Lay Summary

1. A web-based follow-up assessment of anxiety, depression and post-traumatic stress symptoms in a sample of 5501 Italian participants 14 months into the COVID-19 pandemic. 2. We showed overall decrease of depression, anxiety, and stress-related symptoms in the general population; however, a significant proportion of the sample continues to experience general persistent distress over time, associated with female gender, lower age, a history of mental disorder, low resilience, social isolation and COVID-19 infection. 3. Factors associated with change in mental health outcomes could serve to inform interventions to mitigate the psychological and socio-economic long-term impact of the pandemic.

Background

The COVID-19 pandemic exerted an immediate detrimental impact on the population’s psychological wellbeing worldwide. The current longitudinal cohort study investigated the trajectories of depression, anxiety, and stress-related symptoms 14 months into the COVID-19 pandemic in Italy, along with the impact of specific sociodemographic, contextual and psychological predictor variables.

Methods

A web-based survey spread throughout the internet between March and April 2020 (baseline) and between April and May 2021 (follow-up). Selected outcomes were post-traumatic stress symptoms, depression and anxiety. A general distress condition was considered as meeting the threshold score in any of the three outcomes.

Results

A total of 5501 (25.09%) subjects responded to the follow-up assessment. Based on the presence or absence of symptoms at the two timepoints, 2691 subjects (52.03%) were resilient to any outcome, 350 (6.77%) subjects had an incident general distress; 1061 (20.49%) subjects displayed remittent general distress, while 1071 (20.71%) subjects showed persistent general distress. Persistent distress was associated with female gender, lower age, a history of mental disorder, low resilience, social isolation and COVID-19 infection.

Conclusion

We showed overall decrease of depressive, anxiety, and stress-related symptoms in the general population 14 months after the first pandemic peak in Italy. However, a significant proportion of the sample continues to experience clinically relevant symptoms over time. Factors associated with change in mental health outcomes could help in the design of strategies to mitigate the psychological and socio-economic long-term impact of the pandemic.