Were anxiety, depression and psychological distress associated with local mortality rates during COVID-19 outbreak in Italy? Findings from the COMET study

J Psychiatr Res. 2022 Aug:152:242-249. doi: 10.1016/j.jpsychires.2022.06.018. Epub 2022 Jun 16.


Background: The mental health of the Italian population declined at the onset of the COVID-19 pandemic. However, nationwide population prevalence estimates may not effectively reproduce the heterogeneity in distress responses to the pandemic. In particular, contextual determinants specific to COVID-19 pandemic need to be considered. We thus aimed to explore the association between local COVID-19 mortality rates and mental health response among the general population.

Methods: We capitalised on data (N = 17,628) from a large, cross-sectional, national survey, the COMET study, run between March and May 2020. While psychological distress was measured by General Health Questionnaire-12 (GHQ-12), the Depression, Anxiety and Stress Scale-21 Items (DASS-21) was used to assess relevant domains. In addition, a Covid-19 mortality ratio was built to compare single regional mortality rates to the national estimate and official statistics were used to control for other area-level determinants.

Results: Adjusted ordered regression analyses showed an association between mortality ratio and moderate (OR = 1.10, 95%CI 1.03-1.18) and severe (OR = 1.11, 95%CI 1.03-1.21) DASS-21 anxiety levels. No effects of mortality ratio on GHQ-12 scores and DASS-21 depression and stress levels, uniformly high across the country, were estimated.

Conclusions: Although we could not find any association between regional COVID-19 mortality ratio and depression or psychological distress, anxiety levels were significantly increased among subjects from areas with the highest mortality rates. Local mortality rate seems a meaningful driver for anxiety among the general population. Considering the potentially long-lasting scenario, local public health authorities should provide neighbouring communities with preventive interventions reducing psychological isolation and anxiety levels.

Keywords: Anxiety; COVID-19; Depression; Mortality rate; Psychological distress.

MeSH terms

  • Anxiety / epidemiology
  • Anxiety / psychology
  • COVID-19*
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Depression / psychology
  • Disease Outbreaks
  • Humans
  • Pandemics
  • Psychological Distress*
  • SARS-CoV-2
  • Stress, Psychological / epidemiology
  • Stress, Psychological / psychology
  • Surveys and Questionnaires