4.5 Article

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

Journal

EUROPEAN JOURNAL OF NUTRITION
Volume 61, Issue 3, Pages 1491-1505

Publisher

SPRINGER HEIDELBERG
DOI: 10.1007/s00394-021-02752-4

Keywords

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

Funding

  1. Lombardy Region (DG-Welfare) [7082/2020]
  2. AXA Research Fund
  3. Italian Ministry of Health [CF RETE CARDIO-RCR-2020-23670065]

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The study found that psychological distress resulting from the COVID-19 lockdown is directly associated with unhealthy dietary changes, with increased consumption of ultra-processed foods linked to depression, anxiety, stress, and post-traumatic stress disorder. However, adherence to the Mediterranean diet seemed less affected by psychological distress.
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 (R) 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 (beta = - 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.

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