The negative consequences on mental health of the COVID-19 lockdown
The COVID-19 pandemic has been a disruptive experience that has had a decisive impact on people lives worldwide. It has been a unique epidemic due to speed of transmission and in a few weeks after hitting a single country, it became a global health emergency (Wang et al., 2020). Starting from the threat to one's own health and that of loved ones, this is an event that has upset many aspects of daily life suddenly and unexpectedly. The pandemic - and the consequent measures to stem the risk of contagion - have distorted people's daily lives and their habits in the working, relational and family spheres. According to DSM-5 (APA, 2013, p.271) trauma concerns "actual or threatened death, serious injury, or sexual violence", which can be experienced through "direct exposure", by "witnessing, in person", "indirectly, by learning that a close relative or close friend was exposed to trauma "or even through "repeated or extreme indirect exposure to aversive details of the event (s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse)". It is therefore possible to think of the experience of COVID-19 pandemic as a trauma to which the world has been exposed globally in these months and it is not possible not to consider the impact that this will have on people's psyche.
One of the most anticipated consequences after exposure to a trauma according to literature is post-traumatic stress disorder (PTSD), defined as a stress-related disorder that develops as a consequence of the exposure or testimony of a life-threatening traumatic event (Kessler, 2000). Previous studies on COVID 19 and other epidemic events, such as SARS outbreak, have shown that high levels of PTSD were one of the main consequences in percentages ranging from 10 to 47.8% (Chamberlein et al., 2021; Mak et al., 2009; Wu et al., 2009) on general population. In addition to PTSD, there are many other negative outcomes related to the traumatic experience of epidemics such as anxiety (Velotti et al., 2021; Desclaux et al., 2017; DiGiovanni et al., 2004; Bai et al., 2004), insomnia (Taquet et al, 2021; Desclaux et al., 2017; DiGiovanni et al., 2004; Lee et al., 2005), depressed mood (Velotti, Rogier et al., 2021; DiGiovanni et al., 2004; Hawryluck et al., 2004; Lee et al., 2005; Liu et al., 2005) addiction (Rogier, Beomonte Zobel & Velotti, 2021; Dubei et al., 2020) and irritability (Panda et al., 2021; Bai et al., 2004; Lee et al., 2005).
Covid-19 And Post Traumatic Growth
Although the negative outcomes related to traumatic events are well documented, from literature is known that from 80–90% of people who experience traumatic events is able to manage the consequences in an adaptive way, to find a meaning to what happened, to integrate trauma-related memories and to find a new balance in their functioning (Kessler et al., 1995; Pat-Horenczyk & Brom, 2007). This phenomenon, from which it generates the concept of resilience, refers to the idea that it is possible to return to a condition of equilibrium prior to the trauma but in recent years the idea has developed that it is also possible to go ahead and establish a new equilibrium condition as a response to adversity (Walsh, 2002). From the idea that there is a possibility of growth after trauma and disaster, the concept of post-traumatic growth (PTG) was developed (Tedeschi & Calhoun, 1995; Tedeschi, Park, & Calhoun, 1998).
Post Traumatic Growth is defined by Tedeschi & Calhoun (2004, p.108) as the "experience of individuals whose development, at least in some areas has surpassed what was present before the struggle with crises occurred. The individual has not only survived, but has experienced changes that are viewed as important, and that go beyond the status quo". Instead of ruminating on what happened, why it happened and how it happened, PTG processes productively reframes the traumatic event(s), facing these crucial questions with an organized style of thinking that provides an heightened sense of control (Addington, Calhoun, & Tedeschi, 2016). In that sense, the construction of a coherent narrative including temporal continuity between the pre-event, the event and the post-event, is thought to underline the process of “considering the lesson from the struggle” (Calhoun & Tedeschi, 2013). PTG research has shown how this growth can take place in different areas of the individual's life: in their skills and competences (Elder & Clipp, 1989), in self-confidence (Carver, 1998) and in relationships with others (Fromm, Andrykowski, & Hunt, 1996). PTG is a multidimensional construct involving the modification of a plurality of core beliefs including those related to the relevance attributed to interpersonal relationships, to the possibility to follow new and relevant life paths, to the development of spirituality and existential awareness, to a moment-to-moment appreciation of life and to an increased sense of self-efficacy (Tedeschi & Calhoun, 1996).
PTG appears a crucial topic to investigate in time of COVID-19 outbreak. Indeed, it has been shown to buffer the negative consequences of stressful events on mental health (Addington et al., 1986). But primarily, previous studies suggested that individuals having developed high levels of PTG after a stressful event, were more mentally resilient to successive similar stressful events (e.g. violence exposure during war) (Kunst, Winkel, & Bogaerts, 2010). This is relevant because the psychological stressful facets of the COVID-19 phenomena (e.g. lockdown, social distancing and health-related stress) are likely to be chronic. Therefore, we should identify which mechanisms are likely to buffer, with long-term effects, the negative consequences of the outbreak. In turn, we need to know which variables account for PTG in order to provide useful empirical evidences that may orientate institutional policies.
Which psychological variables are likely to enhance PTG during the COVID-19 Lockdown?
The growing interest in the post-traumatic growth construct has led to an examination of the various factors that contribute to growth. The research hypothesizes that among these there are some more obvious aspects, such as the levels of post-traumatic distress and the support of the social network, and others less obvious, such as the environment and the ability to derive restorativeness from it.
