Immediate psychological effects of the COVID-19 quarantine in youth from Italy and Spain

Abstract

The present study aims to examine for the first time the emotional impact of the quarantine on children and adolescents from Italy and Spain, two of the most affected countries by COVID-19. 1,143 parents of Italian and Spanish children aged 3 to 18 years completed a survey providing information about how the quarantine affects their children and themselves, compared to before the home confinement. 85.7% of the parents perceived changes in their children´s emotional state and behaviors during the quarantine. The most frequent symptoms were difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), feelings of loneliness (31.3%), uneasiness (30.4%), and worries (30.1%), and Spanish parents reported more symptoms than Italians. As expected, children of both countries used monitors more frequently, spent less time doing physical activity, and slept more hours during the quarantine. Furthermore, when family coexistence during quarantine became more difficult, the situation was more serious, and the level of stress was higher, parents tended to report more emotional problems in their children.The quarantine impacts considerably on Italian and Spanish youth, reinforcing the need to detect children with emotional and behavioral problems as early as possible to improve their psychological well-being.

Full text

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ORIGINAL RESEARCH
published: 06 November 2020
doi: 10.3389/fpsyg.2020.579038
Edited by:
Gian Marco Marzocchi,
University of Milano-Bicocca, Italy
Reviewed by:
Claudio Longobardi,
University of Turin, Italy
Alessandra Santona,
University of Milano-Bicocca, Italy
*Correspondence:
Mireia Orgilés
morgiles@umh.es
Specialty section:
This article was submitted to
Developmental Psychology,
a section of the journal
Frontiers in Psychology
Received: 02 July 2020
Accepted: 09 October 2020
Published: 06 November 2020
Citation:
Orgilés M, Morales A,
Delvecchio E, Mazzeschi C and
Espada JP (2020) Immediate
Psychological Effects of the
COVID-19 Quarantine in Youth From
Italy and Spain.
Front. Psychol. 11:579038.
doi: 10.3389/fpsyg.2020.579038
Immediate Psychological Effects of
the COVID-19 Quarantine in Youth
From Italy and Spain
Mireia Orgilés1*, Alexandra Morales1, Elisa Delvecchio2, Claudia Mazzeschi2and
José P. Espada1
1Department of Health Psychology, Universidad Miguel Hernández, Elche, Alicante, Spain, 2Department of Philosophy,
Social Sciences and Education, Università degli Studi di Perugia, Perugia, Italy
The COVID-19 quarantine has affected more than 860 million children and adolescents
worldwide, but to date, no study has been developed within Western countries to
examine the psychological impact on their lives. The present study aims to examine
for the first time the emotional impact of the quarantine on children and adolescents
from Italy and Spain, two of the countries most affected by COVID-19. Participants
were 1,143 parents of Italian and Spanish children aged 3 to 18 years who completed
a survey providing information about how the quarantine affects their children and
themselves, compared to before the home confinement. Results show that 85.7% of
the parents perceived changes in their children’s emotional state and behaviors during
the quarantine. The most frequent symptoms were difficulty concentrating (76.6%),
boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), feelings of
loneliness (31.3%), uneasiness (30.4%), and worries (30.1%). Spanish parents reported
more symptoms than Italians. As expected, children of both countries used monitors
more frequently, spent less time doing physical activity, and slept more hours during
the quarantine. Furthermore, when family coexistence during quarantine became more
difficult, the situation was more serious, and the level of stress was higher, parents
tended to report more emotional problems in their children. The quarantine impacts
considerably on Italian and Spanish youth, reinforcing the need to detect children with
problems as early as possible to improve their psychological well-being.
Keywords: COVID-19, quarantine, emotional impact, habits, youths
INTRODUCTION
The outbreak of the 2019 coronavirus disease (COVID-19) emerged in the city of Wuhan (China) in
December 2019. Motivated by its rapid spreading, the World Health Organization (WHO) declared
it a pandemic on March 11, 2020 (World Health Organization (WHO), 2020). Italy and Spain are
two of the most affected countries worldwide, with, respectively, more than 29,000 and 25,000
reported deaths as of May 1 (European Centre for Disease Prevention and Control, 2020) since
its spread. Spain has the world’s second-highest number of deaths in relation to the number of
inhabitants, with 544 deaths per million inhabitants, followed by Italy, with 481 deaths per million
inhabitants, as of May 5 (European Centre for Disease Prevention and Control, 2020). Following
the Chinese government’s retarding the spread of COVID-19, quarantine was implemented in Italy
and Spain, among other countries, starting on March 10 in Italy and 6 days later in Spain. School
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Orgilés et al. Psychological Effects of Quarantine on Youths
closure was mandatory, and gathering in public spaces, with
certain exceptions, was prohibited. During school closures,
children’s routines change, and healthy behaviors, such as
physical activity, adequate diet, or good sleep habits, could
be less probable to happen (Brazendale et al., 2017). Also,
as a recent review of studies concludes, the limited social
interaction increases loneliness, which is associated with mental
health problems in children and adolescents (Loades et al.,
2020). However, the effect of closing schools as a measure
to decrease virus transmission is inconclusive. According to
a systematic review of studies focused on other previous
coronavirus outbreaks, school closure did not seem to have
a very determining effect compared to other social distancing
measures, and following some COVID-19 modeling studies,
school closure may only reduce between 2 and 4% of deaths
(Viner et al., 2020). Esposito and Principi (2020) highlighted
alternative strategies, such as reducing class size or physical
distancing, considering the adverse effects of school closure on
children and their families (e.g., the economic consequences for
parents who remain at home to take care of their children, or
problems in implementing distance learning in the poorest areas
of some countries). However, a recent study examining parents
of Czechia children show that families tend to cope well with
education at home during the COVID-19 confinement, although
they consider that children would need more time for learning
activities (Brom et al., 2020).
