nocebo effects. Objective To evaluate the likelihood of nocebo-induced COVID-19 symptoms in a US sample. Methods An online study on the mental health impact of COVID-19 asked participants to complete a set of biweekly surveys over a 6-month period between April 2020 and May 2021. We focus on responses from 3,027 individuals who reported never testing positive for COVID-19. We assessed the association between two types of worry and self-reported symptoms of COVID-19. We used multi-level models to examine variations across and within participants over time. We further investigated the effects of pre-existing health conditions and mental health status. Results There was a positive association between symptoms and both general (b= 2.56, p<0.01) and personal worry (b=2.77, p<0.01). However, worry reported at one timepoint was not specifically associated with symptoms reported two weeks later (p = 0.63, p=0.56). We also found that a greater number of prior clinical comorbidities and greater mental health burden were significant predictors of symptom reporting. Conclusions These results suggest that increased worries during the COVID-19 pandemic were associated with greater symptoms. Further studies investigating worry and symptoms in populations with confirmed negative COVID-19 tests or isolated populations will be needed to isolate the occurrence of true nocebo effects during the pandemic.
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Abdin AY, De Pretis F, Landes J. Fast Methods for Drug Approval: Research Perspectives for Pandemic Preparedness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2404. [PMID: 36767769 PMCID: PMC9915940 DOI: 10.3390/ijerph20032404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
Public heath emergencies such as the outbreak of novel infectious diseases represent a major challenge for drug regulatory bodies, practitioners, and scientific communities. In such critical situations drug regulators and public health practitioners base their decisions on evidence generated and synthesised by scientists. The urgency and novelty of the situation create high levels of uncertainty concerning the safety and effectiveness of drugs. One key tool to mitigate such emergencies is pandemic preparedness. There seems to be, however, a lack of scholarly work on methodology for assessments of new or existing drugs during a pandemic. Issues related to risk attitudes, evidence production and evidence synthesis for drug approval require closer attention. This manuscript, therefore, engages in a conceptual analysis of relevant issues of drug assessment during a pandemic. To this end, we rely in our analysis on recent discussions in the philosophy of science and the philosophy of medicine. Important unanswered foundational questions are identified and possible ways to answer them are considered. Similar problems often have similar solutions, hence studying similar situations can provide important clues. We consider drug assessments of orphan drugs and drug assessments during endemics as similar to drug assessment during a pandemic. Furthermore, other scientific fields which cannot carry out controlled experiments may guide the methodology to draw defeasible causal inferences from imperfect data. Future contributions on methodologies for addressing the issues raised here will indeed have great potential to improve pandemic preparedness.
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Affiliation(s)
- Ahmad Yaman Abdin
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, D-66123 Saarbrucken, Germany
| | - Francesco De Pretis
- Department of Communication and Economics, University of Modena and Reggio Emilia, 42121 Reggio Emilia, Italy
- VTT Technical Research Centre of Finland Ltd., 70210 Kuopio, Finland
| | - Jürgen Landes
- Department of Philosophy “Piero Martinetti”, University of Milan, 20122 Milan, Italy
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Piumatti G, Amati R, Richard A, Baysson H, Purgato M, Guessous I, Stringhini S, Albanese E. Associations between Depression and Self-Reported COVID-19 Symptoms among Adults: Results from Two Population-Based Seroprevalence Studies in Switzerland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16696. [PMID: 36554578 PMCID: PMC9779289 DOI: 10.3390/ijerph192416696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
(1) Mental health may modulate the perceived risk of SARS-CoV-2 infection. However, it is unclear how psychological symptoms may distort symptom perception of COVID-19 and SARS-CoV-2 infection. We assessed whether depressive symptoms predicted self-reported COVID-19 symptoms, independently of serologically confirmed SARS-CoV-2 infection. (2) Participants (aged 20-64) in the Geneva (N = 576) and Ticino (N = 581) Swiss regions completed the Patient Health Questionnaire before being tested for anti-SARS-CoV-2 IgG antibodies and recalled COVID-19-compatible symptoms on two occasions: April-July 2020 (baseline), and January-February 2021 (follow-up). We estimated prevalence ratios for COVID-19 symptoms by depression scores in interaction with serological status. (3) At baseline, in Geneva, higher depression predicted higher probability of reporting systemic, upper airways, and gastro-intestinal symptoms, and fever and/or cough; in Ticino, higher depression predicted systemic, upper airways, and gastro-intestinal symptoms, fever and/or cough, dyspnea, and headache. At follow-up, in Geneva, higher depression predicted higher probability of reporting systemic symptoms and dyspnea; in Ticino, higher depression predicted higher probability of reporting systemic and upper airways symptoms, dyspnea and headache (all p values < 0.05). (4) We found positive associations between depressive symptoms and COVID-19-compatible symptoms, independently of seropositivity. Mental wellbeing has relevant public health implications because it modulates self-reported infection symptoms that inform testing, self-medication, and containment measures, including quarantine and isolation.
