Comparing the COVID-19-related PTSD symptoms between psychiatric patients and healthy subjects: an observational retrospective study from Northern Italy.

COVID-19 pandemic had a great impact on mental health, both in the general population and psychiatric patients. Little is known about the difference between these two populations in perceiving the pandemic as a traumatic event. The aim of the study was to compare psychiatric patients and healthy controls (HC) in terms of change over time of post-traumatic (PTSD) symptoms. Demographic and clinical variables were collected. Impact of Event Scale Revised (IES-R) scores were registered at T1 as lockdown period (March-April 2020) and T2 as restarting (May-June 2020). Descriptive analyses and linear regression models were performed. A total of 166 outpatients and 57 HC were recruited. Time (F = 15.76; p < 0.001) and diagnosis (F = 4.94; p < 0.001) had a significant effect on the change of IES-R scores, which resulted T1 > T2 (p < 0.001), except for subjects affected by Obsessive-Compulsive Disorder (OCD). Overall, IES-R scores were < in patients than in HC (p = 0.02), particularly in the schizophrenia (SKZ) subgroup (p < 0.001). IES-R scores of subjects with personality disorders (PDs) resulted to be > HC, although not statistically significant. The lockdown period was perceived as more traumatic than the reopening phase by both groups, with the exception of OCD patients, probably because of the clinical worsening associated with the urge of control against risks of contamination. Overall, HC reported more PTSD symptoms than psychiatric patients did, particularly SKZ ones. PD patients, in contrast, may be more vulnerable to PTSD symptoms probably as a result of poor coping skills. Together with OCD patients, subjects with PDs may need closer monitoring during the different phases of the pandemic. Trial Registration: ClinicalTrials.gov Identifier: NCT04694482.

P.0638 Comparing the psychological impact of COVID-19 pandemic between psychiatric patients and healthy subjects: an observational retrospective study from northern Italy

Introduction: From the very beginning, COVID-19 pandemic had a great impact not only on physical, but also on mental health, both in general population and psychiatric patients. Self-isolation, fear of virus exposure and of death, unemployment and poor social network have increased psychological distress and Post-Traumatic Stress Disorder (PTSD) symptoms [1]. Nevertheless, little is known about the difference between subjects affected by mental disorders and healthy individuals in perceiving the pandemic as a traumatic event [2]. Aim: Comparing psychiatric patients and healthy controls (HC) in terms of change over time of post-traumatic symptoms. Methods: Data about demographic and clinical variables were retrospectively collected. Impact of Event Scale Revised (IES-R) scores were registered referring at two time points: T1, during the so-called ‘Phase I’ in March-April 2020 (lockdown period) and T2, during the so-called ‘Phase II’ in May-June 2020 (restarting). Descriptive analyses and linear regression models were performed. Summary of results: A total of 166 outpatients were recruited: 66 patients (39.8%) were affected by Schizophrenia (SKZ), 29 patients (17.5%) by Bipolar Disorder (BD), 36 patients (21.7%) by Major Depressive Disorder (MDD), 17 patients (10.2%) by Anxiety or Obsessive-Compulsive Disorder (OCD), and 18 (10.8%) by Personality Disorders (PDs). HC sample included 57 individuals from general population. The tests of fixed effects showed that time (F=65.44;p<0.001) and diagnosis (F=2.84;p=0.02) each had a significant effect on the change of IES-R scores. In particular, IES-R scores at T1 were overall higher than T2 scores (p<0.001), except for OCD patients. Moreover, patients presented lower IES-R scores than HC (p=0.02), independently from diagnosis. When HC have been compared with the different diagnostic groups, SKZ patients resulted to have significantly lower IES-R scores than HC (p=0.004). Differently, only PD patients showed higher IES-R scores than HC, but the result did not reach the statistical significance (p=0.44). Conclusions: In general, both patients and HC presented a significant decrease of IES-R scores between T1 and T2, when the pandemic showed a decline and preventive restrictions have been removed;only OCD patients have shown a different trend, which can be explained by a global worsening of obsession and compulsion, associated with the urge of control against risks of contamination [3]. Comparing patients and HC, higher scores on IES-R scale have been observed in HC: this trend is particularly meaningful in SKZ subgroup, and it may be explained considering the limited awareness about the risk of infection, associated with less fear or striking emotion related to pandemic [4]. PD patients, in contrast, were found to be more affected by social restrictions than HC, probably because of a greater vulnerability to PTSD symptomatology and poorer coping skills [5], pointing out the need to implement telematic interventions, such as psychotherapy and group therapy. This is, to our knowledge, one of the few studies evaluating and comparing the psychological distress perceived by psychiatric patients (including all major diagnoses) and HC during the first wave of COVID-19 pandemic. Conflict of interest Disclosure statement: The study has been registered on ClinicalTrials.gov with the following ID number: NCT04694482

