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Id Subject Object Predicate Lexical cue
T1 0-113 Sentence denotes Reduced Hedonic Tone and Emotion Dysregulation Predict Depressive Symptoms Severity during the COVID-19 Outbreak:
T2 114-170 Sentence denotes An Observational Study on the Italian General Population
T3 172-180 Sentence denotes Abstract
T4 181-248 Sentence denotes The COVID-19 pandemic has spiked stress-related symptoms worldwide.
T5 249-482 Sentence denotes This study aims to assess depressive symptoms related to the early phase of the COVID-19 outbreak among the Italian general population and to analyze anhedonia and emotion dysregulation as potential predictors of depression severity.
T6 483-796 Sentence denotes Through an online questionnaire, we collected sociodemographic and lockdown-related information; depressive symptoms, hedonic tone, and emotion dysregulation were assessed through the Beck Depression Inventory II, the Snaith–Hamilton Pleasure Scale, and the Difficulties in Emotion Regulation Scale, respectively.
T7 797-904 Sentence denotes In our sample (n = 500), 122 individuals (24.4%) reported depressive symptoms during the COVID-19 outbreak.
T8 905-1033 Sentence denotes Individuals with and without depression differed in gender (X2 = 4.77, df = 1, p = 0.02) and age (X2 = 15.7, df = 4, p = 0.003).
T9 1034-1206 Sentence denotes Among individuals presenting with depressive symptoms, those reporting close contact with confirmed cases of COVID-19 were at higher risk for severe depression (p = 0.026).
T10 1207-1313 Sentence denotes Reduced hedonic tone (p = 0.014) and emotion dysregulation (p < 0.001) also predicted depression severity.
T11 1314-1503 Sentence denotes To the best of our knowledge, these are among the earliest data that focus on the risk for depression among a sizeable sample of the Italian general population during the COVID-19 outbreak.
T12 1504-1708 Sentence denotes Our results indicate emotion dysregulation and reduced hedonic tone as potential factors predicting COVID-19-related depression severity and provide insight into developing targeted intervention policies.
T13 1710-1712 Sentence denotes 1.
T14 1713-1725 Sentence denotes Introduction
T15 1726-1826 Sentence denotes The COVID-19 pandemic and the resulting isolation have spiked stress-related symptoms worldwide [1].
T16 1827-1934 Sentence denotes Italy was the first European Country to face the COVID-19 emergency and to declare a national lockdown [2].
T17 1935-2119 Sentence denotes On 9 March 2020, the Italian government imposed a national quarantine, restricting the movement of the population except for necessity, special work permissions, and health conditions.
T18 2120-2329 Sentence denotes Preventive containment measures during the COVID-19 epidemic, including self-isolation and social distancing, had a strong impact on people’s daily life and adversely affected psychological well-being further.
T19 2330-2476 Sentence denotes Individuals experiencing stress symptoms can feel overwhelmed with emotions and can be at higher risk for developing clinical depressive symptoms.
T20 2477-2688 Sentence denotes However, only mixed evidence is available for whether inter-individual characteristics and demographics may account for determining the psychological response of a population facing massive stressful events [3].
T21 2689-2860 Sentence denotes Hence, as the epidemic continues, enhancing our ability to detect possible predictors of the psychological impact during the COVID-19 outbreak is an important focus point.
T22 2861-3031 Sentence denotes “Anhedonia” is derived from the Greek “a-” (without) “hedone” (pleasure, delight) and is described as the inability to gain pleasure from normally pleasurable activities.
T23 3032-3194 Sentence denotes Pleasure plays a key role in predisposing survival of biological resources and in guaranteeing an essential contribution to the success of adaptive behaviors [4].
T24 3195-3511 Sentence denotes Conversely, anhedonia is an obstacle to achieving evolutionary goals, and it has been considered as a core feature of depressive phenotypes [5], insomuch that Klein proposed the existence of a subtype of major depression, referred to as endogenomorphic depression, marked by characterological anhedonic features [6].
T25 3512-3746 Sentence denotes Indeed, anhedonia is a required symptom for the diagnosis of a major depressive episode, and evidence suggests that trait anhedonia may represent an important prognostic indicator in individuals suffering from affective disorders [7].
