The present study explores for the first time, to our knowledge, the short-term effects of COVID-19 quarantine on four health-related well-being components (lifestyle habits, social context, emotional status, and mental skills) and PWBI in adolescents, that is an integrated score of above mentioned dimensions. The main results can be summarized according two perspectives: 1) considering the single variables within each component; 2) analysing the four health-related well-being components forming the PWBI. Firstly, quarantine induces a lower perception in the psychological and physical well-being, in mood/Emotion, autonomy, relationship with peers, as well as the perception of bullying, while lockdown period seems to encourage healthy behaviors in terms of higher adherence to the Mediterranean Diet and creativity. Secondly, according an integrated approach between the variables and the components, the key findings can be reassumed in the following points: i) during lockdown phase, adolescents showed a lower well-being perception as shown by the decreased PWBI; ii) the four areas, composing PWBI, although maintaining the same order of importance, they changed significantly in percentage terms, increasing during quarantine the contribute to the emotional status; iii) lifestyle habits, social context, and emotional status, in absolute values, decreased during quarantine as compared to baseline conditions, whereas mental skills enhanced during COVID-19 outbreak.
The circumstances related to the COVID-19 pandemic provided an extraordinary and naturalistic context to observe young people’s psychosocial profile, and to study how a condition of environmental deprivation and lack of direct social contact, affect adolescent’s well-being. Before COVID-19, the evidence on the effects of isolation came primarily from animal models [21–23]. Human studies were mainly focused on adults, while there are very few comparable studies on adolescents regarding their quarantine experiences [7, 8]. In adolescents, on the other hand, studies have predominantly pointed out that the nature, quality, and complexity of social connections, and not social deprivation, as positively correlated with grey matter volume of the amygdala, medial pre-frontal cortex, and superior temporal sulcus (STS), that are part of the affective and mentalizing systems [24]. On the contrary, a lack of social connection, such as quarantine, can have detrimental effects on the brain. In fact, neuroimaging evidences shown that individuals who report a lack of social relations had a reduced volume of gray matter on the STS and display problems in processing social input [25]. The study of Sprang et al. assessed the impact of different (H1N1 influenza A, SARS, avian influenza) pandemic occurred in six USA states, Mexico and Canada. The study evaluated the psychological impact of quarantine in terms of incidence of post-traumatic stress disorder, that was in one-third of the children experiencing isolation or quarantine [26]. Saurabh and coworkers studied 121 Indian children quarantined during Covid-19 outbreak and showed that these subjects experienced greater psychological distress, worry, helplessness, and fear in comparison to no-quarantined ones [27]. In another study, Pisano et al. focused on the emotional and behavioral impact of COVID-19 quarantine in children aged between 2–10 years through administering their parents appropriate questionnaires. They found that children have had manifestation of regressive behavior and of opposite behavior, although they also showed manifestations of adaptation, calmness, balance, adaptation to restriction [28].
In comparison to the above-mentioned studies, we enrolled healthy adolescents aged between 10 to 14 years, who fulfilled themselves questionnaires, the first one at school and the second one at home during confinement. Moreover, we administered questionnaires assessing self-perception of well-being without any kind of clinical implication. This means that we maintained our evaluation in a preclinical condition, assessing the difficulties and the issues raised up with quarantine, potentially leading, in the long-term, to post-traumatic stress disorder or other clinical problems. Further, we assessed well-being by means of an integrated and personalized index, PWBI, already published in other studies, based on the relationship among the different statistical weights of the variables belonging to the four dimensions: lifestyle habits, emotional status, social context and mental skills [13, 29]. In the present study, the four PWBI components were also individually assessed in order to ascertain their changes during COVID-19 quarantine. Thanks to this index it is possible to identify, under stressful conditions such as quarantine, the strength and the fragile characteristics of each adolescent to potentiate the first ones and to change or improve the others through the application of personalised educational programs. In this regard, PWBI intervenes at multiple levels in the promotion process of health and well-being in the young in the different psychosocial settings, combining management and empowerment in terms of ability to monitor well-being status and applying prevention strategies to reduce disease burden both in the short-, medium, and long-term.13
The results showed that PWBI significantly fell during COVID-19 quarantine and its breakdown corresponded to a lower score in three over four components that are lifestyle, social context and emotional status. The basal data confirmed the results of our previous work, which highlighted the preponderant role of the social context and the lack of involvement of the mental skills in the perception of well-being [13].
Our data seem to confirm what has recently been hypothesized from Italy, Spain and China studies that suggests significant emotional and behavioral changes during COVID-19 quarantine in adolescents [28, 30]. In fact, emotional status of our sample, during isolation, in terms of self-perception and psychological well-being, compared to the baseline values, was significantly reduced in absolute values. However, when we considered the percentage in which the four areas made up the PWBI, during the quarantine, emotional dimension increased to indicate that in these conditions, the psychological state, although reduced in absolute values, acquired more importance. In other words, if in basal conditions the perception of well-being was much more linked to the social context, during quarantine, an increase in the psychological component is overlapped to a reduction in the role of the social context.
Interestingly, during the closing period of schools and distance learning we have observed an improvement in the cognitive skills as compared to baseline condition. This increase in mental abilities could be explained by the fact that adolescents usually live under such intense stress conditions until they develop burnout, possibly related to school, routine, friendships and other responsibilities [31]. Indeed, this data could be in line with previous studies showing that difficulty situations, sometimes, through resilience mechanisms and empowerment, can have positive effects on cognitive aspect and in general on health status [32, 33]. Data obtained during natural disaster, for example, have shown that resilience depends on adequate communication and preparedness, good social support and capacity to adapt and cope with traumatic events [33].
In addition, in terms of lifestyle, our results are in agreement with the notion that assert that staying at home, with limitation of outdoors and in-gym physical activity, compromises the perception of heaving healthy habits. In our case, overall behaviors linked to lifestyle habits, such as spare time, the perception of health and economic well-being, and not only diet and physical activity are reduced [15]. However, a recent Italian study, aimed to explore the impact of the COVID-19 pandemic on eating habits and lifestyle changes among the Italian adolescents, demonstrated an improvement of lifestyle, with a reduction on tobacco consumption and a higher adherence to the Mediterranean diet [34].
The main limitation of the present study is represented by a self-reported questionnaire and the different place of monitoring. In fact, in baseline, the questionnaires were completed during a school class, and it is possible that the school classroom environment may have biased the students’ responses, especially for items related to the school class environment; while during quarantine, although questionnaires were completed during distance learning in the presence of a teacher, they were conducted in the housing context. However, our web survey was the same one used in other protocols by our group [13, 15, 29]. A strength of our study was represented by the fact that the survey was conducted quickly in the most critical period of the pandemic in Italy, after one month from the start of the lockdown.