P.0500 Investigation into the factors potentially associated with poor psychological wellbeing in italian healthcare professionals during the COVID-19 pandemic

Background: Italy was strongly affected by the COVID-19 pandemic during spring (first wave) and autumn 2020 (second wave);healthcare workers’ mental health was deeply conditioned by this situation and by the exposition to the highest risk to get infected themselves [1]. Aim of this study was to investigate how healthcare workers’ mental wellbeing was altered by the massive exposition to the pandemic, together with pre-existing personal factors which can be involved in mental health. Methods: Sixty-four healthcare workers from Fondazione IRCSS Policlinico, Milan, were included. Information were retrieved from an ad-hoc questionnaire. Mental health was assessed by the following rating scales: Impact of event scale-revised (IESR) and Patient Health Questionnaires-9 (PHQ-9). The first scale evaluates the post-traumatic stress symptoms, while the second severity of depression. The healthcare professionals were asked to fill the scales thinking about their symptoms during both the first and the second wave. Descriptive analyses were performed. Rating scale scores between first and second wave were compared by paired sample t-tests. In addition, second wave rating scale scores were compared between groups defined by qualitative variables through analyses of variance. Correlations were used to analyze the relation between quantitative variables and second wave rating scale scores. Two final multivariable linear logistic regression models were finally performed with the two rating scale scores in the second wave as dependent variables and statistically significant variables in the univariate analyses as independent ones. Results: Total sample included 25 males and 39 females. 53,2% of workers directly took care of COVID19-infected patients.34% and 18% of the total sample manifested respectively in the first and second wave over the threshold scores for significant Post-Traumatic Stress Disorder (PTSD) symptoms as showed by IESR. In addition, 23,2% and 13% of the total sample manifested respectively in the first and second wave over the threshold scores for significant depressive symptoms as showed by PHQ-9. During the second wave the professionals showed less PTSD (t = 5,536, p<0,001) and depressive symptoms (t=-5,559, p < 0.001) compared to the first one. Regression models showed that: (1) IESR scores were significantly associated with type of ward (COVID emergency or not) (β=0.24, p=0,03);(2) PHQ9 scores were significantly associated with male gender (β=0.32, p=0.01) and IESR scores (β=0.62, p<0,001). Conclusions: despite most of available literature is focused on the negative effect of COVID-19 on patients’ mental health [2,3], also healthcare professionals suffered from the psychological consequences of the pandemic. The difference in the scores between the first and the second wave suggests the fact that health workers passed from an acute mental involvement to a chronic accommodation to a stressing situation. Given the large number of workers fighting worldwide against COVID19 pandemics, the presence of mental illness among them can reach huge proportions. Female workers globally showed lower scores at the PHQ9 scales, suggesting the necessity of further investigations on the association between gender and capacity to manage environmental stressors. No conflict of interest

P.0493 COVID-19 related perceived stress in patients with rheumatic diseases: an Italian cross-sectional study

