Psychological distress resulting from the COVID-19 confinement is associated with unhealthy dietary changes in two Italian population-based cohorts

Eur J Nutr. 2022 Apr;61(3):1491-1505. doi: 10.1007/s00394-021-02752-4. Epub 2021 Nov 30.


Purpose: To examine the relationship between psychological distress resulting from the COVID-19 lockdown and dietary changes.

Methods: Cross-sectional analysis from 2 retrospective Italian cohorts recruited from May to September 2020: (1) The Moli-LOCK cohort consists of 1401 participants from the Moli-sani Study (n = 24,325) who were administered a telephone-based questionnaire to assess lifestyles and psychological factors during confinement; (2) the ALT RISCOVID-19 is a web-based survey of 1340 individuals distributed throughout Italy who self-responded to the same questionnaire using Google® forms. Psychological distress was measured by assessments of depression (PHQ-9 and depressive items from the Screening Questionnaire for Disaster Mental Health- SQD-D), anxiety (GAD-7), stress (PSS-4), and post-traumatic stress disorder (SQD-P). Diet quality was assessed either as changes in consumption of ultra-processed foods (UPF) or adherence to Mediterranean diet (MD).

Results: In ALT RISCOVID-19, increased UPF intake was directly associated with depression (both PHQ-9 and SQD-D; p < 0.0001), anxiety (p < 0.0001), stress (p = 0.001) and SQD-P (p = 0.001); similar results were obtained in the Moli-LOCK cohort except for perceived stress. When psychometric scales were analysed simultaneously, only depression (SQD-D) remained associated with UPF (both cohorts). In both cohorts, psychological distress poorly influenced changes toward an MD, except for depression (SQD-D) that resulted inversely associated in the ALT RISCOVID-19 participants (β = - 0.16; 95% CI - 0.26, - 0.06).

Conclusions: Psychological distress from the COVID-19 confinement is directly associated with unhealthy dietary modifications in two Italian cohorts. In view of possible future restrictive measures to contain pandemic, public health actions are warranted to mitigate the impact of psychological distress on diet quality.

Keywords: Anxiety; COVID-19; Depression; Lockdown; Mediterranean diet; Post-traumatic stress disorder; Psychological distress; Stress; Ultra-processed foods.

MeSH terms

  • COVID-19* / epidemiology
  • Communicable Disease Control
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Diet, Mediterranean*
  • Humans
  • Psychological Distress*
  • Retrospective Studies
  • Stress, Psychological / epidemiology