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  • Many psychological problems and important consequences in terms of mental health including stress, anxiety, depression, frustration, uncertainty during COVID-19 outbreak emerged progressively.
  • Common psychological reactions related to the mass quarantine which was imposed in order to attenuate the COVID-19 spread are generalized fear and pervasive community anxiety which are typically associated with disease outbreaks, and increased with the escalation of new cases together with inadequate, anxiety-provoking information which was provided by media.
  • The psychological reactions to COVID-19 pandemic may vary from a panic behavior or collective hysteria to pervasive feelings of hopelessness and desperation which are associated with negative outcomes including suicidal behavior. Importantly, other health measures may be compromised by abnormally elevated anxiety.

Aspecific and uncontrolled fears related to infection:

  • This is commonly one of the most frequent psychological reaction to pandemics.
  • Several existing studies demonstrated that those who have been exposed to the risk of infection may develop pervasive fears about their health, worries to infect others and fear infecting family members.
  • Other studies reported that pregnant women and individuals with young children are the most at risk to develop the fear of becoming infected or transmitting the virus.

Pervasive anxiety:

  • Social isolation related to restrictions and lockdown measures are linked to feelings of uncertainty for the future, fear of new and unknown infective agents resulting in abnormally increased anxiety.

Frustration and boredom:

  • Distress, boredom, social isolation and frustration are directly related to confinement, abnormally reduced social/physical contact with others, and loss of usual habits.
  • Frustration and pervasive loneliness seem to derive by the inhibition from daily activities, interruption of social necessities, not taking part in social networking activities..

Disabling loneliness:

  • The final effect of social isolation is pervasive loneliness and boredom, which have potential dramatic effects on both physical and mental individual well-being.
  • Pervasive loneliness may be significantly associated with increased depression and suicidal behavior.
  • Unfortunately, the isolation is progressively enhanced by anxiety, panic or collective hysteria.
  • Overall, it is well known that long periods of social isolation or quarantine for specific illnesses may have detrimental effects on mental well-being.

Risk factors:


  • The risk of related quarantine distress may be also due to the presence of alexithymic traits which may reduce psychological resilience in some subgroups of individuals.
  • Alexithymic individuals may show significantly higher levels of anxiety, depression and psychological distress than non-alexithymics.

Inadequate supplies

  • Feelings of frustration and incertainty tend to occur even in relation with inadequate basic supplies (e.g. food, water, clothes etc.) during the quarantine period which is a major source of worries, and anxiety/anger even after 4–6 months from quarantine.

Inadequate information

  • Existing evidence suggest that the poor or inadequate information from public health authorities may be a significant stressor because it provides inappropriate guidelines concerning call for actions or leads to confusion about the purpose of quarantine or the importance of measures needed to interrupt the pandemic spread.
  • Confusion may be directly related to different approaches, contradictory health messages, and poor coordination

Protective factors:

  • Resilience
    • Psychological resilience may be generally defined as the ability to support or retrieve psychological well-being during or after addressing stressful disabling conditions.
  • Social support
    • A higher and significant perception of social support is associated with a reduced likelihood to develop psychological distress and psychiatric conditions.
    • Adequate social support for the general population with regard to specific at risk populations (e.g. infected patients, quarantined individuals and medical professionals) should be provided by offering targeted, tailored messages according to the most reliable scientific evidence.
    • Relevantly, a variety of mental health supporting strategies are required in pandemic areas in order to facilitate lifestyle changes and re-adaptation activities required after the occurrence of invalidating outbreaks.

Way Forward:

  • Specific preventive strategies at the community level such as (i) implementing effective communication and (ii) providing adequate psychological services should be carried out in order to attenuate the psychological and psychosocial impact of COVID-19 outbreak.
  • Health education needs to be enhanced using online platforms, social fear related to COVID-19 needs to be correctly addressed while stigma and discrimination need to be recognized as major challenges able to reinforce the feelings of uncertainty in a period of social crisis.
  • Hospitals protocols linked to the early and effective management of health emergency need to be implemented while healthcare professionals need to be supplied by adequate protective facilities.
  • Scientific community should provide appropriate information to attenuate the impact of anxiety, frustration, and all the negative emotions which represent important barriers to the correct management of social crisis and psychological consequences related to pandemic.
  • Unmet needs should be rapidly identified by medical staff who need to communicate frequently and in a timely manner with most of patients to understand the risk to develop new symptoms or worsen a preexisting psychological distress.
  • Furthermore, telephones helplines, Internet access, active social networks, dedicated blogs and forums should be implemented in order to reduce social isolation and loneliness as well as allow to specific populations (e.g. infected subjects in hospitals or quarantine settings) the successful communication with their loved ones.
  • Marginalized populations such as elderly individuals or those with psychological problems should be able to actively consult with clinical psychotherapists to rapidly detect warning signs.
  • Telemedicine should be really implemented especially in areas where mental health services are poorly represented or severely impaired by the rapid spread of pandemic and lockdown restrictions.


  • Implementing community-based strategies to support resilience and psychologically vulnerable individuals during the COVID-19 crisis is fundamental for any community.
  • The psychological impact of fear and anxiety induced by the rapid spread of pandemic needs to be clearly recognized as a public health priority for both authorities and policy makers who should rapidly adopt clear behavioral strategies to reduce the burden of disease and the dramatic mental health consequences of this outbreak.