Background: COVID-19 outbreak is a public emergency that forced people to a radical change in their daily life, generating great insecurities and concerns about health, work, and social relationships [1]. Quarantine measures were responsible for detrimental effects on mental health of the general population, leading to the exacerbation of stress, depression and anxiety [2]. Psychological impact might be even more severe on fragile people such as those suffering from rheumatic diseases (RDs), for whom previous evidence demonstrated a negative effect of psychological stressors on outcome disease [3]. Objective: The aim of the present study is to identify the factors associated with higher levels of perceived stress in patients affected by RDs during the COVID-19 pandemic. Methods: This cross-sectional study analyzed data from an anonymous online survey about mental health of people with RDs. Participants were enrolled through several RD patients’ associations between May and September 2020, after the first pandemic wave in Italy. They filled out a questionnaire including demographic and clinical information, mental health issues and the Perceived Stress Scale (PSS). Perceived stress levels were stratified as follows: low (<14), moderate (14-26) and high (>27). Descriptive analyses were performed on the total sample;one-way analyses of variance (ANOVA) and Pearson's correlation were used to compare PSS scores between groups defined by qualitative and quantitative variables. Finally, multivariate regression analyses were performed to identify independent variables associated with higher PSS scores. Results: 507 patients with RDs participated in the survey: 419 females (82.6%) and 88 males (17.4%) with a mean age of 53.06 years and mean disease duration of 13.74 years. As regard PSS scores, total sample mean (SD) was 18.1 ± 8.1. Specifically, 154 patients (30,4%) reported low, 264 (52.1%) moderate and 89 (17.6%) high levels of stress. PSS scores resulted significantly different with regard to: gender (F=18.32, P<0.01), residence in Lombardy (F=14.90, P<0.01), diagnostic group (F=6.20, P<0.01), hypertension (F=4.06, P=0.04), gastritis (F=3.83, P=0.05), bowel diseases (F=9.74, P<0.01), overweight/obesity (F=5.96, P=0.02), COVID-19 infection (F=4.32, P=0.01), depressive symptoms (F=17.18, P<0.01), anxiety symptoms (F=19.79, P<0.01), prescription of psychiatric therapy before COVID-19 (F=30.90, P<0.01), type of pre-existing psychiatric symptoms (F=12.41, P<0.01), use of psychiatric compounds before COVID-19 (F=36.39, P<0.01), type of psychiatric compounds before COVID-19 (F=13.53, P<0.01), current prescription of psychiatric compounds (F=44.68, P<0.01), type of ongoing psychiatric compounds (F=15.18, P<0.01), anxiety sources (F=30.90, P<0.01). Independent variables associated with higher PSS scores were: female gender (β=0.12, P<0.01), younger age (β=-0.23, P<0.01), residence outside Lombardy (β=-0.09, P=0.03), presence of overweight/obesity (β=0.11, P=0.01), current prescription of psychiatric compounds (β=0.26, P <0.01) and financial difficulties (β=0.19, P <0.01). Conclusion: Our findings highlight the considerable psychological impact derived from COVID-19 pandemic on people affected by RDs. In addition, different factors resulted to be predictive of significant levels of perceived stress in these patients. A multidisciplinary approach, including mental health support, should be considered in order to improve the psychological well-being of fragile patients during traumatic events such as pandemics. No conflict of interest

P.0494 Which rheumatic patients are more vulnerable to the stressful effects of COVID-19?

Background: Post-traumatic stress disorder (PTSD) is a psychiatric condition that may develop after exposure to a traumatic event [1];COVID-19 pandemic could be defined as a traumatic experience since it has resulted in either direct (e.g. the fear of contagion and the risk of death) or indirect aftermaths (e.g. psychological distress, depression and anxiety) [2]. Besides, it has been shown that PTSD, promoting inflammatory responses, might worsen the prognosis of patients affected by illnesses characterized by systemic inflammation such as rheumatic diseases (RDs) [3]. Objective: The aim of the present study is to verify the presence of PTSD symptoms and related factors in patients suffering from RDs during the COVID-19 pandemic. Methods: This cross-sectional study analyzed data from an anonymous online survey about mental health of people with RDs. Participants were enrolled through several RD patients’ associations between May and September 2020, after the first pandemic wave in Italy. They filled out a questionnaire including demographic and clinical information, mental health issues and the 22-items of the Impact of Event Scale-Revised (IES-R). The total score ranges from 0 to 88;a score ≥ 33 defines patients at risk of PTSD. Descriptive analyses were performed on the total sample: one-way analyses of variance (ANOVAs) were used to compare IES-R scores between groups defined by qualitative variables;Pearson's correlations were performed to study the relation between rating scale scores and quantitative variables. Finally, multivariate regression analyses were performed to identify independent variables associated with IES-R scores. Results: 507 patients with RDs participated in the survey: 419 females (82.6%) and 88 males (17.4%) with a mean age of 53.06 years and mean disease duration of 13.74 years. As regard IES-R scores, total sample mean (SD) was 29.7 ± 17.5;of note, 209 participants (41.2%) had scores ≥33. IES-R scores resulted to be significantly different according to: gender (F=14.75, P<0.01), residence in Lombardy (F=8.22, P<0.01), diagnostic group (F=4.17, P= 0.02), prescription of psychiatric therapy before COVID-19 (F=17.87, P<0.01), type of pre-existing psychiatric symptoms (F=7.59, P<0.01), use of psychiatric compounds before COVID-19 (F=27.17, P<0.01), type of psychiatric compounds before COVID-19 (F=14.58, P<0.01), current prescription of psychiatric compounds (F=29.30, P<0.01), type of ongoing psychiatric compounds (F=13.81, P<0.01), anxiety source (F=20.81, P<0.01), and the presence of overweight/obesity (F=7.60, P< 0.01), bowel diseases (F=8.00, P<0.01), depressive symptoms (F=5.74, P=0.02), anxiety symptoms (F=26.81, P<0.01). Independent variables associated with higher IES-R scores were: female gender (β=0.14, P <0.01), living outside Lombardy (β=-0.10, P=0.02), intestinal diseases (β=0.10, P=0.03), anxiety (β=0.19, P <0.01) and health related concerns (β=0.13, P <0.01). Conclusion: These findings point out high rate of severe self-reported distress among Italian RD patients in response to the pandemic. Given that psychological and emotional stressors strictly affect disease severity leading to poorer quality of life, our study sustains the necessity to implement support measures for fragile patients during traumatic events. No conflict of interest

