Takotsubo syndrome in COVID-19 era: Is psychological distress the key?

Covid-19 pandemic, starting from Wuhan, China spread all over the world and Italy was one of the most affected countries, especially in Lombardy, where, on February 20, the first confirmed case was detected. Italian Government ordered a national lockdown on the 9 th March 2020, forcing the population to severe restrictive isolation measures. The burden on mental health of the medical emergency related to COVID19 is progressively been revealed. Takotsubo syndrome (TTS), is estimated to represent 1-3% of patients admitted with suspected STEMI, mostly affecting elderly women with emotional stress and/or acute illness preceding the presentation. Comparing patients hospitalised from February to May 2020 with those of the corresponding period in 2019 we observed a significantly increased number of TTS diagnosis in 2020 (11 patients vs 3 in 2019), especially during the first period of lockdown. The only two males were patients with COVID-19 and were the only two who died in hospital. At psychological examination all patients enrolled report to have lived a particularly stressful experience at IES-R in the last year, without presenting the symptoms of a post-traumatic stress disorder. Most patients were positive to the allostatic overload. Only one patient showed a clinical cut-off for HADS and no one for the Fear COVID-19 scale. We finally concluded that subjects with pre-pandemic psychological distress may have experienced additional psychological overload, opening the door to TTS by a series of physiological alterations as the secretion of cortisol and catecholamines, making the subject more vulnerable to the onset of TTS.

The Impact of Sport Activity Shut down during the COVID-19 Pandemic on Children, Adolescents, and Young Adults: Was It Worthwhile?

We conducted a national retrospective survey of 1764 athletes aged ≤25 years to investigate the benefit-risk balance of sport closure during the COVID-19 pandemic peaks in Italy. Univariate and multivariable analyses were carried out to investigate the association between sport practice during the study period and (1) the risk of SARS-CoV-2 infection in athletes and their families and (2) body mass index (BMI) change, and adherence to World Health Organization (WHO) guidelines for physical activity. The percentage of subjects with a positive SARS-CoV-2 test was similar in those participating and not taking part into sport activities (11% vs. 12%, respectively, p = 0.31). Restricting the analysis to subjects who practiced sports within an organized sport society/center, the risk of SARS-CoV-2 positivity was reduced for athletes who had never stopped their training (odds ratio (OR); 95% confidence intervals (CI): 0.62; 0.41-0.93). On the other side, responders who had stopped sport activity showed a 1% increase in BMI. Adherence to WHO guidelines for physical activity was significantly higher for athletes who had continued sport activities. In conclusion, sport closure and limitations had an important negative impact on the overall health of young athletes, being also not effective in reducing the spread of COVID-19.

Anxiety, Motives, and Intention for Physical Activity during the Italian COVID-19 Lockdown: An Observational Longitudinal Study.

BACKGROUND: The coronavirus (COVID-19) pandemic led governments to adopt strict containment measures to avoid spreading the virus. These essential measures led to home confinement that influenced both the physical and mental health of populations. Physical activity plays a key role in preventing chronic diseases and promoting protective psychological factors. In the context of a lockdown, understanding the motives that guide people to enact physical activity is an important issue for public health. The present study aimed to evaluate the relation between autonomous motivation and physical activity, considering the role of behavioral intention and anxiety in a longitudinal moderated mediation model. METHODS: Italian participants (N = 86; meanage = 29.74, standard deviation = 9.74; female = 53.5%) completed a booklet composed of different questionnaires (motivation, intention, anxiety, and physical activity) 3 weeks apart. RESULTS: The hypothesized model is supported by the evidence; both autonomous motivation and intention are direct predictors of physical activity. The results also show that the direct effect of autonomous motivation on physical activity is stronger in participants with low anxiety, while high levels of anxiety are a significant moderator of the intention-behavior relation. CONCLUSIONS: In conclusion, a multidisciplinary approach should be promoting methods and infrastructures to permit people to adhere to physical activity, as a front line against any health emergency.

Takotsubo syndrome in COVID-19 era: is psycological distress the key?