This is the first time that a quarantine to control a
pandemic has been implemented in Italy and Spain, as well
as in most countries worldwide. Therefore, there is a lack of
conclusive studies providing data on how this measure can affect
children and adolescents. Regarding the specific psychological
consequences of COVID-19 and the measures to cope with them,
few studies have been published. The psychological impact on
the Chinese population after 2 weeks of quarantine was rated
as moderate or brief by 53.8% of the 1,210 participants in a
study with adults from 194 cities in China (Wang C. et al.,
2020). Depression symptoms of moderate to severe severity were
reported by 16.5% of participants, anxiety by 28.8%, and stress
by 8.1%. The results of a study with 4,607 adults aged 17 to
90 years from 31 regions of China, however, reported slight
changes in the frequency with which participants experienced
negative and positive emotions before and after the COVID-
19 imposed quarantine. Rather, some benefits were found, with
reports of fewer sleep problems, fewer aggressive behaviors,
and less alcohol and tobacco use during the quarantine. As
the authors of the study point out, among other reasons, the
quarantine was imposed just before the Chinese New Year
holidays, when the majority of the population were at home with
their families, thus having social support to reduce stress (Li et al.,
2020). Concerning the specific stressors affecting the population
during the quarantine, a review of 24 studies highlights as main
stressors the duration of the quarantine, the fear of infection,
frustration and boredom, and not having adequate information
or clear guidelines from public authorities; as main stressors after
the quarantine, having financial problems and the stigma for
people who were infected or exposed to the disease were reported
(Brooks et al., 2020).
To date, no studies have examined how the quarantine
declared due to COVID-19 may affect children’s and adolescents’
emotional or behavioral well-being within Western countries.
Some previous studies suggest that the effects may be
troublesome. In a recently published study, 23% of Chinese
school-age children reported depressive symptoms, and 19%
reported anxiety symptoms after 34 days of COVID-19
confinement (Xie et al., 2020). A review of 190 studies with
an American population concluded that, compared to vacation
periods and weekends, by being more structured, class days
give children more opportunities to be physically active, spend
less time in front of screens, and regulate their sleep schedules
(Brazendale et al., 2017). Post-traumatic stress is estimated to
be four times higher in children who have been in quarantine
compared to those who have not, and their likelihood of
presenting acute stress disorder, adjustment disorder, and grief
is also higher (Sprang and Silman, 2013). Among the possible
consequences of the COVID-19 emergency, a main concern
is suicidal ideation, as stressful life events are considered a
psychosocial risk factor for suicidality (Carballo et al., 2020).
Some authors have reflected on the possible effects of the COVID-
19 quarantine on children and adolescents. Wang G. et al. (2020)
highlight the need for awareness of the quarantine’s potential
effects on children’s mental health and the importance for
governments, non-governmental organizations, the community,
schools, and parents to act to reduce the possible effects of
this situation. Special attention should be paid to children
and adolescents who are separated from their caregivers who
are infected or suspected of being infected and those whose
caregivers are infected or have died, because they are more
vulnerable to psychological problems (Liu et al., 2020). It is very
important to identify childhood mental health problems as soon
as possible, differentiating normal and pathological reactions
through the use of screening tools that may indicate the need for
intervention (Espada et al., 2020;Liu et al., 2020).
COVID-19 confinement changed the lives of most children
and adolescents. Social relationships and academic routines were
changed by virtual friends and distance learning; leisure was
restricted to indoors as public spaces were closed. Italy and Spain
had one of the most restrictive home confinement rules, not
allowing children to go outside until 3 and 6 weeks, respectively,
after the start of confinement. Although confinement was
necessary to break the pandemic, the interruption of all social
contact and the prohibition from going outside home could have
had immediate effects in children and adolescents. Controversy
in both countries arose over whether confinement would affect
children or whether they could adapt to the new situation without
being emotionally affected. Knowing if confinement has effects on
the well-being of children would help professionals to implement
preventive measures and governments, less strict confinement
rules. Despite that, so far, we have not found any study that
examines the effect in children and adolescents of the quarantine
imposed by COVID-19 within Western countries. The available
studies have been carried out with adult populations—hence, the
results cannot be extrapolated to child populations—and with
Chinese populations, whose cultural differences with the West
make it difficult to generalize their findings. This study is the first
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Orgilés et al. Psychological Effects of Quarantine on Youths
to determine the immediate psychological responses in children
and adolescents of the West to the quarantine imposed to put an
end to COVID-19. The main objective of the study is to examine
the emotional well-being of Italian and Spanish children aged
between 3 and 18 who are in quarantine as a measure imposed
by governments to prevent the transmission of COVID-19.
Specifically, the aim is to know: (a) the immediate psychological
responses in children and adolescents during the quarantine
perceived by parents, (b) the emotional impact of the quarantine
on children’s primary caregivers, (c) the relationship between
the parents’ emotional state and their children’s immediate
psychological responses, (d) the change in children,s habits, and
(e) the relationship between the parents’ emotional state and the
change in their children’s habits. According to the only study
carried out to date to examine the immediate effects of COVID-
19 in children (Xie et al., 2020), and to findings with adult samples
(e.g., Wang C. et al., 2020), it is expected that confinement affects
the well-being of Italian and Spanish children, as it affected the
Chinese population.