P.0447 The psychopathological impact of the SARS-CoV-2 epidemic on subjects suffering from mental disorders: an observational retrospective study

Introduction: SARS-CoV-2 infection causes a pulmonary disease (COVID-19) which spread worldwide in 2020, leading the World Health Organization (WHO) to declare a pandemic [1] and the Italian government firstly to declare a state of emergency, then to impose restrictive measures lasting about two months. COVID-19 pandemic generated fear, anxiety, depression and post-traumatic symptoms in the general population [2,3] as well as among subjects affected by mental disorders [4]. Little is known about which different psychopathological changes the pandemic caused among individuals affected by different psychiatric disorders. Aims: To investigate potential psychopathological changes over time during the first wave of COVID-19 pandemic comparing different psychiatric disorders. Methods: Data about demographic/clinical variables and psychopathological status were retrospectively collected. Specific psychometric scales were administered at three time points: T0 as outbreak of pandemic, T1 as lockdown period, T2 as reopening. Primary outcomes: Brief Psychiatry Rating Scale (BPRS), Clinical Global Impression (CGI), Hamilton Anxiety Rating Scale (HAM-A). Secondary outcomes: Disability Scale (DISS), Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAM-D), Montgomery and Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Descriptive analyses and linear regression models were performed. Summary of results: A total of 166 outpatients were included. Overall, psychometric scores showed a significant worsening at T1 with a mild improvement at T2 (p<0.05). Only psychotic and OC symptoms did not significantly improve at T2. Primary outcomes: time had a significant effect on the change of BPRS (F=26.56;p<0.001), CGI-severity (F=8.29;p<0.001), CGI-improvement (F=41.88;p<0.001) and HAM-A (F=33.63;p<0.001) scores. BPRS and CGI-S scores were higher among subjects affected by personality disorders (PDs) than in the depressed (MDD) and anxiety/obsessive-compulsive (OC) groups (p<0.05). PD patients also showed higher HAM-A scores than schizophrenia (SKZ) ones (p=0.02). Secondary outcomes: Time had a significant effect on the change of DISS-stress (F=40.80;p<0.001), DISS-support (F=9.26;p<0.001), HAM-D (F=9.50;p<0.001) and MADRS (F=9.40;p<0.001) scores. The time effect was not significant for DISS-disability (F=1.23;p=0.29), PANSS (F=1.37;p=0.26), YMRS (F=2.84;p=0.06) and Y-BOCS (F=0.55;p=0.59) scores. DISS-disability scores were higher in the PD group with respect to bipolar disorder (BD) (p=0.009), MDD (p<0.001) and anxiety/OCD (p=0.03) groups;SKZ and BD patients had lower DISS-stress scores than PD ones (both p values = 0.02). Conclusions: Patients affected by PDs showed to be particularly affected by the negative effects of outbreaks on mental health and perhaps they require specific clinical attention in case of traumatic events such as pandemics. Moreover, although SKZ patients reported lower anxiety levels than PD ones, the worsening of psychotic and OC symptoms should be strictly monitored by clinicians, as these aspects did not improve with the end of lockdown measures. Further studies on larger samples would allow an in-depth comparison of the psychopathological impact of pandemics between the different psychiatric diagnoses. The study has been registered on ClinicalTrials.gov with the following ID number: NCT04694482 No conflict of interest

