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

  1. Eleonora Fiorenzato
  2. Silvia Zabberoni
  3. Alberto Costa
  4. Giorgia Cona

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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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  1. Version published to 10.1371/journal.pone.0246204
  2. ScreenIT

    SciScore for 10.1101/2020.10.02.20205237: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: A brief introduction informed the participants about our study’s aims and their informed consent was requested before starting the investigation.
    IRB: The study was conducted in accordance with the Helsinki Declaration and approved by the ethical committee of the School of Psychology (University of Padua), and Fondazione S. Lucia, Rome.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We performed statistical analyses using SPSS Statistic, release version 24.0 (Chicago, IL, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations and strengths: There are a few shortcomings and limitations in the current work that have to be considered. First, the survey sampling was based on the snowball method, involving an online invitation, but leaving unexplored the population who did not use network devices. Furthermore, considering the online distribution, no data about people who refused to participate were collected and no refusal rate was registered. However, during home confinement this was the only feasible sampling method. Moreover, to collect a heterogeneous sample we encouraged participants to invite new respondents by involving elderly and people with a poor access to internet. Indeed, our sample seems to have an adequate representation of the Italian general population in terms of age (range: 18-88 years), geographical distribution across Italy and educational level, but less accurate for gender, as ∼70% of the sample was female. Second, subjective complaints and mental health outcomes are based on self-reported measures rather than clinical diagnoses, although the majority of the selected scales were validated [18,24] or derived from standardized tools [19]. In particular, depression and anxiety prevalence were based on HADS, which has excellent psychometric properties and is extensively used in the general clinical practice [22]. Finally, although our study has not a longitudinal design, it comprised a pre-lockdown assessment, which was used as a reference to conduct pre-post analyses wit...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.10.02.20205237 on medRxiv