The World Health Organization declared Coronavirus Disease 2019 (COVID-19) to be a pandemic on March 12th, 2020 [1]. Italy was the first European country to face this new health emergency and has been harmed, to date, by two separate waves of the pandemic (during spring and autumn 2020), with an emerging third one.
During the COVID-19 outbreak, both the pandemic and containment measures taken by the governments have profoundly impacted daily life [2–4]. Isolation, contact restriction, and economic shutdown have generated dramatic psychological, social, and economic consequences [2, 5].
Since the beginning of the pandemic, children and young people have been considered one of the frailest groups for mental health implications [6]. Among them, those belonging to low-income families are particularly vulnerable: the necessary home confinement, ordered by the government authorities, might have led to a forced interruption of temporary works of their parents, parental unemployment, and financial insecurity [2, 3, 6, 7]. Moreover, basal low-income means a paucity of essential supplies in normal conditions, with evident exacerbation during pandemics, when work opportunities are lacking.
Among the containment measures, school closure has affected millions of children worldwide and has had a significant impact on children and adolescents, especially on socioeconomically disadvantaged ones [5, 6, 8–10]. The necessary shift to the home-based distance learning models has meant the absence of school routines and outdoor activities, reduced social contact, and dropping education [7, 8, 11, 12]. The potentially negative implications of similar modifications on the psychological balance of children and adolescents could be even more pronounced for those living in poverty [7, 8, 11, 12]. They often do not own an electronic device or Internet connections, making homeschooling challenging to take part in [5, 6, 9].
In Bari province, in the South of Italy, Diurnal Socio-Educational Centers (DSECs) support low-income families in the afternoon post-school period, working as semi-residential structures. The DSECs belong to the territorial social services network offering holistic support: they operate in close connection with the school, the social services, and other educational structures; ensure educational support in learning activities; enhance good personal hygiene; contribute to healthy free nutrition by giving the midday meal and a snack; provide parenting support to the children’s families [13]. A few days after the school closure (March 8th, 2020, throughout Italy), on March 12th also the DSECs were closed, as determined by the civil authorities for the entire regional territory to which Bari belongs. Short-term consequences were a further reduction of social contacts and educational support besides the loss of free healthy nutrition. The socioeconomically disadvantaged families enjoying that service found themselves trying to sustain their children through their scarce resources. In this way, DSEC shutdown increased the already heavy load given by school closure.
If poverty is a well-known risk for mental health in children and adolescents, the socio-ecological impact of the pandemic could increase this pre-existing vulnerability, both in the short term and for a lifetime [2]. It is especially true for those mental health conditions, such as depression, that are more prone to environmental risk, like stressors derived from income inequality [14, 15]. One of the research priorities during the current pandemic was monitoring and reporting rates of depression and other mental health problems across the general population and vulnerable groups [2, 6]. Although lower socioeconomic conditions have been often addressed by literature as a risk factor for children’s mental health during COVID-19, only a few original studies have approached this subject, to our knowledge. Findings from the early phases of the pandemic demonstrated more pronounced behavioral and anxiety problems among young children (5 years old or less) from economically disadvantaged households [16, 17]. A large cross-sectional Chinese study found a higher risk for psychosocial problems in children (2–12 years old) from low-income families [18]. In the study by Alvis and colleagues, adolescents suffering from financial difficulties were more likely to develop depressive symptoms and lower belongingness [19].
To date, to the best of our knowledge, no study has assessed the impact of COVID-19 on a homogeneous sample for environmental risk for mental health represented by socioeconomic disadvantage.
This research has aimed to determine whether the COVID-19 pandemic and its containment measures were predictors of mental health problems in a vulnerable group represented by socioeconomically disadvantaged children and adolescents. We recruited a sample of unprivileged children and adolescents attending the DSECs of the Bari province in the South of Italy. We investigated depressive symptoms at the end of the first wave of the pandemic (that in Italy covered the months of March and April 2020, with a slow return to normality during May and June 2020). We assessed if pandemic-related stressors (i.e., Sars-CoV-2 infection, quarantine, food insecurity, parental unemployment, impaired access to homeschooling) and pre-existing neuropsychiatric diagnoses would behave as risk factors for depressive symptoms.