Psychological distress among Italians during the 2019 coronavirus disease (COVID-19) quarantine

Abstract

Background Quarantine as a preventive action to reduce people’s exposure to a contagious disease has substantial psychological impact. We aimed to collect information on psychologically distressing experiences of Italians living in quarantine during the COVID-19 pandemic. Methods From 6 to 20 April 2020 participants filled out an online questionnaire. Demographic and physical symptoms data from the prior 14 days of quarantine were collected. Psychological impact of quarantine was assessed by the COVID-19 Peritraumatic Distress Index (CPDI). Results In all, 20,158 participants completed the online survey. Of these, 11,910 (59.1%) were from Lombardy, the region with 37.7% of positive cases identified during the survey period. 30.1% of responders were male. About half (55.9%) of responders were 18–50 years old, 54.3% had a tertiary level of education, 69.5% were workers, 84.1% were living in houses with ≥3 rooms, and 13.7% were living alone. 9.7% had had contact with COVID-19 positive people. Of all responders, 9978 (48.6%) reported a psychological impact, 8897 (43.4%) of whom reported mild or moderate and 1081 (5.2%) severe psychological impact. The multivariate analysis, after adjustments, showed that an increasing CPDI score was associated with gender (female), first-second educational level, being unemployed, living in a ≤2 room house, having had new health problems during the previous 14 days, and not having been out of the house in the previous week. Concerning the type of psychological distress, 2003 responders (9.9%) reported moderate to severe depressive symptoms, 1131 (5.5%) moderate to severe anxiety symptoms, and 802 (3.9%) moderate to severe physical symptoms. A positive correlation was found between responder rate (per 10.000 residents) and positive COVID-19 cases (per 10.000 residents) by region (rs = + 0.83, p = < 0.0001), and between responder rate and region latitude (rs = + 0.91, p = < 0.0001), with a greater response rate in the north. Considering Lombardy Region responders, a negative correlation between CPDI score and distance from place of residence to the red zone (Nembro-Alzano) was found. Higher prevalence of psychological distress was found up to 25 km away from the red zone and, in particular, severe distress up to 15 km. Conclusions Policy makers and mental health professionals should be aware of quarantine’s adverse mental health consequences. Factors influencing the success of quarantine and infection control practices for both disease containment and community recovery should be identified and additional support to vulnerable persons at increased risk of adverse psychological and social consequences of quarantine should be guaranteed.

COVID-19 Peritraumatic Distress as a Function of Age and Gender in a Spanish Sample

“…Furthermore, we found gender differences in the mild/moderate distress range (17.92% and 82.07% for men and women, respectively) and the severe distress range (7.26% and 92.73% for men and women, respectively). These findings are in line with those obtained by other studies using the CPDI [ 9 , 23 , 24 , 25 , 26 , 27 ]. Furthermore, studies using instruments other than the CPDI to measure stress symptoms reported similar findings, with women experiencing higher levels of psychological distress than men [ 8 , 13 , 15 , 38 ].…”

“…Overall, it seems that being female constitutes an important risk factor for developing COVID-related stress symptoms. A recent Italian large-scale study with 20,158 participants found that higher CPDI scores were significantly associated with gender, being two-fold in women in comparison to men [ 25 ]. Similar results were found in Chinese [ 9 ], Brazilian [ 26 ], and Bangladeshi [ 27 ] samples.…”

“…Regarding the psychometric properties of the CPDI, several studies from different countries provided the Cronbach’s alpha for internal consistency and reliability [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Megalakaki et al [ 28 ] reported the Cronbach’s alpha in a French sample for pretest and posttest measures, together with the stability effect.…”

COVID-19 lockdown and lifestyles: A narrative review

“…Higher stress levels associated with lockdown measures were observed in some groups, such as women [185][186][187] (particularly pregnant women 188,189 ), single/divorced adults 81 , older people (particularly with pre-existing mental health conditions 175,190 ), parents with young children 191 , university students and young adults [192][193][194] , workers 195 , those self-medicating 196 , the economically deprived 143 , those with pre-existing depression 197 , bipolar disorders 198 , and other chronic medical conditions 139,189,[199][200][201] . A large study of 56,679 participants in China found that quarantine had a profound effect on the mental health of specific vulnerable groups, including those with pre-existing mental disorders, chronic physical diseases, frontline workers, and those living in the most affected areas 202 .…”

Burnout in Intensive Care Unit Workers during the Second Wave of the COVID-19 Pandemic: A Single Center Cross-Sectional Italian Study

“…Based on recent expertise during the pandemic [ 21 , 22 ], the survey was organized and managed according to previous methods used in survey studies by the authors. The present study aimed to investigate the psychological impact of the pandemic on front-line staff working at the new COVID-19 ward at Milano Fiera, Lombardy during the second pandemic wave.…”