Covid-19 pandemic, starting from Wuhan, China has spread all over the word and Italy was one of the most affected countries, especially in Lombardy, where, on 20 February the first case was confirmed. Italian Government ordered a national lockdown on the 9 March 2020, forcing the population to severe restrictive isolation measures. The burden on mental health of the medical emergency related to COVID-19 is progressively been revealed. Takotsubo syndrome (TTS), is estimated to represent 1–3% of patients admitted with suspected STEMI, mostly affecting elderly women with emotional stress and/or acute illness preceding the presentation. Comparing patients hospitalized from February to May 2020 with those of the corresponding period in 2019 we observed a significantly increased number of TTS diagnosis in 2020 (11 patients in 2020 vs. 3 in 2019), especially during the first period of lockdown. The only two males were patients with COVID-19 and were the only two who died in hospital. At psychological examination all patients enrolled report to have lived a particularly stressful experience at IES-R in the last year, without presenting the symptoms of a post-traumatic stress disorder. Most patients were positive to the allostatic overload. Only one patient showed a clinical cut-off for HADS and no one for the fear COVID-19 scale. We finally concluded that subjects with pre-pandemic psychological distress may have experienced additional psychological overload, opening the door to TTS by a series of physiological alterations as the secretion of cortisol and catecholamines, making the subject more vulnerable to the onset of TTS.

Promoting Media Literacy Online: An Intervention on Performance and Appearance Enhancement Substances with Sport High School Students.

The outbreak of coronavirus required adjustment regarding the delivery of interventions. Media literacy interventions are necessary to help people acquire relevant skills to navigate the complexities of media communications, and to encourage health-promoting behaviors. The present study aimed to promote a media literacy intervention regarding performance and appearance enhancement substances use in sports high school students. The COVID-19 contingency allowed us to evaluate whether online sessions can effectively promote greater awareness of media influence, a stronger sense of confidence in persuading others to deal with media messages, and healthier attitudes about PAES use among high school students. The study relied on an "intervention group" comprising 162 students (31.5% female) and a "control group" comprising 158 students (42% female). Data were analyzed through repeated measures of Group X Time MANOVA and ANOVA, demonstrating some degree of efficacy of the media literacy intervention. The "intervention group" reported higher awareness of potential newspapers' influence and a significant increase in their sense of confidence in dealing with media influence compared to the "control group". Findings support the efficacy of online media literacy programs to prevent doping consumption in adolescents.

What Will Be the Impact of the Covid-19 Quarantine on Psychological Distress? Considerations Based on a Systematic Review of Pandemic Outbreaks.

Background: The novel coronavirus (SARS-CoV-2) and related syndrome (COVID-19) has led to worldwide measures with severe consequences for millions of people. In the light of the psychopathological consequences of restrictive measures detected during previous outbreaks, a systematic review was carried out to provide an evidence-based assessment of possible effects of the current COVID-19 quarantine on mental health. Methods: This review included studies that assessed mental health indexes (e.g., overall psychological distress, depressive and PTSD symptoms) during and after quarantine periods adopted to management different outbreaks (e.g., COVID-19, SARS, MERS). Results: Twenty-one independent studies were included for a total of 82,312 subjects. At least 20% of people exposed to restrictive measures for the management of pandemic infections reported clinically significant levels of psychological distress, especially PTSD (21%) and depressive (22.69%) symptoms. Overall, original studies highlighted relevant methodological limitations. Conclusions: Nowadays, almost one out of every five people is at risk of development of clinically significant psychological distress. Further research on mental health after the current COVID-19 quarantine measures is warranted.

The Italian COVID-19 Psychological Research Consortium (IT C19PRC): General Overview and Replication of the UK Study.