MATERIALS AND METHODS
Participants
Table 1 reports sample characteristics and differences in
sociodemographic variables by country. Of the 1,143 participants,
62.3% were recruited from 94 cities in Italy, and the rest, from
87 cities in Spain. The respondents were aged 18 to 66 and
were the primary caregiver of children aged 3 to 18 (47.5% were
females). Most children were not diagnosed with a physical or
psychological problem (89%). The caregivers’ educational level
was relatively high; more than half of them (61.9%) had attended
college to earn an undergraduate degree, a Master’s degree, or a
Ph.D., and only 6.9% had basic studies. The mothers’ and fathers’
current employment situations varied. In many cases, the parents
had a full-time job or smart-worked. Around 5% reported having
lost their job because of the COVID-19 situation. More than half
of the participants (69.4%) reported having some at-risk friends
or family, but they did not live with them during the quarantine;
only 9% belonged to an at-risk group.
The Italian and Spanish samples were equivalent, except
for respondents’ educational level, the mothers’ or fathers’
current employment situation, respondents’ situation concerning
COVID-19, children’s age, and the proportion of children
with physical or psychological problems (Table 1). In the
Spanish sample, there was a higher proportion of parents with
postgraduate or doctoral studies or with secondary education
than in the Italian sample. Compared to Spain, a higher
proportion of Italian women were employed (84.3 vs. 94.8%), and
they had part-time jobs (8.4 vs. 18.9%). The Italian children were
slightly older than the Spanish ones (9.40 vs. 8.55 years), although
the effect size was very low.
Procedure
Participants were recruited via social networks (Twitter,
Facebook, WhatsApp, Instagram), as face-to-face contact was
not allowed. An online survey was created ad hoc using Google
Forms and distributed in each country using a snowball sampling
strategy. Before participants completed the survey, information
about the objectives of the study was provided, and informed
consent was requested. Data were collected for 15 days in both
countries, with the study starting 15 days after the lockdown.
The approval of the Ethics Board of the authors’ institution was
obtained for the research.
Survey Development
Scientific literature related to the psychological impact of
quarantine was reviewed by six experts in clinical psychology, and
questionnaires applied in previous studies with adult populations
were considered for creating the survey. After a pilot study
with a group of parents was conducted, the final version of
the questionnaire was structured in four sections, collecting
information on: (a) the sociodemographics of parents and
children (see Table 1); (b) parental perception on how quarantine
emotionally affects children through 31 symptoms, ranging from
1 (much less compared to before quarantine) to 5 (much more
compared to before quarantine), reaching a Cronbach’s alpha
of 0.95; (c) parents’ perception of family coexistence during
quarantine, severity of the situation caused by coronavirus
with regard to the family’s well-being, and parents’ stress, on
a five-point scale; and (d) children’s routines: time of screen
use, physical activity, and hours of sleep during quarantine
compared to before.
Data Analyses
All analyses were performed with SPSS v.26 for Mac. Descriptive
statistics were run to analyze participants’ sociodemographic
variables and other variables of interest for the study. Because
the variables were not normally distributed (according to the
Kolmogorov–Smirnov test, p<0.05), non-parametric tests were
used. Differences between Italy and Spain in sociodemographic
variables, children’s psychological responses, emotional impact
on the children’s primary caregivers, and the children’s routines
were analyzed using chi-square (χ2) (categorical variables) and
the Mann–Whitney Utest (continuous variables). Bonferroni
corrections applied to pvalues were used to reduce the risk of type
I error. For example, considering α= 0.05 and the comparison
of 31 symptoms between both countries, adjusted alpha was
set at 0.0016. The odds ratio (OR) was reported for 2 ×2
tables. The effect size of the intergroup differences was calculated
using the Rosenthal rstatistic, which is interpreted according
to the following ranges: 0.1, small; 0.3 medium; and 0.5, large
(Rosenthal, 1991). Cramer’s Vwas calculated as a measure of
association between multi-categorical variables and interpreted
as follows: >0.25, very strong; >0.15, strong; >0.10, moderate;
>0.05, weak; and >0, none or very weak (Akoglu, 2018).
Multivariate analyses were performed by generalized linear
(GENLIN) modeling. For each child psychological reaction,
GENLIN modeling was used to examine differences between
both countries, adjusting for baseline differences, parents’ age,
and parental stress. GENLIN models for child routines were
used to identify changes during home confinement, compared
to before this period and between both countries during home
confinement. All models were adjusted for baseline differences
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TABLE 1 | Sample characteristics and differences by country.