T26 3747-3985 Sentence denotes Differences in anhedonia have also been studied on an individual level, suggesting that the subjective hedonic experience originates from brain areas that activate to drive us toward the attainment of primary or secondary human needs [8].
T27 3986-4125 Sentence denotes These regions are part of the so-called brain reward system: amygdala, nucleus accumbens, orbitofrontal cortex (OFC), and cingulate cortex.
T28 4126-4403 Sentence denotes In particular, Zhang et al. [9] suggested that the morphology of the OFC reflects quantitative traits of anhedonia that are continuously distributed throughout the general population and may serve to identify subjects who are at enhanced risk of developing affective disorders.
T29 4404-4681 Sentence denotes Emotional responses are multifaceted phenomena that are associated with bodily symptoms, subjective experiences, cognitive changes, and action tendencies, whereas the hedonic marking of emotions is the quality that distinguishes affects from other psychological processes [10].
T30 4682-4848 Sentence denotes Research on emotion regulation has highlighted that individuals actively respond and often try to modify their affective states rather than passively experience them.
T31 4849-5075 Sentence denotes Indeed, emotion regulation broadly refers to the ability to monitor and evaluate emotional experiences, modulate their intensity or duration, and adaptively manage emotional reactions in order to meet situational demands [11].
T32 5076-5225 Sentence denotes A substantial body of literature suggests the role of emotion dysregulation in accounting for the onset, overlap, and maintenance of depression [12].
T33 5226-5511 Sentence denotes Studies examining emotion regulation in depression have also suggested that depressed individuals exhibit more frequent use of maladaptive strategies, including suppression and rumination, when regulating affects and show difficulties effectively implementing adaptive strategies [13].
T34 5512-5707 Sentence denotes The documented connection between epidemics and mental health sequelae dates back more than 100 years ago, when Menninger associated the 1918 Spanish flu pandemic with psychiatric morbidity [14].
T35 5708-6098 Sentence denotes Over the past few months, a number of studies reported on the prevalence of depressive symptoms among the general population during the COVID-19 pandemic and identified several potential predictive factors, including age, gender, marital status, education level, occupation, loneliness, having an acquaintance infected with COVID-19, as well as past history of medical disorders [15,16,17].
T36 6099-6254 Sentence denotes Conversely, relatively few studies have investigated psychological determinants of depressive symptoms severity during the COVID-19 outbreak [18,19,20,21].
T37 6255-6538 Sentence denotes In light of these observations, we aimed at filling this gap by reporting prevalence of depressive symptoms and distribution patterns of hedonic and emotional dysregulation in a sizeable sample of 500 healthy individuals assessed in the early phase of the COVID-19 outbreak in Italy.
T38 6539-6730 Sentence denotes Further, we sought to identify risk factors predicting depression severity among demographic characteristics, medical and psychopathological variables, and information on lockdown conditions.
T39 6731-6881 Sentence denotes We hypothesized that reduced hedonic capacity and emotional dysregulation might specifically predict depression severity during the COVID-19 pandemic.
T40 6883-6885 Sentence denotes 2.
T41 6886-6907 Sentence denotes Materials and Methods
T42 6908-7013 Sentence denotes The study was conducted through an on-line survey, starting on 10 April 2020 and ending on 13 April 2020.
T43 7014-7277 Sentence denotes This timeline was chosen in order to assess participant response during an early phase of the COVID-19 outbreak, after the lockdown in Italy following the governmental decree of 9 March 2020, and the WHO characterization of COVID-19 as a pandemic (11 March 2020).
T44 7278-7409 Sentence denotes During this period, the total COVID-19 confirmed cases and deaths were 147.577 and 18.849, respectively (Italian Civil Department).
T45 7410-7481 Sentence denotes The snowball sampling method was employed to recruit participants [22].
T46 7482-7943 Sentence denotes In an attempt to ensure an adequately representative sample of the Italian population, an initial subset of invitees (five participants) was selected according to fixed socio-demographic variables, including age groups (18–27, 28–37, 38–47, 48–57, and >57 years old) gender (male, female), occupation (student, employed, unemployed), education level (graduate, undergraduate), and geographic location (northern Italy, central Italy, southern Italy and islands).
