Changes in mental health outcomes in the general population 14 months into the COVID-19 pandemic in Italy

Background: The COVID-19 pandemic exerted an immediate detrimental impact on the population's psycho-logical wellbeing worldwide. This 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 socio-demographic, 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 and the lack of social meetings. Limitations: Due to the web-based design, potential biases such as self-selection bias and systematic bias in estimating mental health outcomes could not be excluded. Conclusion: We showed overall decrease of distress 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 long-term impact of the pandemic.