Total (n= 1,143) Italy (n= 712) Spain (n= 431) Testaz pbEffect sizec
Parents
Female, N(%) 1,006 (88)627 (88.1)379 (87.9)0.004 0.94 –
Age, M(SD) 42.30 (6.17)42.38 (6.64)42.17 (5.32)14,870 −1.21 0.22 –
Educational level, N(%)
Doctoral or Master’s degree 213 (18.6)107 (15)106 (24.6)48.89 <0.001 0.20
Undergraduate 495 (43.3)297 (41.7)198 (45.9)
Secondary school 356 (31.1)270 (37.9)86 (20)
Primary school 79 (6.7)38 (5.4)41 (9.5)
Monthly family income (euros)
Up to 999 64 (6.4)33 (5.3)31 (8.3)9.03 0.06 –
Between 1,000 and 1,999 277 (27.7)164 (26.2)113 (30.1)
Between 2,000 and 2,999 307 (30.7)209 (33.4)98 (26.1)
Between 3,000 and 4,999 275 (27.5)169 (27)106 (28.3)
5,000 or more 78 (7.7)51 (8.1)27 (7.2)
Mother’s current employment situation
Self-employed 180 (16)118 (16.8)62 (14.5)55.93 <0.001 0.22
Part-time 168 (14.9)132 (18.9)36 (8.4)
Full-time 285 (25.2)176 (25.2)109 (25.5)
Unemployed 103 (9.1)36 (5.1)67 (15.7)
Lost job due to COVID-19 57 (5.1)30 (4.3)27 (6.3)
Smart-working 260 (23.1)157 (22.5)103 (24.1)
Other 74 (6.6)50 (7.2)24 (5.5)
Father’s current employment situation
Self-employed 279 (25)184 (26.6)95 (22.4)43.31 <0.001 0.20
Part-time 28 (2.5)15 (2.2)13 (3.1)
Full-time 503 (45.1)335 (48.5)168 (39.5)
Unemployed 32 (2.9)15 (2.2)17 (4)
Lost job due to COVID-19 51 (4.6)17 (2.5)34 (8)
Smart-working 200 (17.9)120 (17.4)80 (18.8)
Other 22 (2)4(0.6)18 (4.2)
Your situation concerning COVID-19
I belong to a risk group 103 (9)41 (5.8)62 (14.4)34.07 <0.001 0.17
People belonging to a risk group live with me 151 (13.2)94 (13.2)57 (13.2)
Friends or family are at-risk population (not living with us) 793 (69.4)501 (70.4)292 (67.7)
I do not know anyone who belongs to an at-risk population 96 (8.4)76 (10.6)20 (4.7)
The house where you live has, N(%)
Only windows 102 (8.9)25 (3.5)77 (17.9)167.97 <0.001 0.38
Garden 445 (38.9)368 (51.7)77 (17.9)
Terrace 272 (23.8)151 (21.1)121 (28.1)
Balcony 286 (25)141 (19.9)145 (33.5)
Another exit 38 (3.3)27 (3.8)11 (2.6)
Square meters home, M(SD) 126.11 (63.22)123.14 (62.29)124.99 (62.86)136,342 −3.31 0.001 0.09
Children
Female, N(%) 543 (47.5)351 (49.3)192 (44.5)2.42 0.11 –
Age, M(SD) 9.08 (4.22)9.40 (4.46)8.55 (3.73)138,750.50 −2.72 0.006 0.08
Physical or psychological problems. Yes, N(%) 126 (11)52 (7.3)74 (17.2)26.64 <0.001 0.15
Is your child receiving treatment for that problem? Yes, N(%) 96 (8.4)42 (5.9)54 (12.5)45.32 <0.001 0.19
M, mean; SD, standard deviation. aχ2for categorical variables and U Mann–Whitney for continuous variables. bBonferroni correction applied to p values was used to
reduce the risk of type I errors of a chi-squared test. cEffect size = Cramer’s V for multi-categorical variables and Rosenthal r statistic for continuous variables.
between both countries, parents’ age, and parental stress (since
this variable was the most related to child psychological
reactions). All models were adjusted for sociodemographic
differences between countries. Because of the ordinal nature of
the variables, Spearman correlations were calculated to analyze
the relationship between the primary caregivers’ emotional effects
due to COVID-19 and their children’s psychological responses.
The relationship between changes in children’s habits (time of
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screen use, physical activity, and hours of sleep) and parental
variables (parents’ perception of family coexistence during
quarantine, severity of the situation caused by coronavirus with
regard to the family’s well-being, and parents’ stress) was also
analyzed using Spearman correlations. A new variable, “change,”
was created by subtracting the score on the child routine variables
at the time “before confinement” from that “during quarantine.”
RESULTS
Parental Perception of the Emotional
Effects of the Quarantine on Their
Children
Nine hundred and eighty parents (85; 83.8 in Italy and 88.9%
in Spain) observed changes in their children’s emotional state
and behaviors during the quarantine. The most common changes
(present in at least 20% of the responses) were that, during
quarantine, their children had more difficulty concentrating
(76.6%), felt more bored than usual (52%), were more irritable
(39%), were more restless (38.8%), were more nervous (38%),
felt lonelier (31.3%), were more uneasy (30.4%), were more
worried (30.1%), were more likely to argue with the rest of
the family (29.7%), were more dependent on them (28%), were
more anxious (28.4%), were angrier (25.9%), were more reluctant
(24.7%), were sadder (23.3%), were afraid of COVID-19 infection
(23.1%), were more worried when someone left the house (22%),
and ate more than usual (21.9%). Table 2 details the percentage
of primary caregivers who perceived changes in their children’s
emotional state and behaviors during the quarantine and the
differences between Italy and Spain.
Spanish children were significantly more psychologically
affected than Italian children during the quarantine (88.9 vs.
83.8%; β= 0.38, SE = 0.19, Wald χ295% CI [0, 0.77], p= 0.05),
controlling for sociodemographic differences between samples
TABLE 2 | Primary caregivers’ perception of the emotional and behavioral effects of the quarantine in their children.