T47 7944-8068 Sentence denotes This subset of participants then forwarded the questionnaire to five referrals whom they considered suitable for the survey.
T48 8069-8158 Sentence denotes This second subset forwarded the survey in the same way and so on, until data saturation.
T49 8159-8232 Sentence denotes The survey was anonymous, and confidentiality of information was assured.
T50 8233-8458 Sentence denotes Participants aged 18–75 years, living in Italy for at least four weeks from February 2020, with adequate command over written and spoken Italian language, and with at least five years of education were eligible for the study.
T51 8459-8655 Sentence denotes Respondents were excluded if they were non-Italian language speakers, were currently hospitalized, reported a history of mental disorder, and/or could not complete the online survey independently.
T52 8656-8734 Sentence denotes The study followed the European Survey Research Association (ESRA) guidelines.
T53 8735-8801 Sentence denotes All participants completed the questionnaire on-line via EUSurvey.
T54 8802-9254 Sentence denotes The study was approved by the Agostino Gemelli University Hospital Foundation IRCCS-Catholic University of the Sacred Heart of Rome Ethics Committee (approval protocol number ID 3114) and was undertaken in accordance with the Principles of Human Rights, as adopted by the World Medical Association at the 18th WMA General Assembly, Helsinki, Finland, June 1964 and subsequently amended at the 64th WMA General Assembly, Fortaleza, Brazil, October 2013.
T55 9255-9393 Sentence denotes The provision of electronic informed consent was mandatory in order to start the survey, and anonymity was guaranteed to all participants.
T56 9394-9475 Sentence denotes The final study sample included 500 subjects from the Italian general population.
T57 9476-9577 Sentence denotes The number of participants was estimated according to sensitivity analysis conducted on G*Power [23].
T58 9578-9833 Sentence denotes Power analysis suggested that an aprioristic sample size of N = 500 would detect with a probability ≥ 0.9 a minimally interesting effect size of δ = 0.2, assuming a two-sided criterion for detection that allows for a maximum Type I error rate of α = 0.05.
T59 9834-10284 Sentence denotes A dedicated, self-report questionnaire was adopted to collect main demographic characteristics (age, gender, educational level, occupation, marital status), medical variables (lifetime history of chronic diseases, family history of psychiatric disorders) and information on lockdown conditions (living alone, change in working activities, working on frontline, and having had close contact with confirmed COVID-19 cases; see Supplementary Materials).
T60 10285-10486 Sentence denotes To measure the severity of depressive symptoms we adopted the Beck Depression Inventory II (BDI-II) [24], one of the most widely recognized as well as valid and reliable screening tests for depression.
T61 10487-10640 Sentence denotes Participants must rate their agreement with each statement on a 4-point Likert scale (0 = not at all; 3 = severely) referring to the preceding two weeks.
T62 10641-10750 Sentence denotes Each of the 21 items of the BDI-II corresponding to a symptom of depression is summed to give a single score.
T63 10751-10794 Sentence denotes The BDI-II total score ranges from 0 to 63.
T64 10795-10932 Sentence denotes Consistently with previous validation studies, we adopted a cut-off score of >13 to detect the likelihood of presence of depression [24].
T65 10933-11166 Sentence denotes Hedonic tone was investigated by the Snaith–Hamilton Pleasure Scale (SHAPS) [25], a 14-item self-report instrument that assesses the ability to feel consummatory pleasure in response to stimuli that typically elicit positive emotion.
T66 11167-11273 Sentence denotes The SHAPS covers four domains: interests/pastimes, social interaction, sensory experience, and food/drink.
T67 11274-11433 Sentence denotes Subjects are requested to agree or disagree with a statement for each item on a Likert-type scale (definitely agree, agree, disagree, and definitely disagree).
T68 11434-11507 Sentence denotes In order to avoid response set, some items are phrased in negative terms.
T69 11508-11601 Sentence denotes The four available answers are divided into dichotomous categories (agree = 0; disagree = 1).
T70 11602-11640 Sentence denotes Scores range, therefore, from 0 to 14.
T71 11641-11840 Sentence denotes To assess deficits in emotion regulation we used the Difficulties in Emotion Regulation Scale (DERS) [26], a 36-item self-report instrument that targets the individual level of emotion dysregulation.