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Affiliation(s)
| | - Rebecca Amati
- Institute of Public Health, Faculty of BioMedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Aude Richard
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland
| | - Hélène Baysson
- Division of Primary Care, Geneva University Hospitals, 1206 Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Marianna Purgato
- Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, 37134 Verona, Italy
- Cochrane Global Mental Health, University of Verona, 37129 Verona, Italy
| | - Idris Guessous
- Division of Primary Care, Geneva University Hospitals, 1206 Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Silvia Stringhini
- Division of Primary Care, Geneva University Hospitals, 1206 Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of BioMedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland
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Amanzio M, Cipriani GE, Mitsikostas DD. The nocebo phenomenon in the COVID-19 pandemic: a nocebodemic effect. Expert Rev Clin Pharmacol 2022; 15:1377-1382. [DOI: 10.1080/17512433.2022.2142115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Dimos D. Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Lecci L, Page GR, Keith JR, Neal S, Ritter A. The Effects of Health Anxiety and Litigation Potential on Symptom Endorsement, Cognitive Performance, and Physiological Functioning in the Context of a Food and Drug Administration Drug Recall Announcement. Front Psychol 2022; 13:818724. [PMID: 35769761 PMCID: PMC9236552 DOI: 10.3389/fpsyg.2022.818724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Drug recalls and lawsuits against pharmaceutical manufacturers are accompanied by announcements emphasizing harmful drug side-effects. Those with elevated health anxiety may be more reactive to such announcements. We evaluated whether health anxiety and financial incentives affect subjective symptom endorsement, and objective outcomes of cognitive and physiological functioning during a mock drug recall. Hundred and sixty-one participants reported use of over-the-counter pain medications and presented with a fictitious medication recall via a mock Food and Drug Administration (FDA) website. The opportunity to join a class-action lawsuit was manipulated. We assessed health anxiety, recalled drug usage, blood pressure, heart rate, and performance on a computerized Trail Making Test (TMT). Symptom endorsement was strongly predicted by health anxiety. When combined, three health anxiety measures explained 28.5% variance (Cohen’s d = 1.26). These effects remain strong after controlling for depression and anxiety. Litigation condition did not predict symptom endorsement. Blood pressure and heart rate were modestly predicted by health anxiety, but not by litigation condition. TMT performance was consistently predicted by health anxiety, with higher scores associated with poorer performance. Although there were no main effects for litigation, interactions consistently emerged for the TMT, with generally poorer performance for those with higher health anxiety in the non-litigation condition; whereas health anxiety was unrelated to performance for the litigation condition. All but one participant joined the litigation when given the opportunity, despite a healthy sample and minimal use of pain medication. Subsequent data from 67 individuals with no mention of the FDA scenario or litigation showed that health anxiety still significantly predicts symptom endorsement (12.6% variance), but the explained variance is less than half that obtained in the FDA scenario. The findings suggest that health anxiety plays a significant role in adverse symptom reporting, beyond anxiety or depression, and this effect is independent of the presence of the FDA recall. The lack of differences for health anxiety and symptom endorsement between litigation and non-litigation conditions rules out malingering. Although it is general practice in drug recalls to list potential adverse side effects caused by medications, this may elicit unintended symptom experiences and health anxious individuals may be more susceptible.