Total Italy Spain βSE Wald χ295% CI
N%n%n%
My child is worried 344 30.1 226 31.7 118 27.4 0.20 0.14 −0.08, 0.49
My child is restless 443 38.8 247 34.7 196 45.5 0.38 0.13 0.12, 0.65
My child is anxious 325 28.4 146 20.5 179 15.7 1.02 0.14 0.73, 1.31***
My child is sad 266 23.3 189 26.5 77 17.9 −0.61 0.16 −0.93, −0.29***
My child has nightmares 126 11 62 8.7 64 14.8 0.39 0.20 −3.73, 0.79
My child is reluctant 282 24.7 192 27 90 20.9 −0.32 0.15 −0.63, −0.01
My child feels lonely 358 31.3 280 39.3 78 18.1 −1.14 0.15 −1.45, −0.83***
My child wakes up frequently 138 12.1 70 9.8 68 15.8 0.38 0.19 0, 0.77
My child sleeps little 125 10.9 52 7.3 31.3 16.9 0.91 0.21 0.50, 1.32***
My child is very indecisive 131 11.5 62 8.7 69 16 0.54 0.21 0.12, 0.95
My child is uneasy 347 30.4 184 25.8 163 37.8 0.45 0.14 0.17, 0.73***
My child is nervous 434 38 243 34.1 191 44.3 0.38 0.13 0.11, 0.65
My child is afraid to sleep alone 197 17.2 94 13.2 103 23.9 0.62 0.17 0.28, 0.97***
My child argues with the rest of the family 339 29.7 165 23.2 174 40.4 0.86 0.14 0.58, 1.15***
My child is very quiet 126 11 102 14.3 24 5.6 −0.85 0.25 −1.35, −0.35***
My child cries easily 195 17.1 97 13.6 98 22.7 0.50 0.17 0.16, 0.85
My child is angry 296 25.9 157 22.1 139 32.3 0.47 0.14 0.18, 0.77***
My child asks about death 155 13.6 102 14.3 53 12.3 −0.49 0.20 −0.90, −0.09
My child feels frustrated 213 18.6 113 15.9 100 23.2 0.35 0.16 0.02, 0.68
My child is bored 596 52.1 383 53.8 213 49.4 −0.21 0.13 −0.47, 0.04
My child is irritable 446 39 260 36.5 186 43.2 0.20 0.13 −0.06, 0.46
My child has sleeping difficulties 195 17.1 90 7.9 105 9.2 0.64 0.17 0.30, 0.98***
My child has no appetite 98 8.6 48 6.7 50 11.6 0.54 0.23 0.07, 1.01
My child is easily alarmed 138 12.1 78 11 60 13.9 0.11 0.20 −0.28, 0.52
My child has difficulty concentrating 875 76.6 577 81 298 69.1 0.59 0.15 0.30, 0.89***
My child is afraid of COVID-19 infection 264 23.1 164 23 100 23.2 −0.06 0.15 0.37, 0.23
My child is very dependent on us 320 28 163 22.9 157 36.4 0.56 0.14 0.27, 0.85***
My child has physical complaints (headache, stomach ache.) 159 13.9 72 10.1 87 20.2 0.68 0.18 0.32, 1.05***
My child has behavioral problems 185 16.2 57 8 128 29.7 1.46 0.18 1.10, 1.83***
My child eats a lot 250 21.9 142 19.9 108 25.1 0.22 0.15 −0.08, 0.52
My child worries when one of us leaves the house 251 22 121 17 130 30.2 0.69 0.15 0.38, 0.99***
χ2= chi-square; OR = odds ratio; CI = confidence interval. ***p <0.001. Bonferroni correction applied to p values was used to reduce the risk of type I errors of a
chi-squared test.
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TABLE 3 | Spearman correlations between primary caregivers’ perception of
emotional and behavioral effects on their children and their perception of the
situation due to COVID-19.
Child symptoms How easy is
living together
in the family?
How serious
do you
perceive the
current
situation to
be?
How stressed do
you feel?
My child is worried −0.003 0.124** 0.126**
My child is restless −0.098** 0.109** 0.235**
My child is anxious −0.063* 0.158** 0.238**
My child is sad −0.017 0.060* 0.155**
My child has
nightmares
−0.017 −0.010 0.019
My child is reluctant −0.050 0.052 0.118**
My child is feels lonely 0.004 0.074* 0.099**
My child wakes up
frequently
0.011 0.054 0.094**
My child is sleeps little −0.011 0.051 0.046
My child is very
indecisive
−0.022 0.053 0.116**
My child is uneasy −0.078** 0.072* 0.200**
My child is nervous −0.120** 0.110** 0.260**
My child is afraid to
sleep alone
−0.026 0.048 0.106**
My child argues with
the rest of the family
−0.155** 0.071* 0.188**
My child is very quiet 0.069* −0.025 −0.063*
My child is cries easily −0.032 0.061* 0.089**
My child is angry −0.107** 0.100** 0.196**
My child asks about
death
0.001 0.003 0.047
My child is feels
frustrated
−0.084** 0.028 0.092**
My child is bored −0.016 0.137** 0.183**
My child is irritable −0.133** 0.066* 0.174**
My child has sleeping
difficulties
−0.038 0.039 0.075*
My child has no
appetite
0.022 0.007 0.002
My child is easily
alarmed
−0.042 0.046 0.106**
My child has difficulty
concentrating
−0.076** 0.073* 0.139**
My child is afraid of
COVID-19 infection
0.040 0.140** 0.091**
My child is very
dependent on us
−0.057 0.057 0.129**
My child has physical
complaints
(headache, stomach
ache.)
−0.041 −0.001 0.036
My child has
behavioral problems
−0.139** 0.025 0.102**
My child eats a lot −0.021 0.048 0.042
My child worries when
one of us leaves the
house
−0.009 0.089** 0.074*
*p <0.05; **p <0.01.
from Italy and Spain, parents’ age, and parental stress. Compared
to Italian children, Spanish children had more behavioral
problems (8 vs. 29.7%), were more likely to argue with the rest
of the family (23.2 vs. 40.4%), had more physical complaints
(10.1 vs. 20.2%), were more afraid to sleep alone (13.2 vs.