T72 11841-11946 Sentence denotes Exploratory factor analysis of the original validation study highlighted a six-factor model for the DERS.
T73 11947-12701 Sentence denotes The six-factor model is reflected into six subscales yielding a total score: (a) lack of emotional awareness (Awareness; “I am attentive to my feelings”); (b) lack of emotional clarity (Clarity; “I have difficulty making sense out of my feelings”); (c) impulse control difficulties when distressed (Impulse; “When I’m upset, I become out of control”); (d) difficulties engaging in goal-directed behaviors when distressed (Goals; “When I’m upset, I have difficulty getting work done”); (e) unwillingness to accept emotional responses (Non-acceptance; “When I’m upset, I become angry at myself for feeling that way); and (f) lack of access to emotion regulation strategies (Strategies; “When I’m upset, I believe there is nothing I can do to feel better”).
T74 12702-12802 Sentence denotes Participants rate each item using a 5-point Likert-type scale (1 = almost never; 5 = almost always).
T75 12803-12846 Sentence denotes The DERS total score ranges from 36 to 180.
T76 12847-12932 Sentence denotes The higher the DERS total scores, the greater the difficulties in emotion regulation.
T77 12933-13219 Sentence denotes In prior studies, the DERS has demonstrated convergent validity with other established measures of emotion dysregulation, good test–retest reliability, excellent internal consistency, and adequate predictive validity of several behavioral outcomes associated with emotion dysregulation.
T78 13220-13558 Sentence denotes To fit our aims, we compared individuals presenting with and without depression according to BDI-II cut-off scores on the basis of contingency table/χ2 for categorical measures, including demographic characteristics, medical variables, information on lockdown conditions, and Student’s t-test for hedonic tone and emotional dysregulation.
T79 13559-13605 Sentence denotes The level of significance was set at p < 0.05.
T80 13606-13797 Sentence denotes In the group of depressed participants, a multivariate general linear model was conducted to test the effect of all factors of interest on depression severity according to BDI-II total score.
T81 13798-14021 Sentence denotes Specifically, multiple linear regression was used to predict depression severity on the basis of demographic characteristics, medical variables, information on lockdown conditions, hedonic tone, and emotional dysregulation.
T82 14022-14182 Sentence denotes Possible multicollinearity between variables of interest was tested through variance inflation factor (VIF) indicators obtained from linear regression analysis.
T83 14183-14280 Sentence denotes All statistical analyses were performed using SPSS 24.0 for Windows (IBM Corp., Armonk, NY, USA).
T84 14282-14284 Sentence denotes 3.
T85 14285-14292 Sentence denotes Results
T86 14293-14347 Sentence denotes A total of 500 individuals were included in the study.
T87 14348-14462 Sentence denotes One hundred and twenty-two individuals (24.4%) reported relevant depressive symptoms during the COVID-19 outbreak.
T88 14463-14591 Sentence denotes Individuals with and without depression differed in gender (χ2 = 4.77, df = 1, p = 0.02) and age (χ2 = 15.7, df = 4, p = 0.003).
T89 14592-14734 Sentence denotes Specifically, among individuals displaying depressive symptoms, most participants were female (n = 83, 68%) and were aged 18–27 (n = 39, 32%).
T90 14735-14910 Sentence denotes Subjects presenting with depressive symptoms reported reduced hedonic tone (F = 36, df = 1, p < 0.001) and higher levels of emotion dysregulation (F = 161, df = 1, p < 0.001).
T91 14911-15234 Sentence denotes The two groups did not differ for medical variables and information on lockdown conditions, including lifetime history of chronic diseases, family history of psychiatric disorders, living alone, change in working activities, working on the frontline, and having had close contact with confirmed cases of COVID-19 (Table 1).
T92 15235-15381 Sentence denotes Among subjects with depressive features, those reporting close contacts with confirmed cases of COVID-19were at higher risk for severe depression.
T93 15382-15489 Sentence denotes Reduced hedonic tone and emotional dysregulation also specifically predicted depression severity (Table 2).
T94 15490-15625 Sentence denotes There was no significance of multicollinearity in the model, as indicated by the fact that the VIF of all variables of interest was <2.
