The COVID-19 pandemic and subsequent lockdowns had a profound impact globally, particularly in Italy, one of the first European countries severely affected. Previous research indicated increased anxiety, depression, and distress, but often relied on non-representative samples obtained via social media, introducing potential biases. This study aimed to address these limitations by investigating the psychological impact of COVID-19 on a representative sample of the Italian population, encompassing diverse age groups, genders, and geographic locations. The researchers hypothesized that specific socio-demographic factors and experiences during the lockdown would be associated with higher levels of depressive symptoms. The importance of understanding this impact is crucial for effective policy and support measures.

Existing international studies, primarily using convenience samples, revealed increased anxiety, depression, stress, and sleep disturbances associated with the pandemic. Risk factors identified included female gender, student status, COVID-19 symptoms, poor perceived health, unpredictability, uncertainty, misinformation, and social isolation. Studies in Italy, while showing similar trends using online surveys and snowball sampling, also revealed high rates of post-traumatic stress, depression, anxiety, and sleep disorders, with females disproportionately affected. Other risk factors included quarantine, loss of a loved one to COVID-19, work discontinuity, and pandemic-related stressors. However, these studies suffered from potential sampling biases.

This cross-sectional study used a random and representative sample of 6692 Italian individuals (aged 16-65+), stratified by age, gender, geographic area, and education level. Data collection occurred in June 2020, immediately after the lockdown's phase 1, using a mixed CATI (Computer Assisted Telephone Interviewing) and CAWI (Computer Assisted Web Interviewing) approach. The Short Mood and Feelings Questionnaire (SMFQ), a 13-item self-report measure, was used to assess depressive symptoms. A score of 12 or higher indicated clinically relevant depressive symptoms. Socio-demographic data, employment status, living situation, and COVID-19 family history were also collected. Data were analyzed using count data models (Poisson with double censoring) to account for the integer nature of the SMFQ scores and sample weights. Robust standard errors were employed.

The average SMFQ score was 5.2, with 14.4% of the sample scoring above the 12-point cutoff. Younger adults (16-24) had significantly higher average scores (7.04) and a higher percentage above the cutoff (24.17%) compared to adults (25+). Regression analysis revealed that female gender, younger age, unemployment, lay-off, poverty, living alone, having a COVID-19 case in the family, and experiencing complete lockdown were all significant predictors of higher SMFQ scores. Interestingly, the number of local COVID-19 cases or deaths was not a significant predictor. The effect of having a COVID-19 case in the family was substantial, approximately doubling the probability of high depressive symptoms across all ages. Lockdown had a notable effect, though less pronounced. Separate analyses for young adults and adults confirmed the key findings, with some differences: wealth was not a significant factor for young adults; the size of the municipality was less important for younger individuals; and a U-shaped relationship between age and depressive symptoms was found.

This study, the first of its kind to use a large, representative sample of the Italian population, confirmed previous findings that women and younger adults are more vulnerable to depressive symptoms during a pandemic. It extended this understanding by highlighting the significance of professional uncertainty, low socioeconomic status, loneliness, and COVID-19 within the family. Notably, the regional variation in COVID-19 cases did not correlate with depressive symptoms, suggesting that the impact of lockdown and pandemic-related anxieties were widespread nationwide. The finding that those who continued working during lockdown had lower depressive symptoms suggests the importance of routine and social interaction, even if anxiety-inducing. These findings emphasize the importance of policies and interventions tailored to address the mental health needs of vulnerable groups.

This study underscores the significant psychological impact of the COVID-19 pandemic and lockdown on the Italian population, especially for vulnerable groups. Future longitudinal research is needed to track the long-term effects, and comparative studies across countries are essential to understand the scope of the problem and identify protective factors. Continued monitoring of those seeking mental health services is crucial to prevent a secondary wave of psychological distress. The use of telemedicine and online support systems may be crucial for effective mental health care.

The cross-sectional design limits causal inferences. Self-report measures might overestimate psychological distress. Anxiety, stress, and quality of life were not assessed, limiting a comprehensive view of mental health outcomes. The focus on the immediate post-lockdown period may not fully capture the long-term consequences.