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Adorni F, Jesuthasan N, Perdixi E, Sojic A, Giacomelli A, Noale M, Trevisan C, Franchini M, Pieroni S, Cori L, Mastroianni CM, Bianchi F, Antonelli-Incalzi R, Maggi S, Galli M, Prinelli F. Epidemiology of SARS-CoV-2 Infection in Italy Using Real-World Data: Methodology and Cohort Description of the Second Phase of Web-Based EPICOVID19 Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1274. [PMID: 35162295 PMCID: PMC8835202 DOI: 10.3390/ijerph19031274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 12/29/2022]
Abstract
Digital technologies have been extensively employed in response to the SARS-CoV-2 pandemic worldwide. This study describes the methodology of the two-phase internet-based EPICOVID19 survey, and the characteristics of the adult volunteer respondents who lived in Italy during the first (April-May 2020) and the second wave (January-February 2021) of the epidemic. Validated scales and ad hoc questionnaires were used to collect socio-demographic, medical and behavioural characteristics, as well as information on COVID-19. Among those who provided email addresses during phase I (105,355), 41,473 participated in phase II (mean age 50.7 years ± 13.5 SD, 60.6% females). After a median follow-up of ten months, 52.8% had undergone nasopharyngeal swab (NPS) testing and 13.2% had a positive result. More than 40% had undergone serological test (ST) and 11.9% were positive. Out of the 2073 participants with at least one positive ST, 72.8% had only negative results from NPS or never performed it. These results indicate that a large fraction of individuals remained undiagnosed, possibly contributing to the spread of the virus in the community. Participatory online surveys offer a unique opportunity to collect relevant data at individual level from large samples during confinement.
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Affiliation(s)
- Fulvio Adorni
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Nithiya Jesuthasan
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Elena Perdixi
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Aleksandra Sojic
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (M.G.)
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy; (M.N.); (S.M.)
| | - Caterina Trevisan
- Geriatric Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy
| | - Michela Franchini
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | - Stefania Pieroni
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | - Liliana Cori
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Fabrizio Bianchi
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy; (M.N.); (S.M.)
| | - Massimo Galli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (M.G.)
| | - Federica Prinelli
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
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Mitsikostas DD, Aravantinou-Fatorou K, Deligianni C, Kravvariti E, Korompoki E, Mylona M, Vryttia P, Papagiannopoulou G, Delicha EM, Dellis A, Tsivgoulis G, Dimopoulos MA, Amanzio M, Sfikakis PP. Nocebo-Prone Behavior Associated with SARS-CoV-2 Vaccine Hesitancy in Healthcare Workers. Vaccines (Basel) 2021; 9:vaccines9101179. [PMID: 34696287 PMCID: PMC8541064 DOI: 10.3390/vaccines9101179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 12/13/2022] Open
Abstract
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 treatments due to negative expectations. To investigate this hypothesis a cross-sectional survey was performed 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 logistic regression model, with Q-No score, age, gender, and occupation as independent variables, estimated 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 behavior in HCWs is associated with SARS-CoV-2 vaccination hesitancy indicating a potential benefit of a campaign focused on nocebo-prone people.
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Affiliation(s)
- Dimos D. Mitsikostas
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
- Correspondence: ; Tel./Fax: +30-2107289282
| | - Konstantina Aravantinou-Fatorou
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Christina Deligianni
- Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, 2600 Copenhagen, Denmark;
| | - Evrydiki Kravvariti
- 1st Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.M.); (P.P.S.)
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (P.V.); (M.A.D.)
| | - Maria Mylona
- 1st Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.M.); (P.P.S.)
| | - Pinelopi Vryttia
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (P.V.); (M.A.D.)
| | - Georgia Papagiannopoulou
- 2nd Neurology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (G.T.)
| | | | - Athanasios Dellis
- 2nd Surgery Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Georgios Tsivgoulis
- 2nd Neurology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (G.P.); (G.T.)
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (P.V.); (M.A.D.)
| | - Martina Amanzio
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy;
| | - Petros P. Sfikakis
- 1st Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.M.); (P.P.S.)
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Siguan AA. Conspiracies and the nocebo effect during the COVID-19 pandemic. J Public Health (Oxf) 2021; 44:e623-e624. [PMID: 34426841 PMCID: PMC8499766 DOI: 10.1093/pubmed/fdab327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 07/24/2021] [Accepted: 08/09/2021] [Indexed: 01/19/2023] Open
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