T95 15626-15796 Sentence denotes Regression lines of estimated marginal means depicting the relationship between depression and anhedonia, adjusted for emotional dysregulation, are reported in Figure S2.
T96 15798-15800 Sentence denotes 4.
T97 15801-15811 Sentence denotes Discussion
T98 15812-15896 Sentence denotes To date, the mental health impacts of the COVID-19 outbreak is still under-reported.
T99 15897-16150 Sentence denotes Individual emotional responses during the massive infectious disease outbreaks are likely to include feelings of extensive fear and uncertainty that, along with social and economic consequences, may eventually cause a dramatic mental health burden [27].
T100 16151-16319 Sentence denotes For this reason, we conducted a survey to investigate the occurrence of depressive symptoms among the Italian general population during the early phase of the pandemic.
T101 16320-16448 Sentence denotes We also went further, by hypothesizing that distinct psychopathological risk factors may conjointly predict depression severity.
T102 16449-16563 Sentence denotes The results provide additional support for societal concerns of the stressful impact of COVID-19 on mental health.
T103 16564-16708 Sentence denotes Our findings indicated, in fact, that nearly 25% of our sample displayed a relevant depressive symptomatology according to BDI-II cutoff scores.
T104 16709-16898 Sentence denotes Similar rates of depressive symptoms were reported by cross-sectional studies conducted among the general population of worst-hit countries during the initial stage of the pandemic [28,29].
T105 16899-16988 Sentence denotes Of note, the majority of individuals in our sample reported no depressive symptomatology.
T106 16989-17144 Sentence denotes This might be due to the still relatively short exposure to the pandemic or to possible interindividual protective factors promoting mental health [30,31].
T107 17145-17332 Sentence denotes Our results also suggested that women and younger individuals were, to a certain degree, more likely to experience significant symptoms of depression in response to the COVID-19 outbreak.
T108 17333-17584 Sentence denotes These findings may in part be due to the fact that women represent a greater percentage of the workforce that has been negatively affected by the COVID-19 outbreak, including retail, service industry, and healthcare, in addition to biological factors.
T109 17585-17727 Sentence denotes Similarly, work loss and unpredictability that derived from the COVID-19 pandemic may be particularly stressful among younger age groups [15].
T110 17728-17883 Sentence denotes The present findings highlighted that direct exposure to confirmed cases ofCOVID-19 may significantly account for the determination of depression severity.
T111 17884-17982 Sentence denotes The COVID-19 pandemic may embody a number of negative emotional states and overwhelming stressors.
T112 17983-18175 Sentence denotes A few of these include loss of employment; deaths of family members, friends, or colleagues; financial insecurity; isolation from others; as well as risk of exposure to contagious individuals.
T113 18176-18408 Sentence denotes The fact that COVID-19 is human-to-human transmissible, associated with high morbidity, as well as being potentially fatal, may intensify depressive feelings, particularly among those who reported contacts with confirmed cases [32].
T114 18409-18631 Sentence denotes In line with our results, a recent population-based study among the community of Wuhan, China identified close contact with individuals with COVID-19 as a risk factor for depression during the first month of lockdown [33].
T115 18632-18750 Sentence denotes Decreased emotion regulation abilities as well as anhedonia significantly predicted depression severity in our sample.
T116 18751-18981 Sentence denotes Sustained negative affects and stressors tend to deplete one’s energy and ability to adaptively cope with situational challenges, which in turn may exacerbate the experience of negative affects, including depressive symptoms [34].
T117 18982-19234 Sentence denotes An important issue pertaining to emotion regulation concerns the interindividual variability in experiencing negative or positive affects, as well as the habitual tendency to prefer some regulatory strategies over others to control distressful affects.
T118 19235-19349 Sentence denotes On the one hand, depression has long been associated with increased levels of negative and stressful affects [35].
T119 19350-19534 Sentence denotes On the other hand, one of the key components of emotion dysregulation is the inability to regulate negative emotion and to decrease the duration of negative affect once it arises [36].
T120 19535-19703 Sentence denotes Consistently with this conceptual framework, there is evidence linking impaired emotion regulation mechanisms with depressive symptoms, also at a neurobiological level.