During the acute phases of the COVID-19 outbreak, several nations decided for social distancing and for “stay-at-home” orders. Consequently, home became, for most people, the predominant environmental context being the only place where we slept, eat, socialized and engaged in recreative activities. Past studies, based on the socioecological framework, documented that environmental features impact on mental health and well-being. During the lockdown, the time spent at home may have potentiated the relevance of the relationship between home features and mental health. Supporting this idea, a study conducted by Amerio et al. (2020), during the lockdown, highlighted that poor housing is predictive of depression, stressing the role of views and indoor quality. These promising results call for further research investigating the relationship between home and mental outcomes during forced “stay-at-home” conditions. Moreover, we may speculate that home-related experiences would impact mental health not only negatively but also positively, for instance enhancing PTG. However, this hypothesis has not been empirically tested. Also, we lack from a psychological explanation of why experiencing home would account for mental outcomes. Regarding this point, the construct of perceived restorativeness is likely to illuminate this issue. It has been developed within the framework of environmental psychology that highlighted how some environments are able to promote the "recovery" of resources and energies, since environmental conditions play a fundamental role in stress-related mechanisms: they can be both stressful factors, challenging human adaptive abilities, but also coping strategies, contributing to the re-establishment of a balance between environment demands and individual resources (Berto, 2014). The Attention Restoration Theory (ART; Kaplan, 1995) and the Stress Recovery Theory (SRT; Ulrich, 1983) argue that places vary in their capacity to restore from psychophysiological stress and that this capacity arises from different components. For instance, a specific place would be perceived as more restorative if it provides a sensation of escape or “being away” that relieves from daily stress. Also, the perceived presence of coherence organizing the place and elements eliciting spontaneous selective attention are thought to contribute to the restorative capacity of a specific place. Finally, the opportunities provided by the place that allow the individual to pursue own interests and inclinations is a central feature that make a place especially restorative. Noteworthy, the restorative capacity of a specific place is not an objective feature but a subjective experience. Therefore, we may speculate that inter-individual differences in the perceived restorativeness of own home are likely to account for mental health outcomes (e.g. PTG) during the COVID-19 lockdown.
Connection to Nature
Another potential variable accounting for PTG during the COVID-19 lockdown is relationship with Nature and, in particular, levels of Nature Relatedness (NR). This construct identifies the subjective sense of connection people have with the natural environment (Nisbet, Zelenski, & Murphy, 2009). There are several reasons for speculating that NR fostered PTG during the COVID-19 lockdown.
First, broadly speaking, NR is thought to be associated with a greater coping capacities and emotion regulation capacities (e.g. mindfulness) that are likely to buffer the disruptive psychological effects of a stressful event (Huynh, 2017; Pritchard et al., 2020). In particular, research has shown the positive influence of the environment on three emotional dimensions: anger, fear and positive affects (Ulrich et al., 1991; Zuckerman, 1977; Ulrich, 1979). For instance, experimental studies have confirmed the role of exposure to nature in the restoration process from psychological stress and fatigue, qualifying it precisely as a coping strategy (Hartig et al., 2003; Ulrich et al., 1991). The natural environment would lie in its ability to produce positive changes in emotional states and to act as a mediator between stress and elicited negative emotions (Kaplan, 1995). This awareness even led some authors to advise the watching of documentary on nature during the COVID-19 lockdown to relive from stress (Young-Mason, 2020). However, this would explain why individuals with higher NR should experience less negative outcomes, but it does not fully explain why they should experience higher PTG.
A second explanation may arise from the observation that the COVID-19 outbreak elicited numerous -and somewhat catastrophic- reappraisal of the event in light of an ecological perspective. Indeed, we assisted to a so-called temporary “Nature’s return”. Anecdotal stories about wild animals invading cities were documented. Air, water and noise pollution indexes dramatically decreased (Paital, 2020; Helm, 2020; Yunus et al. 2020). This leads a number of journalists and scientists expressing the idea that the COVID-19 was part of a “self-generation plan” of Mother Nature and that the lockdown was a natural levelling strategy used to re-order the ecosystem (e.g. Dossey, 2020; Paital, 2020). Whereas it is beyond the scope of the present study to examine this debate, we may speculate that this line of argument has been likely to influence the processes of giving a restructured and coherent meaning to the stressful event of the pandemic. In other words, the identification of a transcendental meaning in this ecological discourse may have fostered the PGT processes. Preliminary evidences supporting the idea that individuals developed an heightened sensitivity to ecological thematic have been brought by the analyses of Google trends (Rousseau & Deschacht, 2020). Following the assertion of Dunn (2019) that states that stressful events “change the way we live and relate to both the human and non-human world […] we need to reimagine and respect the things we value”, we may speculate that people who have develop the value of being connected to Nature during the COVID-19 would experience higher levels of spiritual change (a component of PTG). Indeed, the process of change in spirituality may have been even more enhanced in individuals with high Nature Relatedness that see in Nature a superior entity. The relationship of humans with Nature is central in a number of religions and is an highly spiritually connoted topic (Zabaniotou, 2020).
Finally, the COVID-19 lockdown period has been characterized by an increase of green area frequentation, especially in urban areas. For instance, nearby half of the sample of Brode (2020) reported to be more engaged in outdoor activities as such as hiking, visiting local parks, and boating/fishing. As noted by Sachs (2020) many people are connecting with nature more than they have do in their whole life, if ever. This phenomenon may have led to the discovery of new possibilities offered by daily life, that is a central component of PTG.
As a whole, a number of potential reasons exist to hypothesize that both the perceived restorativeness of own home and the levels of nature relatedness would longitudinally predict the PTG related to the COVID-19 lockdown beyond and above the role played by PTSD. However, to our knowledge, no empirical data on the topic is available. Therefore, we conducted a study aiming to test this hypothesis and bring preliminary evidences that may guide institutional policies aiming to increase the psychological resilience of population during future outbreaks.