23.9%), and were more worried when one of the parents left
the house (for example, to buy groceries) (17 vs. 30.2%). Other
differences between Spanish and Italian children’s emotional state
and behaviors during the quarantine are detailed in Table 2.
Compared to Spanish children, Italians felt sadder (17.9 vs.
26.5%) and lonelier (18.1 vs. 39.3%) during the quarantine.
Family Coexistence During the
Quarantine, Perception of Severity, and
Stress Due to COVID-19
Primary caregivers reported that family coexistence during the
quarantine was found to be moderately easy (M= 3.68, SD = 1.98,
range = 1–5). Only 11.4% reported that family coexistence during
the quarantine was difficult or very difficult, and more than
half (61.8%) informed that family coexistence was easy or very
easy. The neutral option was selected by 26.8%. The parents
perceived the current situation due to COVID-19 to be quite
serious (M= 3.63, SD = 0.96, range = 1–5). Approximately
one-half (55.4%) perceived the situation to be serious or very
serious. Only 11.6% considered the current situation to be a little
serious or not serious. The rest (33%) perceived the situation
to be somewhat serious. Parental level of stress was moderate
(M= 3.18, SD = 1.02, range = 1–5). Approximately one-third of
the parents (35.4%) reported being stressed or very stressed, and
39.4% chose the option “somewhat stressed.” One in four (25.2%)
parents indicated that they did not feel stressed because of the
current situation.
When comparing the data of Italy and Spain, adjusting
for differences in sociodemographic variables between both
countries, parents’ age, and parental stress, no differences were
observed in the perception of how easy it is for the family to live
together during the quarantine (β= 0.04, SE = 0.06, Wald χ2
95% CI [−0.07, 0.16], p= 0.43), how serious the current situation
caused by the coronavirus is with regard to their well-being and
their family’s well-being (β= 0.04, SE = 0.05, Wald χ295% CI
[−0.06, 0.15], p= 0.41), and the level of parental stress (β= 0.02,
SE = 0.06, Wald χ295% CI [−0.10, 0.14], p= 0.72).
Relationship Between Primary
Caregivers’ Perception of COVID-19 and
Their Children’s Immediate
Psychological Responses During the
Quarantine
The primary caregivers’ perception of how easy it is for the family
to live together during the quarantine was related to 11 of the
31 child symptoms (Table 3). When family coexistence during
the quarantine was rated as more difficult, the parents tended to
rate their children as more restless, more anxious and uneasy,
more nervous, more likely to argue with the rest of the family,
angrier, more frustrated, more irritable, having more difficulty
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Orgilés et al. Psychological Effects of Quarantine on Youths
concentrating, presenting more behavioral problems, and less
likely to be quiet (compared to before home confinement).
Spearman correlations were indirect (except for being quiet) and
low, ranging from −0.06 to −0.15.
Primary caregivers’ perception of the seriousness of the
current situation caused by the coronavirus with regard to their
well-being and their family’s well-being was associated with 15
of the 31 child symptoms. Caregivers who perceived the current
situation as more serious with regard to their family’s well-
being tended to report that, during quarantine, their children
were more concerned, were more restless, were more anxious,
were sadder, were lonelier, were more nervous and uneasy,
were more likely to argue with the rest of the family, cried
more easily, were angrier, were more bored, had more difficulty
concentrating, were more afraid of COVID-19 infection, and
were more worried when one of them left the house (compared
to before home confinement). Spearman correlations were direct
and low, ranging from 0.06 to 0.15.
Primary caregivers’ level of stress was related to 25 of the
31 child symptoms. Parents who perceived themselves as more
stressed by the situation tended to report that, during quarantine,
their children were more worried, were more restless, were
more anxious, were sadder, were more reluctant, were lonelier,
woke up more frequently, were more indecisive, were more
uneasy, were more nervous, were more afraid to sleep alone,
were more likely to argue with the rest of the family, cried
more easily, were angrier, were more frustrated, were more
bored, were more irritable, had more difficulty concentrating
and sleeping, were more easily alarmed, were more afraid of
COVID-19 infection, were more dependent on them, had more
behavioral problems, and were more worried when one of
them left the house (compared to before home confinement).
Spearman correlations were direct, ranging from low (ρ= 0.07)
to moderate (ρ= 0.26). However, parental stress was indirectly
related to being quiet, suggesting that parents who are more
stressed perceive their children as being less quiet, although this
correlation was low (ρ=−0.06).
Children’s Patterns of Use of Screens,
Daily Physical Activity, and Hours of
Sleep Before and During the Quarantine
Table 4 indicates that, during the quarantine, children spent
more time daily using screens such as iPads, TVs, mobiles, or
computers (β= 64.98, SE = 0.08, Wald χ295% CI [55.38, 76.25],
p<0.001); spent less time doing physical activity (β= 0.04,
SE = 0.07, Wald χ295% CI [0.03, 0.04], p<0.001); and tended
to sleep a bit more (mean hours) (β= 1.24, SE = 0.07, Wald
χ295% CI [1.07, 1.42], p<0.01) compared to before this
period and controlling for parental’ age and stress. These changes
in children’s routines during the quarantine were confirmed
in both countries.
During the quarantine, Italian children spent more time using
screens (β= 46.56, SE = 0.09, Wald χ295% CI [38.37, 56.49],
p<0.001), less time daily doing physical activity (β= 0.06,
SE = 0.08, Wald χ295% CI [0.05, 0.07], p<0.001), and more
time sleeping during the week (β= 1.47, SE = 0.04, Wald χ295%
CI [1.35, 1.61], p<0.001) compared to before the quarantine.