T121 19704-19902 Sentence denotes Indeed, depression has been repeatedly associated with dysfunction in brain regions that are normally implicated in emotion regulation, including prefrontal cortex, (PFC), amygdala, and hippocampus.
T122 19903-20163 Sentence denotes Intriguingly, these regions have been implicated in the regulation of stress and coping, with the PFC and the hippocampus providing inhibitory control over stress responses, whereas the amygdala has been implicated in potentiating stress-related behaviors [5].
T123 20164-20282 Sentence denotes A growing body of evidence suggests that acute stressors may also adversely affect sensitivity to hedonic stimuli [7].
T124 20283-20494 Sentence denotes Similarly, anhedonic symptoms have long been conceptualized in terms of blunted response to positive reinforcement, which in turn represents a biological endophenotype of increased depression vulnerability [37].
T125 20495-20707 Sentence denotes Taken together, emotion dysregulation and anhedonia may therefore reflect a more general individual incapacity to regulate adaptive responses when facing stressful events, which may ultimately lead to depression.
T126 20708-20949 Sentence denotes The findings reported here may have practical implications, as the effect of emotion dysregulation and impaired hedonic tone on depressive symptoms is actionable and modifiable through specific interventions on emotion regulation mechanisms.
T127 20950-21088 Sentence denotes The emerging fields of emotion research and affective neuroscience have, in fact, paved the way for new potential therapeutic venues [38].
T128 21089-21333 Sentence denotes This literature points to mutually inhibitory relationships among neural regions implicated in emotion regulation, and a wide network of cortical areas that are involved in downregulating early reactivity to emotionally salient stimuli [11,39].
T129 21334-21427 Sentence denotes We understand that the choice of an online survey is not free from methodological risks [40].
T130 21428-21623 Sentence denotes However, this was necessary in order to reach a sizeable percentage of the Italian population in a short time during an early phase of the outbreak, when face-to-face contacts are forbidden [41].
T131 21624-21747 Sentence denotes Before drawing a study conclusion, we must acknowledge some issues that might mitigate the generalizability of our results.
T132 21748-21835 Sentence denotes First, the study was carried out throughout four days and lacks longitudinal follow-up.
T133 21836-21966 Sentence denotes Indeed, the mental health impact of the COVID-19 outbreak on the Italian general population might become more stressful over time.
T134 21967-22221 Sentence denotes Second, the survey design involved a non-probabilistic sampling method which relied upon the capacity of participants to forward online invitations to others, so that each participant’s suitability may be not controlled for once sample increases in size.
T135 22222-22319 Sentence denotes Third, people not using network devices, as well as non-Italian language speakers, were excluded.
T136 22320-22501 Sentence denotes This might represent a selection bias, as there is evidence that COVID-19 disproportionately affects minority groups as well as those living in socially disadvantaged contexts [42].
T137 22502-22641 Sentence denotes Fourth, it was not possible to calculate the participation rate, since it is unclear how many individuals received the link for the survey.
T138 22642-22727 Sentence denotes Finally, the reliability of self-administered questionnaires may be partially biased.
T139 22729-22731 Sentence denotes 5.
T140 22732-22743 Sentence denotes Conclusions
T141 22744-23076 Sentence denotes In conclusion, our result indicate that a relevant percentage of our sample may have experienced relevant depressive symptoms during the early phase of the COVID-19 outbreak and that direct exposure to COVID-19+ confirmed cases, along with emotion dysregulation and anhedonia, may significantly predict depression symptoms severity.
T142 23077-23312 Sentence denotes It seems fundamental to recognize the potential for mental health consequences of COVID-19 to be large in scale, to identify that these effects can be long-lasting, and to consider preventative action to help mitigate its effects [43].
T143 23313-23473 Sentence denotes As the pandemic continues, more work is necessary to clarify risk factors associated with mental health negative outcomes related to the COVID-19 outbreak [44].
T144 23474-23663 Sentence denotes Besides, interventions or policies aimed at empowering emotion regulation strategies and stress resilience may have beneficial effects on health and well-being during the COVID-19 pandemic.
