key: cord-0726886-4cps22s7 authors: Rossi, R.; Socci, V.; Talevi, D.; Mensi, S.; Niolu, C.; Pacitti, F.; Di Marco, A.; Rossi, A.; Siracusano, A.; Di Lorenzo, G. title: COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. An N=18147 web-based survey. date: 2020-04-14 journal: nan DOI: 10.1101/2020.04.09.20057802 sha: 1d6be465c078d169fd40b53bc020600ad1e1679a doc_id: 726886 cord_uid: 4cps22s7 Background The psychological impact of the COronaVIrus Disease 2019 (COVID-19) outbreak and lockdown measures on the Italian population are unknown. The current study assesses rates of mental health outcomes in the Italian general population three to four weeks into lockdown measures and explores the impact of COVID-19 related potential risk factors. Methods A web-based survey spread throughout the internet between March 27th and April 6th 2020. 18147 individuals completed the questionnaire, 79.6% women. Selected outcomes were post-traumatic stress symptoms (PTSS), depression, anxiety, insomnia, perceived stress and adjustment disorder symptoms (ADS). Seemingly unrelated logistic regression analysis was performed to identify COVID-19 related risk factors. Results Respondents endorsing PTSS, depression, anxiety, insomnia, high perceived stress and adjustment disorder were 6604 (37%), 3084 (17.3%), 3700 (20.8%), 1301 (7.3%), 3895 (21.8%) and 4092 (22.9%), respectively. Being woman and younger age were associated with all of the selected outcomes. Quarantine was associated with PTSS, anxiety and ADS. Any recent COVID-related stressful life event was associated with all the selected outcomes. Discontinued working activity due to the COVID-19 was associated with all the selected outcomes, except for ADS; working more than usual was associated with PTSS, Perceived stress and ADS. Having a loved one deceased by COVID-19 was associated with PTSS, depression, perceived stress and insomnia. Conclusion We found high rates of negative mental health outcomes in the Italian general population three weeks into the COVID-19 lockdown measures and different COVID-19 related risk factors. These findings warrant further monitoring on the Italian population s mental health. Background 24 The psychological impact of the COronaVIrus Disease 2019 outbreak and lockdown 25 measures on the Italian population are unknown. 26 The current study assesses rates of mental health outcomes in the Italian general population three 27 to four weeks into lockdown measures and explores the impact of COVID-19 related potential risk 28 factors. 29 Background 50 The psychological impact of the COronaVIrus Disease 2019 outbreak and related 51 lockdown measures among the Italian population are unknown. The COVID-19 pandemic is a 52 global health emergency that could potentially have a serious impact on public health, including 53 mental health (World Health Organization, 2020a; Xiang et al., 2020) . Since clusters of atypical 54 pneumonia of unknown etiology were discovered in the city of Whuan, Hubei province, in late 55 December 2019, the viral disease has continued to exponentially spread throughout China and 56 worldwide. Italy has been the first European country that had to face the pandemic. On March 9 th 57 2020, lockdown measures were enforced by the government on entire national territory. 58 Lockdown measures included travel restrictions, the mandatory closure of schools, nonessential 59 commercial activities and industries. People were asked to stay at home and socially isolate 60 themselves to prevent being infected. 61 As previously reported, health emergencies such as epidemic can lead to detrimental and long-62 lasting psychosocial consequences, due to disease related fear and anxiety, large-scale social 63 isolation, and the overabundance of (mis)information on social media and elsewhere (Dong and 64 Bouey, 2020). At the individual level, epidemics are associated with a wide range of psychiatric 65 comorbidities including anxiety, panic, depression and trauma-related disorders (Tucci et al., 66 2017) . The psychosocial impact of health emergences seems to be even higher during quarantine 67 measures (Brooks et al., 2020) . Quarantine has been associated with high stress levels 68 (DiGiovanni et al., 2004) , depression (Hawryluck et al., 2004) , irritability and insomnia (Lee et 69 al., 2005) . Furthermore, being quarantined is associated with acute stress (Bai et al., 2004) and 70 trauma-related (Wu et al., 2009 ) disorders, particularly in specific at-risk populations such as 71 health workers (Lai et al., 2020) . 72 Concerning the COVID-19 pandemic, a study on 1210 respondents in China found rates of 30% 73 of anxiety and 17% of depression (Wang et al., 2020) . Further, in a nationwide survey including 74 more than 50.000 Chinese respondents, almost 35% of the participants reported trauma-related 75 distress symptoms, with women and young adults showing significantly higher psychological 76 distress (Qiu et al., 2020) . 77 Together, these findings strongly suggest the need to accurately and timely assess the magnitude 78 of mental health outcomes in the general population exposed to COVID-19 pandemic, with 79 particular regard to the implementation of preventive and early interventions strategies for those at 80 higher risk. However, no study to date has investigated mental health outcomes and associated 81 risk factors in the Italian population. This could be of additional relevance considering the 82 implementation of the strict lockdown and social distancing measures imposed on the entire 83 national territory. 84 The aim of the current study was to assess rates of mental health outcomes in the Italian general 85 population three to four weeks into lockdown measures and to explore the impact of COVID-19 86 related potential risk factors. This study aims at providing evidence that could potentially inform 87 subsequent research strategies and mental health delivery in Italy and Europe. 