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      Poor Sleep Quality and Its Consequences on Mental Health During the COVID-19 Lockdown in Italy

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          Abstract

          Background

          Coronavirus disease 2019 (COVID-19) seriously affected the whole of Italy. The extreme virulence and the speed of propagation resulted in restrictions and home confinement. This change was immediately perceived by people who found themselves exposed to feelings of uncertainty, fear, anger, stress, and a drastic change in the diurnal but above all nocturnal lifestyle. For these reasons, we aimed to study the quality of sleep and its connection to distress levels and to evaluate how lifestyle changed in the Italian population during the lockdown.

          Methods

          By means of an Internet survey we recruited 6,519 adults during the whole of the COVID-19 lockdown (from March 10–1st phase to May 4–2nd phase). We investigated the sociodemographic and COVID-19-related information and assessed sleep quality using the Medical Outcomes Study–sleep scale (MOS-SS) and mental health with the short form of Depression, Anxiety, and Stress Scales–21 Items (DASS-21). Multiple logistic regression model was used to evaluate the multivariate association between the dependent variable (good sleeper vs. poor sleeper) and all the variables that were significant in the univariate analysis.

          Results

          A total of 3,562 (55.32%) participants reported poor sleep quality according to the MOS-Sleep Index II score. The multiple binary logistic regression results of poor sleepers revealed several risk factors during the outbreak restrictions: female gender, living in Central Italy, having someone close who died because of COVID-19, markedly changed sleep–wake rhythms characterized by earlier or postponed habitual bedtime, earlier habitual awakening time and reduced number of afternoon naps, and extremely severe levels of stress, anxiety, and depression.

          Conclusion

          This is the first study designed to understand sleep quality and sleep habits during the whole of the lockdown period in the Italian population that provides more than 6,000 participants in a survey developed specifically for the health emergency related to COVID-19. Our study found that more than half of the Italian population had impaired sleep quality and sleep habits due to elevated psychological distress during the COVID-19 lockdown containment measures. A multidisciplinary action should be undertaken in order to plan appropriate responses to the current crisis caused by the lockdown for the COVID-19 outbreak.

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          Most cited references74

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          Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing

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

            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

              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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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                09 November 2020
                2020
                09 November 2020
                : 11
                : 574475
                Affiliations
                [1] 1Department of Medicine and Surgery, University of Parma , Parma, Italy
                [2] 2Department of Humanities, Social Sciences and Cultural Industries, University of Parma , Parma, Italy
                [3] 3IRCCS Istituto delle Scienze Neurologiche di Bologna , Bologna, Italy
                [4] 4Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AOUP) , Pisa, Italy
                [5] 5IRCCS Fondazione Santa Lucia , Rome, Italy
                [6] 6Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
                [7] 7Department of Humanistic Studies, University of Naples Federico II , Naples, Italy
                [8] 8Department of Health Sciences, University of Milan , Milan, Italy
                [9] 9Department of Psychology, Catholic University of Milan , Milan, Italy
                [10] 10Psychology Research Laboratory, Ospedale San Giuseppe, Istituto Auxologico Italiano IRCCS , Verbania, Italy
                [11] 11Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena, Italy
                [12] 12Medical Center, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg , Freiburg, Germany
                Author notes

                Edited by: Antonella Granieri, University of Turin, Italy

                Reviewed by: Yiqi Lin, Fujian Provincial Hospital, China; Ravi Yadav, National Institute of Mental Health and Neurosciences (NIMHANS), India; Constance Fung, VA Greater Los Angeles Healthcare System, United States

                *Correspondence: Christian Franceschini, christian.franceschini@ 123456unipr.it

                This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2020.574475
                7693628
                33304294
                cbb09045-4136-4cfa-bc3a-3660cea5cb3b
                Copyright © 2020 Franceschini, Musetti, Zenesini, Palagini, Scarpelli, Quattropani, Lenzo, Freda, Lemmo, Vegni, Borghi, Saita, Cattivelli, De Gennaro, Plazzi, Riemann and Castelnuovo.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 19 June 2020
                : 15 October 2020
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 75, Pages: 15, Words: 0
                Categories
                Psychology
                Original Research

                Clinical Psychology & Psychiatry
                sleep quality,sleep habits,covid-19,italian lockdown,depression,anxiety,stress,clinical psychology

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