T145 23665-23788 Sentence denotes Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
T146 23790-23813 Sentence denotes Supplementary Materials
T147 23814-23913 Sentence denotes The following are available online at https://www.mdpi.com/1660-4601/18/1/255/s1, Questionnaire S1:
T148 23914-23946 Sentence denotes Survey questionnaire, Figure S2:
T149 23947-24089 Sentence denotes Regression lines of estimated marginal means depicting the interaction between depression and anhedonia, adjusted for emotional dysregulation.
T150 24090-24126 Sentence denotes Click here for additional data file.
T151 24128-24148 Sentence denotes Author Contributions
T152 24149-24220 Sentence denotes M.D.N., A.F., G.S., and L.J. designed the study and wrote the protocol.
T153 24221-24301 Sentence denotes G.G., L.M. (Laura Monti), and M.M. managed the literature searches and analyses.
T154 24302-24412 Sentence denotes L.M. (Lorenzo Moccia) and D.J. undertook the statistical analysis and wrote the first draft of the manuscript.
T155 24413-24621 Sentence denotes Data curation, G.G. and B.A.; Investigation, M.M.; Project administration, E.C.; Resources, L.M. (Laura Monti); Supervision, A.F., G.S., M.D.N. and L.J.; Writing—original draft, L.M. (Lorenzo Moccia) and D.J.
T156 24622-24698 Sentence denotes All authors have read and agreed to the published version of the manuscript.
T157 24700-24707 Sentence denotes Funding
T158 24708-24751 Sentence denotes This research received no external funding.
T159 24753-24789 Sentence denotes Institutional Review Board Statement
T160 24790-25051 Sentence denotes The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Agostino Gemelli University Hospital Foundation IRCCS-Catholic University of the Sacred Heart of Rome (protocol code 3114, 8 April 2020).
T161 25053-25079 Sentence denotes Informed Consent Statement
T162 25080-25150 Sentence denotes Informed consent was obtained from all subjects involved in the study.
T163 25152-25179 Sentence denotes Data Availability Statement
T164 25180-25268 Sentence denotes The data presented in this study are available on request from the corresponding author.
T165 25270-25291 Sentence denotes Conflicts of Interest
T166 25292-25336 Sentence denotes The authors declare no conflict of interest.
T167 25338-25397 Sentence denotes Table 1 Sociodemographic and psychometric characteristics.
T168 25398-25486 Sentence denotes Characteristics(n,%) Total No Depressive Symptoms DepressiveSymptoms χ2 or t df p
T169 25487-25523 Sentence denotes Overall 500 378 (75.6) 122 (24.4)
T170 25524-25547 Sentence denotes Age 15.7 4 0.003
T171 25548-25587 Sentence denotes 18–27 116 (23.2) 77 (20.4) 39 (32.0)
T172 25588-25627 Sentence denotes 28–37 129 (25.8) 95 (25.1) 34 (27.9)
T173 25628-25666 Sentence denotes 38–47 83 (16.6) 59 (15.6) 24 (19.7)
T174 25667-25704 Sentence denotes 48–57 81 (16.2) 70 (18.5) 11 (9.0)
T175 25705-25741 Sentence denotes >57 91 (18.2) 77 (20.4) 14 (11.5)
T176 25742-25768 Sentence denotes Gender 4.77 1 0.029
T177 25769-25808 Sentence denotes Male 202 (40.4) 163 (43.1) 39 (32.0)
T178 25809-25850 Sentence denotes Female 298 (59.6) 215 (56.9) 83 (68.0)
T179 25851-25887 Sentence denotes Educational level 1.24 1 0.266
T180 25888-25937 Sentence denotes ≤Undergraduate 147 (29.4) 116 (30.7) 31 (25.4)
T181 25938-25982 Sentence denotes ≥Graduate 353 (70.6) 262 (69.3) 91 (74.6)
T182 25983-26012 Sentence denotes Occupation 0.03 2 0.985