The COVID-19 pandemic represents a major stressor for the psychological health of people worldwide. In the UK, the COVID19-Psychological Research Consortium Study (C19PRC) launched to evaluate the psychological impact of COVID-19 in the general population and its implications. The project was then extended to Italy and several other countries. This article provides an overview of the Italian C19PRC study and its replication of two specific findings from the UK C19PRC. In the first part, the relationship between anxiety and somatic symptomatology is examined. In the second part, we analyze the association between several factors and psychological health outcomes: depression/anxiety, traumatic stress, COVID-19 anxiety. In line with the study conducted in the UK, an online survey was administered to the adult Italian general population. The sample included 1038 respondents (age, mean = 49.94, SD = 16.14, 51.15% females) taken from four regions: Lombardia, Veneto, Lazio, and Campania. The relationship between predictors and outcomes was evaluated by means of logistic regression models. Somatic indices showed a positive association with anxiety, worse somatic symptoms were associated with mourning a loss of a beloved one due to COVID-19 and with precarious health conditions. Females showed a higher incidence of psychological issues. No differences in anxiety, depression, and traumatic stress were found across regions but the Campania region showed the most severe somatic symptomatology. In the second analysis, the factors associated with more severe psychological outcomes (i.e., anxiety and/or depression, traumatic stress, and COVID-19 related anxiety) were younger age, the presence of minors in the household, traumatic stressors, and precarious health conditions. No differences across regions emerged. The Italian results correspond to the UK findings for anxiety, depression, and traumatic stress. Both in the UK and Italy, the factors associated with worse psychological health were gender (female), younger age, having children, pre-existing health issues (both for oneself or someone close), and the moderate/high perceived risk of contracting COVID-19 within one month. In Italy, unlike the UK, lower household income and having (had) COVID-19 were not associated with poorer mental health. The psychological impact of COVID-19 can last for months; future research should explore all aspects of the psychological burden of COVID-19 in order to implement psychological interventions and promote psychological health.

Psychosocial variables and quality of life during the COVID-19 lockdown: a correlational study on a convenience sample of young Italians.

BACKGROUND: In 2020, to limit the spread of Coronavirus (COVID-19), many countries, including Italy, have issued a lengthy quarantine period for the entire population. For this reason lifestyle has changed, bringing inevitable repercussions to the Quality of Life (QoL). The present study aims to identify which psychosocial variables predict behaviors capable of affecting the QoL during the lockdown period, potentially highlighting factors that might promote well-being and health in the Italian population during the epidemic. METHODS: Between 27 April 2020 and 11 May 2020, we administered a web-survey to a sample of young Italian people (age M = 21.2; SD = 3.5; female = 57.7% of the sample). Employing variance-based structural equation modeling, we attempted to identify whether social connectedness, social support, and loneliness were variables predictive of the QoL of young Italians. We also sought to identify specific psychological factors, such as symbolic threat, realistic threat, and the threat from potentially contaminated objects, was correlated to COVID-19 fear and whether engaging in particular behaviors was likely to improve the QoL. RESULTS: Our results suggest that social connectedness and loneliness are significant predictors of QoL, while social support did not have a significant effect on QoL. Furthermore, we observed that symbolic and realistic threats and the threat from potentially contaminated objects are significant and positive predictors of COVID-19 fear. Moreover, COVID-19 fear had significant and positive relationships with the carrying out of specific behaviors, such as creative activities during the isolation period and that this related to affirming individuals' country-specific identity. Finally, COVID-19 fear is a significant predictor of behavioral factors related to the adherence to public health advice in line with national guidance regarding the containment of COVID-19; this factor, however, did not correlate with QoL. CONCLUSION: Our results suggest the importance of social context and psychological factors to help devise intervention strategies to improve the QoL during lockdown from epidemic events and, in particular, support the importance of promoting social communication and accurate information about the transmission of the virus.

The Italian COVID-19 Psychological Research Consortium (IT C19PRC): General Overview and Replication of the UK Study

The COVID-19 pandemic represents a major stressor for the psychological health of people worldwide. In the UK, the COVID19-Psychological Research Consortium Study (C19PRC) launched to evaluate the psychological impact of COVID-19 in the general population and its implications. The project was then extended to Italy and several other countries. This article provides an overview of the Italian C19PRC study and its replication of two specific findings from the UK C19PRC. In the first part, the relationship between anxiety and somatic symptomatology is examined. In the second part, we analyze the association between several factors and psychological health outcomes: depression/anxiety, traumatic stress, COVID-19 anxiety. In line with the study conducted in the UK, an online survey was administered to the adult Italian general population. The sample included 1038 respondents (age, mean = 49.94, SD = 16.14, 51.15% females) taken from four regions: Lombardia, Veneto, Lazio, and Campania. The relationship between predictors and outcomes was evaluated by means of logistic regression models. Somatic indices showed a positive association with anxiety, worse somatic symptoms were associated with mourning a loss of a beloved one due to COVID-19 and with precarious health conditions. Females showed a higher incidence of psychological issues. No differences in anxiety, depression, and traumatic stress were found across regions but the Campania region showed the most severe somatic symptomatology. In the second analysis, the factors associated with more severe psychological outcomes (i.e., anxiety and/or depression, traumatic stress, and COVID-19 related anxiety) were younger age, the presence of minors in the household, traumatic stressors, and precarious health conditions. No differences across regions emerged. The Italian results correspond to the UK findings for anxiety, depression, and traumatic stress. Both in the UK and Italy, the factors associated with worse psychological health were gender (female), younger age, having children, pre-existing health issues (both for oneself or someone close), and the moderate/high perceived risk of contracting COVID-19 within one month. In Italy, unlike the UK, lower household income and having (had) COVID-19 were not associated with poorer mental health. The psychological impact of COVID-19 can last for months;future research should explore all aspects of the psychological burden of COVID-19 in order to implement psychological interventions and promote psychological health.

