How did mental health outcomes in the Italian general population change 14 months into the COVID-19 pandemic?

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In a recent study published in the Journal of Affective Disorders, a team of researchers from Italy investigated the change in mental health outcomes such as anxiety, depression, and stress-related problems among the general population 14 months after the onset of the coronavirus disease 2019 (COVID-19) pandemic.

Study: Changes in mental health outcomes in the general population 14 months into the COVID-19 pandemic in Italy. Image Credit: Ahmet Misirligul/Shutterstock
Study: Changes in mental health outcomes in the general population 14 months into the COVID-19 pandemic in Italy. Image Credit: Ahmet Misirligul/Shutterstock


Apart from the unprecedented number of deaths and the immense healthcare burden unleashed by the COVID-19 pandemic, another serious impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak was on the mental health of people worldwide. While fear of COVID-19 and anxiety about contracting the virus caused much psychological distress, the disease mitigation measures such as social distancing and lockdowns, the loss of income and employment, and disruption of education also took a toll on the mental health of individuals.

Italy was one of the countries that had the largest number of COVID-19 cases and associated mortality. The present study’s authors previously reported on the mental health outcomes among the general Italian population from March to April 2020, when the first lockdown occurred in the country.

The rates of self-reported symptoms of mental health issues such as depression and anxiety were 28% among over 18,000 individuals, with demographic groups such as females, younger people, people with lower education, homemakers, and unemployed individuals experiencing worse outcomes of mental health. They also examined the role of resilience and age in response to COVID-19-related stress. Here, the researchers examine the changes in mental health levels 14 months after the onset of the COVID-19 pandemic.

About the study

In the present study, the researchers conducted a longitudinal cohort analysis to examine the trajectories of anxiety, depression, and post-traumatic stress disorder (PTSD) over 14 months with respect to psychological, contextual, and sociodemographic predictors. This web-based study was part of a program set up to monitor the mental health outcomes of healthcare workers and the general population of Italy in the long term. The assessment in 2020 was considered a baseline, and follow-up assessments were conducted between April and May 2021. All individuals above the age of 18 living in Italy were eligible for the study.

The outcomes were measured using a global psychotrauma screen, which allows yes or no answers for 17 symptoms, including PTSD, depression, dissociation, sleep problems, substance abuse, self-harm, and other emotional, social, or psychological problems. The global psychotrauma screen also covers protective and risk factors such as a history of mental illness, childhood trauma, psychological resilience, social support, and other stressful events.

Additionally, a nine-item patient health questionnaire and a seven-item generalized anxiety disorder questionnaire were used to assess depression and anxiety symptoms, respectively. The sociodemographic predictors used in the analysis were age, gender, employment type, education, geographical area of residence, nationality, history of SARS-CoV-2 infections, working pattern (work from home or office), and the frequency at which the individuals had socialized in the last one year.


The results reported that out of the 25.09% (5501) individuals who responded during the follow-up assessment, 52.03% (2691) were resilient to mental health outcomes, 20.49% (1061) reported having remittent general distress, 20.71% (1071) had persistent general distress, and 6.77% (350) reported having general incident distress.

The authors noted that during the 14 months between the baseline assessment and the follow-up, Italy experienced a second wave of COVID-19 between October and November 2020, which could have influenced the proportion of people reporting persistent general distress symptoms. Furthermore, having a history of mental illness was associated with increased persistent and general incident distress, indicating that the COVID-19 pandemic posed an increased risk to individuals with existing mental health disorders.

When the demographic predictors were analyzed, consistent with the baseline assessment results, women and younger individuals displayed profiles of persistent general distress, suggesting that these two demographic groups were particularly vulnerable to the COVID-19 pandemic-related anxiety. However, the follow-up assessment also showed associations between younger individuals and the remission of distress symptoms, indicating that potential mediating factors were involved in improving mental health conditions during the 14 months.

Sociodemographic predictors such as being self-employed, having a lower level of education, residence in southern and central Italy, and decreased social interactions during the pandemic were also associated with persistent general distress symptoms. Surprisingly, a history of SARS-CoV-2 infections was not associated with mental health conditions.


Overall, the results suggested that over the course of 14 months since the onset of the COVID-19 pandemic, the incidence of mental health conditions such as depression, stress-related issues, and anxiety had decreased among the Italian population, indicating a level of resilience. However, intervention measures are still required to provide support for the groups, such as individuals with a history of mental disorders, younger people, women, people with lower education levels, or those who are self-employed and continue to experience incident or persistent levels of anxiety.

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