T183 26013-26053 Sentence denotes Student 72 (14.4) 55 (14.6) 17 (13.9)
T184 26054-26097 Sentence denotes Employed 350 (70.0) 264 (69.8) 86 (70.5)
T185 26098-26141 Sentence denotes Unemployed 78 (15.6) 59 (15.6) 19 (15.6)
T186 26142-26175 Sentence denotes Marital status 0.81 1 0.367
T187 26176-26218 Sentence denotes Married 181 (36.2) 141 (37.3) 40 (32.8)
T188 26219-26263 Sentence denotes Unmarried 319 (63.8) 237 (62.7) 82 (67.2)
T189 26264-26350 Sentence denotes Lifetime history of chronic disease 148 (29.6) 107 (28.3) 41 (33.6) 1.24 1 0.265
T190 26351-26439 Sentence denotes Family history of psychiatric disorders 67 (13.4) 50 (13.2) 17 (13.9) 0.03 1 0.842
T191 26440-26501 Sentence denotes Living alone 70 (14.0) 55 (14.6) 15 (12.3) 0.39 1 0.533
T192 26502-26583 Sentence denotes Changes in working activities 439 (87.8) 331 (87.6) 108 (88.5) 0.08 1 0.779
T193 26584-26654 Sentence denotes Working on frontline 128 (25.6) 97 (25.7) 31 (25.4) 0.01 1 0.956
T194 26655-26731 Sentence denotes Contact with COVID-19 cases 65 (13.0) 49 (13.0) 16 (13.1) 0.01 1 0.965
T195 26732-26764 Sentence denotes Psychometric assessment (M ± SD)
T196 26765-26821 Sentence denotes SHAPS 1.2 ± 2.4 0.7 ± 1.6 2.8 ± 3.7 −8.6 1 <0.001
T197 26822-26884 Sentence denotes DERS 75.7 ± 23.1 68.2 ± 16.7 98.8 ± 24.7 −15.4 1 <0.001
T198 26885-26924 Sentence denotes Significant results in bold characters.
T199 26925-27211 Sentence denotes Abbreviations: M, mean; SD, standard deviation; df, degrees of freedom; χ2, chi-squared test; p, statistical significance; t, Student’s t; SD standard deviation; BDI-II, Beck Depression Inventory II; SHAPS, Snaith–Hamilton Pleasure Scale; DERS, Difficulties in Emotion Regulation Scale.
T200 27212-27242 Sentence denotes Table 2 General linear model:
T201 27243-27286 Sentence denotes Effect of predictors on BDI-II total score.
T202 27287-27342 Sentence denotes Predictor Estimate SE 95% Confidence Interval t p
T203 27343-27355 Sentence denotes Lower Upper
T204 27356-27406 Sentence denotes Age −0.453 0.4370 −1.3195 0.413 −1.037 0.302
T205 27407-27459 Sentence denotes Gender −2.243 1.2604 −4.741 0.255 −1.779 0.078
T206 27460-27521 Sentence denotes Educational level 0.436 1.3793 −2.298 3.170 0.316 0.753
T207 27522-27576 Sentence denotes Occupation 0.773 1.1109 −1.429 2.975 0.696 0.488
T208 27577-27635 Sentence denotes Marital status 1.809 1.3260 −0.819 4.438 1.364 0.175
T209 27636-27717 Sentence denotes Lifetime history of chronic disease −1.071 1.3192 −3.685 1.544 −0.812 0.419
T210 27718-27803 Sentence denotes Family history of psychiatric disorders −0.669 1.6447 −3.929 2.591 −0.407 0.685
T211 27804-27862 Sentence denotes Living alone −0.204 1.6858 −3.545 3.138 −0.121 0.904
T212 27863-27939 Sentence denotes Changes in working activities −3.006 1.8719 −6.7167 0.704 −1.606 0.111
T213 27940-28007 Sentence denotes Working on frontline −1.811 1.4169 −4.6197 0.998 −1.278 0.204
T214 28008-28080 Sentence denotes Contact with COVID-19 cases 4.052 1.7994 0.4853 7.619 2.252 0.026
T215 28081-28131 Sentence denotes SHAPS 0.393 0.1575 0.0804 0.705 2.492 0.014
T216 28132-28182 Sentence denotes DERS 0.174 0.0234 0.1277 0.221 7.434 <0.001
T217 28183-28222 Sentence denotes Significant results in bold characters.
T218 28223-28386 Sentence denotes Abbreviations: p, statistical significance; SE, size effect; t, t statistic; SHAPS, Snaith–Hamilton Pleasure Scale; DERS, Difficulties in Emotion Regulation Scale.