Spanish children spent more time using screens (β= 152.69,
SE = 0.14, Wald χ295% CI [114.36, 203.88], p<0.001), less time
daily doing physical activity (β= 0.01, SE = 0.13, Wald χ295%
CI [0.01, 0.02], p<0.001), and more time sleeping during the
week (β= 1.24, SE = 0.07, Wald χ295% CI [1.07, 1.42], p<0.01)
compared to before quarantine.
Differences between Italy and Spain were found in the use
of screens during the quarantine (β=−0.83, SE = 0.13, Wald
χ295% CI [−1.01, −0.56], p<0.001). During the quarantine,
Spanish children tended to spend more time using screens than
did Italian children, such that 89.7% of the Spanish children
used screens for at least 60 min per day, whereas 81.6% of the
TABLE 4 | Children’s patterns of use of screens, daily physical activity, and hours of sleep before and during the quarantine.
Total Italy Spain
Children’s activity patterns Before quarantine During quarantine Before quarantine During quarantine Before quarantine During quarantine
Use of screens (min)
Less than 30 253 (22.1)39 (3.4)129 (18.1)32 (4.5)124 (28.8)7(1.6)
From 30 to 60 403 (35.3)136 (11.9)252 (35.4)99 (13.9)151 (35)37 (8.6)
From 60 to 90 262 (22.9)208 (18.2)173 (24.3)135 (19)89 (20.7)73 (16.9)
From 90 to 120 125 (10.9)214 (18.7)86 (12.1)129 (18.1)39 (9)85 (19.7)
From 120 to 180 63 (5.5)205 (17.9)47 (6.6)101 (14.2)16 (3.7)104 (24.2)
More than 180 37 (3.3)341 (29.9)25 (3.5)216 (30.3)12 (2.8)125 (29)
Physical activity (min per day)
Less than 30 155 (13.6)635 (55.6)125 (17.6)404 (56.7)30 (7)231 (53.6)
From 30 to 60 369 (32.3)336 (29.4)251 (35.2)198 (27.8)118 (27.4)138 (32)
From 60 to 90 320 (28)108 (9.3)177 (24.9)67 (9.4)143 (33.2)41 (9.5)
From 90 to 120 150 (13.1)38 (3.3)83 (11.7)27 (3.9)67 (15.5)11 (2.6)
From 120 to 180 83 (7.3)12 (1)36 (5.1)8(1.1)47 (10.9)4(0.9)
More than 180 66 (5.7)14 (1.2)40 (5.5)8(1.1)26 (6)6(1.4)
Hours of sleep/week M(SD)9.44 (0.01)9.66 (0.06)8.88 (0.06)9.38 (0.05)9.39 (0.51)9.40 (0.07)
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Orgilés et al. Psychological Effects of Quarantine on Youths
Italian children did so. No differences between Spain and Italy
in physical activity during the quarantine (β= 0.22, SE = 0.14,
Wald χ295% CI [−0.05, 0.50], p= 0.11) and mean hours of
sleep during the week (β=−0.01, SE = 0.09, Wald χ295% CI
[−0.20, 0.16], p= 0.84) were found. All models were adjusted
for sociodemographic differences between the samples from Italy
and Spain, parental age, and stress.
Relationship Between Primary
Caregivers’ Perception of COVID-19 and
Their Children’s Patterns of Use of
Screens, Daily Physical Activity, and
Hours of Sleep
Spearman correlations indicated that changes in child routines
were related to parental perception on how easy it is for the family
to live together during the quarantine, parental perception on
how serious the situation is, and parental stress. When family
coexistence during the quarantine was rated as easier, parents
informed that their children tended to spend more time doing
physical exercise (ρ= 0.08; p= 0.004). For parents who perceived
the situation as more serious, their children made more use of
screens (ρ= 0.07; p= 0.01) during quarantine compared to the
rest. Parents with higher levels of stress tended to report that their
children made more use of screens (ρ= 0.05; p= 0.01), spent less
time on physical activity (ρ=−0.10; p≤0.001) and slept fewer
hours than the rest (ρ=−0.12; p≤0.001).
When the Italian sample was selected, changes in child
routines were related to parental perception on how serious the
situation is and parental stress. Parental perception of how easy
coexistence is during quarantine was not related to changes in
child habits during home confinement. Parents who perceived the
situation as more serious had children who made greater use of
screens (ρ= 0.10; p= 0.008), compared to the rest. Parents who
were more stressed by the situation reported that their children
slept fewer hours compared to the rest (ρ=−0.08; p= 0.02).
When the Spanish sample was selected, changes in child
routines were related to parental perception on how easy it is
for family to live together during quarantine and parental stress.
When family coexistence during the quarantine was rated as
easier, parents informed that their children tended to spend less
time using screens (ρ=−0.09; p= 0.04), spend more time
doing physical exercise (ρ= 0.16; p= 0.001), and sleep more
hours (ρ= 0.11; p= 0.02). Parents who were more stressed by
the situation reported that their children spent less time doing
physical activity (ρ=−0.22; p≤0.001) and slept fewer hours
compared to the rest (ρ=−0.08; p= 0.02).
DISCUSSION
This study is the first one developed to examine the psychological
impact of the COVID-19 quarantine on children and adolescents
of the West. Italy and Spain are two of the countries most
affected worldwide by COVID-19, and the emotional well-
being of youth needs to be explored to provide parents and
caregivers with guidelines to reduce the impact of the quarantine
on their children.
Results indicate that 85.7% of the parents reported changes
in their children’s emotional state and behaviors during
the quarantine. The most frequent symptom was difficulty
concentrating, with 76.6% of the parents reporting this symptom.
