Cognitive and mental health changes and their vulnerability factors related to COVID-19 lockdown in Italy

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Abstract

The COVID-19 pandemic and government imposed social restrictions like lockdown exposed most individuals to an unprecedented stress, increasing mental health disorders worldwide.

We explored subjective cognitive functioning and mental health changes and their possible interplay related to COVID-19-lockdown. We also investigated potential risk factors to identify more vulnerable groups. Across Italy, 1215 respondents completed our Qualtrics-based online-survey during the end of a seven to 10-week imposed lockdown and home confinement (from April 29 to May 17, 2020). We found subjective cognitive functioning and mental health severely changed in association with the lockdown. Under government regulations, cognitive complaints were mostly perceived in routine tasks involving attention, temporal orientation and executive functions—with no changes in language abilities. A paradoxical effect was observed for memory, with reduced forgetfulness compared to pre-lockdown. We found higher severity and prevalence of depression, anxiety disorders, abnormal sleep, appetite changes, reduced libido and health anxiety: with mild-to-severe depression and anxiety prevalence climbing to 32 and 36 percent, respectively, under restrictions. Being female, under 45 years, working from home or being underemployed were all identified as relevant risk factors for worsening cognition and mental health. Frequent consumers of COVID-19 mass media information or residents in highly infected communities reported higher depression and anxiety symptoms, particularly hypochondria in the latter. If similar restrictions are reimposed, governments must carefully consider these more vulnerable groups in their decisions, whilst developing effective global and long-term responses to the cognitive and mental health challenges of this type of pandemic; as well as implementing appropriate psychological interventions with specific guidelines: particularly regarding exposure to COVID-19 mass-media reports.

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The psychological impact of quarantine and how to reduce it: rapid review of the evidence

Samantha K. Brooks, Rebecca K Webster, Louise E. Smith … (2022)

Summary The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.

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Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Cuiyan Wang, Riyu Pan, Xiaoyang Wan … (2020)

Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

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The hospital anxiety and depression scale.

A Zigmond, R P Snaith (1983)

A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

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Author and article information

Contributors

Eleonora Fiorenzato:

ORCID: https://orcid.org/0000-0001-7947-5903

Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Silvia Zabberoni: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing

Alberto Costa: Role: Writing – review & editing

Giorgia Cona: Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing

Stephen D. Ginsberg: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 27 January 2021

Publication date Collection: 2021

Publication date PMC-release: 27 January 2021

Volume: 16

Issue: 1

Electronic Location Identifier: e0246204

Affiliations

[1 ] Department of General Psychology, University of Padua, Padua, Italy

[2 ] IRCCS Fondazione Santa Lucia, Rome, Italy

[3 ] Niccolò Cusano University, Rome, Italy

[4 ] Padova Neuroscience Center, University of Padua, Padua, Italy

Nathan S Kline Institute, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: giorgia.cona@ 123456unipd.it

Author information

Eleonora Fiorenzato https://orcid.org/0000-0001-7947-5903

Article

Publisher ID: PONE-D-20-30843

DOI: 10.1371/journal.pone.0246204

PMC ID: 7840042

PubMed ID: 33503055

SO-VID: 60e0471d-af30-49ff-b5c4-f87b8f735508

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 30 September 2020

Date accepted : 14 January 2021

Page count

Figures: 6, Tables: 2, Pages: 25

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100003196, Ministero della Salute;

Award ID: GR-2018-12366002

Award Recipient : Silvia Zabberoni

Funded by: funder-id http://dx.doi.org/10.13039/501100003500, Università degli Studi di Padova;

Award Recipient : Giorgia Cona

This work was supported by Grant ‘Giovani Ricercatori – Ricerca Finalizzata 2018’ code GR-2018-12366002 from Ministry of Health, Italy (SZ). This work was carried out within the scope of the project "use-inspired basic research", for which the Department of General Psychology of the University of Padova has been recognized as "Dipartimento di eccellenza" by the Ministry of University and Research" (GC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability Data cannot be shared publicly due to ethical restrictions, as we have no permission from the participants of our survey to share the de-identified dataset with the general public. Readers can contact the ethical committee of the School of Psychology of University of Padua ( comitato.etico.area17@ 123456unipd.it ) as well as the author ( giorgia.cona@ 123456unipd.it ) to request the data.

Outbreaks COVID-19

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Cognitive and mental health changes and their vulnerability factors related to COVID-19 lockdown in Italy

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Novel Coronavirus Disease COVID-19

Most cited references 62

The psychological impact of quarantine and how to reduce it: rapid review of the evidence

Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

The hospital anxiety and depression scale.

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Cited by 66

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