Effect of COVID-19 pandemic on sleep disorders in patients with inflammatory arthritis

Background: A decrease in physical activity, exposure to daylight and a decline in psychological wellbeing due to COVID19 pandemic have led to increased incidence of sleep disorders such as difficulties falling asleep, sleep disruption, insomnia, nightmares and daytime sleepiness (1). Patients with inflammatory arthritis are more vulnerable to pain, depression, anxiety and sleep disorders. These complaints are linked in a cyclical pattern that may negatively affect daily-life activities (2-4). To our knowledge, the impact of pandemic on sleep disturbances in patients with inflammatory arthritis has not been evaluated yet. Objectives: The aim of this study is to establish the COVID-19 related impact on sleep disturbances among patients with inflammatory arthritis who experienced the COVID-19 quarantine in Italy. Methods: Data about chronic inflammatory arthritis (rheumatoid arthritis [RA], psoriatic arthritis [PsA] and ankylosing spondylitis [AS]) were retrieved from a large nationwide online survey involving patients affected by different rheumatic diseases. From May to September 2020, eleven patients' associations sent a call to rheumatic patients asking them to complete an anonymous online survey with specific questions also about sleep disturbances and pre-and post-lockdown self-reported use of psychopharmacotherapy. Data were analysed by a binary logistic regression model having the presence of sleep disturbances during COVID 19 pandemic as dependent variable. Results: 375 of 507 (74%) of patients had inflammatory arthritis: 249 RA, 77 PsA and 49 AS. 291 (77.6%) were females with a median (IQR) age of 54 (44-63) years. There was an increase in the use of psychiatric compounds after quarantine period (59 [15,7%] vs 65 [17,3%]), especially for sleep medications (23 [6,1%] vs 28 [7,5%]) and anxiolytics (15 [4%] vs 18 [4,8%]). 246 (65.6%) of patients had trouble staying asleep, 238 (63.5%) had trouble falling asleep, and 112 (29.9%) had dreams about pandemic (Figure 1 below). Conclusion: These results confirm that sleep disturbances have been a relevant concern in patients with inflammatory arthritis after COVID-19 national lockdown. Changes in daily life related to confinement have influenced psychological distress leading to a significant impact on sleep difficulties such as inability to fall early asleep or to maintain adequate sleep. Furthermore, older patients who had coronavirus infection and were previously treated for psychiatric disorders were at higher risk developing sleep disorders.

The impact of COVID-19 quarantine on mental health of patients with fibromyalgia

Background: Detrimental psychological effects, including symptoms of post-traumatic stress disorder (PTSD), stress, anxiety, and depression have been related to COVID-19 quarantine measures (1). These aspects may be particularly relevant in stress-related disorders such as fibromyalgia (FM) in which previous evidence demonstrated a causal effect of psychological stressors on chronic non-inflammatory pain of FM (2). Recent studies highlighted a significant worsening of FM symptoms after COVID-19 related lockdown period (3-4), but the levels of perceived stress and distress have not been evaluated yet. Objectives: The aim of this study is to establish the COVID-19 related perceived stress and distress among patients with FM who experienced the COVID-19 quarantine in Italy. Data were retrieved from a larger nationwide online survey involving patients affected by different rheumatic diseases (RD). Methods: We collected data from May to September 2020 from RD patients living in Italy during the COVID-19 quarantine by an ad-hoc online survey. Eleven associations of RD patients sent a call by using their mailing list, webpages and social network. They asked to complete an anonymous online survey which included the Perceived Stress Scale (PSS), and the Impact Event Scale-Revised (IES-R). Descriptive statistics were used to summarize results. Results: 79 of 507 (15.6%) of RD patients who completed the survey declared to have been diagnosed FM. 77 (97.5%) were females, with a mean (± SD) age of 51.0 ± 12.4 yrs. In FM patients, the mean (SD) PSS score was 23.8 ± 8.1. In particular, 8 (10.1%) reported low, 38 (48.1%) moderate and 33 (41.8%) high PSS scores. Moreover, IES-R mean (SD) score was 38.5 ± 17.2. Among FM patients, 51 (64.6%) reported scores greater than 33, indicating the probable presence of a PTSD. With regard to the IES-R subscale scores, the total sample did not show a prominence of one of the three main domains: intrusion (13.9 ± 7.3), avoidance (11.9 ± 6.1) and hyperarousal (12.6 ± 5.9). In these FM patients, self-reported major sources of anxiety were related to personal and relatives' health (59.5%), followed by social withdrawal (21.5%) and employment loss/ financial difficulties (11.4%). There was a slight increase of self-reported use of antidepressants (15 [18.9%] vs 16 [20.2%]) and anxiolytics drugs (4 [5.1%] vs 5 [6.3%]) after lockdown period. Conclusion: These results confirm that psychosocial stress and distress were highly pervasive in FM after COVID-19 national lockdown. It is known that stressed status may exacerbate and/or precipitate later development of FM symptoms. These data support the substantial worsening of somatic burden of FM after lockdown period reported in previous studies (3-4). Coping strategies should be implemented to ameliorate psychological well-being of these patients in this stressful era.

