Mental health and access of care during Covid-19 pandemics: an italian cross-sectional study

Background COVID-19 emergency forced nations to introduce containment measures to reduce the spread of the virus. This study assessed the possible effects of the pandemic on mental health and care access. Methods A cross-sectional study was conducted in Italy in two observation periods in 2020: April-May (first lockdown) and November-December (no lockdown). Categorical variables were compared with χ2 tests. Mental health outcomes (PHQ-2 ≥ 3;or GAD-2 ≥ 3) and outcomes related to care access were considered. Multivariable logistic regression models were performed. Results Participants were 2673 (66.8% female;mean age=44 years, SD = 15). Depressive symptoms were found in 24.7% of participants, while 24.2% showed an anxious symptomatology. A total of 12.5% said they voluntarily gave up scheduled medical service, 6.4% avoided acute treatments, and 5% changed therapy themselves. Comparing the two periods, there were no significant differences in the outcomes under study. Students were at higher risk of depressive symptoms (OR = 2.23;95% CI 1.42-3.52;p = 0.001). Women and those who increased the time on internet presented an increased risk of developing depressive and anxious symptomatology. The scheduled medical service was mainly postponed by those who said they were afraid to go out of necessity (OR = 2.49;95% CI 1.87-3.32;p < 0.001) or to cause themselves an injury (OR = 1.78;95% CI 1.32-2.40;p < 0.001). Foreigners (OR = 4.24;95% CI 1.70-10.55;p < 0.002) are more likely to avoid acute treatment. Workers and those with anxious disorders appear to be more inclined to self-medicate (OR = 2.05;95% CI 1.29-3.26;p = 0.003). Conclusions Compared to the pre-pandemic period, higher levels of anxiety and depression were observed. No differences in mental health and care access were shown between the two observation periods. Being afraid to go out of necessity and avoidance of physical activity for fear of injury is related to reduced access to care, but not to self-medication. Key messages The 24.7 % of the sample reported depressive symptoms, and 24.2 % anxious symptoms. Similar increases were observed in both periods: April-May (first lockdown) and November-December (no lockdown). During the pandemic, delayed access to planned and acute care, avoidance of physical activity for fear of injury, and self-medication pose a major public health challenge in the coming period.