88 89 A cross-sectional web-based survey design was adopted. Approval for this study was obtained 92 from the local IRB at University of L'Aquila. On-line consent was obtained from the participants. 93 . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . Participants were allowed to terminate the survey at any time they desired. The survey was 94 anonymous, and confidentiality of information was assured. 95 Data on mental health were collected between March 27 th and April 6 th 2020 using an on-line 96 questionnaire spread throughout the internet, using sponsored social network advertisement 97 together with a snowball recruiting technique. The investigated timeframe corresponds to the 98 contagion peak in Italy, according to epidemiogical data confirmed by the World Health 99 Organization (World Health Organization, 2020 Region of residence was inserted in order to account for the different incidence of COVID-19 136 among Italian regions. COVID-19 related independent variables were: 1) being under quarantine 137 either because infected or in close proximity to infected people; 2) any changes in working 138 activity compared to "working as usual" (e.g., smart-working, working activity discontinued due 139 to lockdown measures, higher workload due to ; 3) having a loved one infected, 140 hospitalized or deceased due to COVID-19; 4) any stressful events comprised in the IDAQ 141 checklist, purposely modified in order to capture only stressful events due to COVID-19. The 142 IADQ checklist comprises 8 questions about any potential stressful life event occurred in the 143 recent past, with a yes/no response, including financial, working, educational, housing, 144 relationship, own or loved one' s health and caregiving problems. In order to separate COVID-19 145 related stressful life events from non-COVID-19 related events, responses to the checklist were 146 modified as follows: "no"; "yes"; "yes, due to COVID-19". . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . Seemingly unrelated logistic regression analyses are reported in In this study, we report for the first time on the mental health outcomes related to outbreak and related lockdown measures on the general population in Italy. To the best of our 207 knowledge, this is the first study to report on mental health outcomes related to the COVID-19 208 outbreak in Europe on such a large sample size. This study shows relatively high rates of PTSS, 209 Depression, Anxiety, Insomnia, Perceived stress and ADS, with young women having higher odds 210 of endorsing a mental health outcome. These outcomes were associated with a number of COVID-211 19-related risk factors, including being under quarantine, having a loved one deceased by COVID-212 19, working activity discontinued due to lockdown measures, or experiencing other stressful 213 events (i.e. working, financial, relationship or housing problems) due to the pandemic or 214 lockdown measures. These findings were adjusted for previous psychiatric illness and a history of 215 childhood trauma, suggesting that the COVID-19 pandemic is exerting an independent effect on 216 the population mental health. 217 218 Compared to an early report on the mental health outcomes related to COVID-19 in China on 220 1210 respondents (Wang et al., 2020), we found lower rates of anxiety, similar rates of depression 221 and higher levels of perceived stress, notwithstanding differences in assessment tools. The 222 negative association with age and the positive association with female gender was confirmed, 223 suggesting that young women may be at heightened risk for mental disorders. Compared to 224 another large web-based survey from China on 52730 respondents that evaluated peritraumatic 225 . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . stress-related symptoms, we found similar rates of PTSS (Qiu et al., 2020 . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . We found high rates of negative mental health outcomes in the Italian general population three to 268 four weeks into the COVID-19 pandemic and lockdown measures. This work is supported by Territori Aperti, a project founded by "Fondo Territori Lavoro e 282 Conoscenza CGIL CISL UIL". 283 The authors have no conflict of interest to disclose. 285 The COronaVIrus Disease 2019 (COVID-19) pandemic is a global health emergency that could 287 potentially have a serious impact on public health, including mental health. The psychological 288 impact of the COVID-19 outbreak and related lockdown measures among the Italian population 289 are unknown. In this web-based study, we report for the first time on the psychological impact of 290 COVID-19 outbreak on the general population in Italy. This study shows high rates of post-291 traumatic symptoms, Depression, Anxiety, Insomnia, Perceived stress and Adjustment Disorder 292 associated with a number of COVID-19-related risk factors. This study represents the first 293 European report on mental health in the time of the COVID-19, and it could have a strong impact 294 on subsequent research and clinical intervention strategy for global mental health related to 295 COVID-19. 296 297 . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10. 1101 /2020 Tucci, V., Moukaddam, N., Meadows, J., Shah, S., Galwankar, S. C., and Bobby Kapur, G. (2017 CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10. 1101 /2020 Working Activity Change As Usual 1.00 (ref) Smart-Working PTSS: Post-Traumatic Stress Symptoms; ADS: Adjustment Disorder Symptom; ยง Age is standardized and reversed, younger age has an OR>1 if associated with heightened risk