A citizen science approach to capture poor mental health related to COVID-19 in rheumatic patients after confinement during pandemic in italy

Background: A considerable psychosocial burden is one of the relevant consequences of the COVID-19 pandemic. In particular, quarantine measures have been related to negative psychological effects, including symptoms of post-traumatic stress disorder, stress, anxiety, and depression (1). This rise in mental health disorders might be even worse among people more vulnerable to psychological stress such as patients suffering from chronic rheumatic diseases (RDs). Objectives: The present Italian nationwide survey engages patients with rheumatic conditions through eleven associations of RD patients. It is conducted to establish the COVID-19 related self-reported poor mental health symptoms and to identify potential factors associated with these concerns among RDs who experienced the COVID-19 quarantine in Italy. Methods: We collected data from May to September 2020 from RD patients living in Italy during the COVID-19 quarantine by an ad-hoc online survey. By using their mailing list and the related webpage and social network, eleven patients' associations sent a call to RD patients asking them to complete an anonymous online survey which included the Perceived Stress Scale (PSS), and the Impact Event Scale-Revised (IES-R). χ2 tests were performed to detect statistically significant differences in both rating scale scores between groups defined by qualitative variables. Correlation analyses were realized with quantitative variables and rating scale scores. Variables significant in univariate analyses were then inserted in multivariate regression models. Results: In total, 507 RD patients completed to the survey. 375 (73.9%) patients had inflammatory arthritis (243 rheumatoid arthritis, 76 psoriatic arthritis, 49 ankylosing spondylitis, and 7 Still's disease), and 96 (18.9%) with connective tissue diseases or systemic vasculitis. 31 (6.1%) patients had primary fibromyalgia and 5 osteoarthritis or crystal arthropathies. Self-reported major sources of anxiety are reported in the Figure 1 below. The mean (SD) scores of the PSS-10 and the IES-R were 18.1 ± 8.1 and 29.7 ± 17.5, respectively. With regard to the IES-R subscale scores, the total sample did not show a prominence of one of the three main domains (intrusion, avoidance and hyperarousal). Higher PSS scores were significantly associated with younger age (p<0.01), female gender (p<0.01), living outside Lombardy (p=0.03), presence of overweight/obesity (p=0.01), ongoing psychopharmacotherapy (p<0.01), and anxiety for loss of incomes (p<0.01). Female gender (p<0.01) and living outside Lombardy (p=0.02) were associated also with higher IES-R scores, together with the presence of intestinal diseases (p=0.03), anxiety disorders (p<0.01), and worries about health (p<0.01). Conclusion: This nationwide study revealed a high impact of self-reported distress, anxiety, and perceived stress among rheumatic patients after confinement during COVID-19 pandemic in Italy. Different factors were found to be predictive of poor mental health such as having female gender, younger age, living outside Lombardy, having overweight/obesity, or intestinal diseases, having a history of psychiatric symptoms (e.g. anxiety). Moreover, the lockdown experience worsened psychiatric symptoms and increased the assumption of psychopharmacotherapy in this vulnerable population. Prevention strategies focused on specific variables should be implemented to ameliorate psychological well-being of fragile patients during pandemics.