A Systematic Review and Provisional Metanalysis on Psychopathologic Burden on Health Care Workers of Coronavirus Outbreaks.

BACKGROUND: The new coronavirus (SARS-CoV-2) shows several similarities with previous outbreaks of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Aim of this systematic review and meta-analysis is to provide evidence of the psychopathologic burden on health care workers (HCWs) of the first two deadly coronavirus outbreaks to get lessons for managing the current burden of COVID-19 outbreak. METHOD: According to Cochrane Collaboration guidelines and the PRISMA Statement, the study quantified the effects of frontline work on mental health of HCWs. Major databases - Pubmed, Scopus, Embase, Medline, and Web of Science - were searched for observational and case-control studies evaluating mental health indexes reported by front-line work. This study computed the percentage of sample that reported clinically significant levels of psychiatric symptoms. Cohen's d was used for comparing mental health outcomes of health care workers directly involved in addressing pandemic emergency with a control group that was not directly exposed to such conditions. Pooled effect sizes (dw ) were estimated whenever at least three independent studies yielded data. Heterogeneity of findings and bias of publication were estimated as well. FINDINGS: Fifteen studies have been selected for a total of 7,393 HCWs. From 9.6% to 51% of HCWs reported symptoms of Post-Traumatic Stress Disorder (PTSD) and from 20% to 75% reported psychiatric symptoms, with a prevalence of anxiety and depression. From one to the three years after outbreak, from 2% to 19% reported PTSD symptoms and from 5% to 90% psychiatric symptoms. Interestingly, HWCs who were directly involved in pandemic emergency showed significantly higher depressive and anxious symptoms (dw = .66 (.46-.85); p <.001) than ones who were not directly exposed. Similarly, the direct involvement significantly affected the severity of PTSD symptoms (dw = .30 (.21-.39); p <.001). CONCLUSION: Health care professionals in general and most of all frontline workers showed an association with a likely risk of developing psychiatric disorders following outbreaks and for at least three years later. Mental health interventions for professionals exposed to COVID-19 need to be immediately implemented. Further studies are warranted to investigate long-term consequences carefully, and to look for mediating and buffering factors as well. The role of clinical psychologists and psychiatrists in delivering adequate interventions is critically important.

COVID-19 Outbreak and Physical Activity in the Italian Population: A Cross-Sectional Analysis of the Underlying Psychosocial Mechanisms.

Italy is one of the first European epicenters of the COVID-19 pandemic. In attempts to hinder the spread of the novel coronavirus disease, Italian government hardened protective measures, from quarantine to lockdown, impacting millions of lives dramatically. Amongst the enacted restrictions, all non-essential activities were prohibited as well as all outdoor activities banned. However, at the first spur of the outbreak, for about a dozen of days, physical and sports activities were permitted, while maintaining social distancing. In this timeframe, by administering measures coming from self-determination theory and theory of planned behavior and anxiety state, in an integrated approach, we investigated the prevalence of these activities by testing, via a Structural Equation Model, the influence of such psychosocial variables on the intention to preserve physical fitness during the healthcare emergency. Through an adequate fit of the hypothesized model and a multi-group analysis, we compared the most COVID-19 hit Italian region - Lombardy - to the rest of Italy, finding that anxiety was significantly higher in the Lombardy region than the rest of the country. In addition, anxiety negatively influenced the intention to do physical activity. Giving the potential deleterious effects of physical inactivity due to personal restrictions, these data may increase preparedness of public health measures and attractiveness of recommendations, including on the beneficial effects of exercise, under circumstances of social distancing to control an outbreak of a novel infectious disease.