chapter two -
LITERATURE REVIEW II
This chapter will analyse the psychosocial-related literature created during the outbreak (the year 2020). An increasing number of researchers focused on populations' behaviour, the long-lasting impact of the pandemic and the effects of public-health preventive measures on population mental-health fitness.
Current research on psychological consequences of COVID-19
The pandemic represents a severe threat to the population's physical and mental health (Gao et al., 2020; Kang et al., 2020).
Considering the recentness of the outbreak and the ongoing fluid and dynamic situation, the usual methods to gather data for research (survey data or health insurance claims by nation information) are not available. To overcome these difficulties, Brodeur et al. (2020) and Kim and Zhao (2020) used world-browse recurrence in a well-known search engine (Google and Baidu) to obtain frequency data on words related to mental health well-being. The key words used for these researches were depression, scared, fear, anxiety, stress, nervousness, fatigue, self-harm and suicide. There was a substantial rise in the search index of these words compared to the previous year: depression increased by 225%, scared by 235%, fear by 216%, anxiety by 371%, stress by 335%, nervous by 92%, self-harm by 139% and suicide by 203% (Kim and Zhao, 2020). Brodeur et al. (2020) concluded: 'Our findings indicate that people's mental health may have been severely affected by the lockdown. There is a substantial increase in the search intensity for boredom, at two times the standard deviation in Europe and over one standard deviation in the US. We also find a significant surge in searches for loneliness, worry and sadness: these estimated coefficients are over one half of a standard deviation in Europe, but lower in the US'.
Young adults and adolescents have shown low respect for public-health actions to prevent the diffusion of COVID-19 (Geller and Warner, 1997; Yeager, Dahl and Dweck, 2018; Barari et al., 2020; Schwartz et al., 2020).
A longitudinal cohort study reported that young women conformed better to public health measures against COVID-19. The research aimed to identify the psychological components that increased the risk of noncompliance, leading young men from Switzerland to comply poorly with the public-health rules implemented to prevent pandemic diffusion. This survey involved 737 young adults of age 22. Antecedent sociodemographic, social and psychological factors were measured at ages 15 through 20. The results suggested a correlation between 'antisocial potential' and noncompliance: low acceptance of moral rules, mistrust in government, legal cynicism and poor self-control were the most relevant elements that were observed.
The modification in school management also had a significant impact on children and youths. Gruber et al. (2020) found that sleep behaviour improved thanks to changing start times. As consequences of online school starting at 10:00 a.m., there was an amelioration of sleep quality, with lower daytime sleepiness and reduced stress among adolescents. Many students woke up naturally and reported less fatigue. The pandemic forced a societal change that was beneficial for the circadian rhythm of minors.
Sleep quality is associated with the quality of mental and physical well-being and helps increase the effectiveness of treatment in Covi-19 patients, boosting their immune system (Yang et al., 2020).
The public-policy measures adopted to contain the diffusion of the pandemic had a detrimental effect on family happiness, and the magnitude of such interference in regular day-care was so high that Huebener describes the phenomena as 'disruptive exogenous shock'. In their research paper, the authors noted the challenges posed by additional at-home childcare or dependent siblings. These different pressures in the family nucleus were not evenly distributed: women and low-incoming social classes had a magnified negative impact. Women had to tolerate the highest workload, with an increased risk of reducing working hours to keep up with the children's education at home, thus leading to decreased economic power and heightened job insecurity. Furthermore, greater family stress leads to an augmentation of domestic violence. Children from lower social levels suffered the worst consequences of home education in relation to the cultural group of parents, with a reduced capability to acquire all the technological means to follow the online teaching. This difference in schooling capacity increased the tensions and stress among household members. The public policy to close day care and schools in order to slow down the pandemic had an adverse effect on educational accomplishments in low-income social groups. The studies reported 'life satisfaction declines by between 0.16 and 0.26 standard deviations (depending on the age of the youngest kid) relative to individuals without children' (Huebener et al., 2020). A descriptive analysis compared well-being during the pandemic with welfare previous to the diffusion of COVID-19 among various subgroups. They used the COMPASS survey to measure life satisfaction during the outbreak and the German Socio-Economic Panel (SOEP) as inventory for the well-being in pre-COVID-19 times. They also added a variation in different research designs to evaluate the family's differential effects with children during the pre- and post-outbreak, using adults without offspring as a control group. The idea behind this was that the eudemonia of parents with children would have followed the same trend as the control group. Their findings evidenced that school closure decreased the family's life satisfaction in nucleus composed of parents and children (especially in mothers).
This study is also particularly interesting for two other aspects: 1) the role of grandparents and 2) the social-policy measures to increase the maternal workforce. Grandparents are often the secondary childcare support in the family (after the parents). Still, due to the pandemic's specificity and the higher mortality ratio in older people, grandparents had to abandon their secondary role in the domestic duty to protect themselves.
In developed countries, there is a continuous increase effort in social policies to offer gender parity on the workforce. The primary strategy in these programs is the funding of a day-care centre, allowing the mothers to maintain their jobs even after a new child is born. The expansion of kindergarten facilities, all-day schooling, after-school programs, physical or artistic activities and care clubs strengthened the working mothers' freedom. Closing all of these activities for the pandemic would negate all the efforts of the social guidelines. In this case, public-health policies and societal programmes are antithetic and not compatible.
This public-health decision is somehow acceptable in the emergency when prompt actions are required, and the life of citizens has to be protected. In emergencies, public-health policies should prevail. However, it is not a situation that could continue for an indefinite amount of time, and it has to be used only as 'extrema ratio'.
Summarising, 'The satisfaction with life overall, with family life, and with day care decreased under COVID-19 far more for individuals with children than other individuals' (Huebener et al., 2020). The findings showed a relevant decrease in well-being for lower secondary-schooling studies, for families with children under eleven years old and for women.
'As reported in a recent survey administered during the COVID-19 pandemic, children and young adults are particularly at risk of developing anxious symptoms (Orgilés et al., 2020). The research involved a sample of 1,143 parents of Italian and Spanish children (range 3 to 18). In general, parents observed emotional and behavioural changes in their children during the quarantine: symptoms related to difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), sense of loneliness (31.3%), uneasiness (30.4%) and worries (30.1%). From the comparison between the two groups-Spanish and Italian parents-it emerged that the Italian parents reported more symptoms in their children than the Spanish parents. Further data collected on a sample of college students at the time of the spread of the epidemic in China showed how anxiety levels in young adults are mediated by certain protective factors, such as living in urban areas, the economic stability of the family and cohabitation with parents' (Saladino, Algeri and Auriemma, 2020).
Young adults and children are in risk categories that need special attention from public-health managers. Another precarious category is composed of the first respondent and physicians dealing with COVID-19 infected patients. These professionals are at high risk of contagion and possible mortality. 'The countries with the most reported physician deaths were Italy (121/278; 44%), Iran (43/278; 15%), Philippines (21/278; 8%), Indonesia (17/278; 6%), China (16/278; 6%), Spain (12/278; 4%), USA (12/278; 4%) and the UK (11/278; 4%). Ninety percent (175/194) of the deceased physicians were male. General practitioners and emergency-room doctors (78/254), respirologists (5/254), internal-medicine specialists (11/254) and anaesthesiologists (6/254) comprised 52% of those dying. Two percent of the deceased were epidemiologists (4/254), 2% were infectious disease specialists (4/254), 4% were ENTs (8/254), 4% were ophthalmologists (7/254) and 5% were dentists (9/254)' (Ing et al., 2020). Two-hundred-seventy-eight physicians died because...