Boredom, irritability, restlessness, nervousness, feelings of
loneliness, and being more uneasy and more worried were
reported by more than 30% of parents. As expected, and
according to the study of Xie et al. (2020) with Chinese children,
the COVID-19 confinement also impacts negatively on the Italian
and Spanish children’s well-being. Results by country show that
Spanish children were more affected than Italian children on
most symptoms. Although more research is needed to clarify
this finding, the permission given on March 31 by the Italian
government to parents to take under-18-year-old youths for a
short walk (access to parks, gardens, and all kinds of public spaces
is still not allowed) might explain the differences between Spain
and Italy. Whereas in Italy, after 3 weeks of home confinement,
children were allowed to go out for a short walk close to home
accompanied by one adult, in Spain, children could only go
outside for a justified reason. Furthermore, many more Italian
homes have gardens compared to Spanish homes (52 vs. 18%),
so this provided children with the opportunity to be more active,
benefiting their mental well-being. These differences in rules and
the characteristics of the homes of the two countries may explain
why Spanish children showed a worse behavioral and emotional
response to the quarantine. Staying at home without the chance
to go outside may increase responses of anxiety and other
related problems such as sleep problems, physical complaints,
and worries and also behavioral problems that involve the family,
such arguing with other relatives, maybe because the children
need to be more physically active. In contrast, Italian children
were perceived by their parents as sadder, and lonely, maybe due
to the longer duration of the quarantine in Italy compared to
Spain. As expected, routines also changed during the quarantine
for the children of both countries, spending more time using
screens, spending less time doing physical activity, and sleeping
more hours. For instance, during the quarantine, only 14.8%
of the youth practice at least 60 min of physical activity, as
recommended by the WHO for children between 5 and 17 years
old, compared to before the quarantine, when that percentage
reached 54.1%. In accordance with a review of studies that
observed differences in habits between weekdays and vacation
days, the present study found more healthy routines in youth
before the quarantine (Brazendale et al., 2017). This finding is also
in line with other reflections that warn about the consequences
of children’s home confinement, specifically affecting not only
their mental well-being but also their weight status and the risk of
increasing screen time (Lancet Child Adolescent Health, 2020).
Although only 11.4% of the Italian and Spanish parents
informed that family coexistence was difficult or very difficult,
most parents perceived the situation due to COVID-19 as serious
or very serious, and one-third of the parents reported being
stressed or very stressed, with no differences between the two
countries. Furthermore, parents’ perception of COVID-19 seems
to be related to their children’s psychological symptoms during
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Orgilés et al. Psychological Effects of Quarantine on Youths
the quarantine. When family coexistence during the quarantine
was more difficult, the situation was more serious, or the level
of stress was higher, parents tended to report more emotional
problems in their children; specifically, the primary caregiver’s
level of stress was related to 25 of the 31 child symptoms. Child
routines were also related to the parents’ perception of COVID-
19. Specifically, a higher level of parental stress was related to
more use of screens, less time of physical activity, and fewer
hours of children’s sleep. Different correlation patterns between
children’s routines and parental variables were found in Spain and
Italy, although parental stress was common in both. Although
a causal relationship cannot be confirmed, it is expected that
children’s behavioral problems will negatively affect the family
climate, and also, parents with a high level of stress may apply
more inconsistent discipline with their children.
CONCLUSION
COVID-19 quarantine impacts considerably on Italian and
Spanish youth’s lives, and most parents perceive changes in their
children’s emotional state and behaviors during the quarantine
compared to before the quarantine. Spanish children show
more emotional and behavioral symptoms compared to Italian
children, as reported by their parents, possibly because Italian
youth have more opportunities to be more physically active.
The emotional and behavioral symptoms of children from both
countries seem to be positively related to the parents’ well-
being, specifically to their level of stress. On the basis of these
findings, we can conclude that children and parents are both
affected by such a stressful situation as the quarantine. The
present study has some limitations. Although a multi-informant
method would be desirable, self-reports were not adequate for
the youngest children. As a main objective of this study was to
evaluate emotional and behavioral changes in children before
and during confinement, assessing for themselves whether they
manifested each symptom more or less frequently was not
considered adequate for children. Also, as behavioral symptoms
were included in the survey (such as arguing with the rest of
the family, restlessness, or irritability), it was considered that
the parents were better informants than the children. Despite
this limitation, this study is the first providing data on the
psychological repercussions of the COVID-19 quarantine on
children and adolescents from Western countries. Some practical
implications can be derived from the results. First, the obtained
data could help governments to decide the confinement rules
to apply to children to preserve their mental health (such as
considering the importance of going out for daily walks). Second,
our results could guide parents and caregivers. For example, as
being worried when parents leave home is common in children
under confinement, clear and age-appropriate information could
reduce their uncertainty and concerns. Also, since the greater
the stress of the parents, the more symptoms in the children,
not expressing frequent concerns in front of their children could
help parents to protect their mental health. Finally, professionals
should be alert to the more common psychological responses of
youth to detect the need for intervention as early as possible.
Vulnerable children and adolescents, including those with risk
factors, should receive special attention (Espada et al., 2020).
In line with this, as Liu et al. (2020) recommended, receiving
training to detect children’s psychological problems should be a
main objective for pediatric health-care workers. Also, programs
focused on providing children with psychosocial skills could help
them cope with the COVID-19 situation (Orgilés et al., 2020).
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from
the corresponding author upon reasonable request. Requests to
access the datasets should be directed to MO, morgiles@umh.es.
ETHICS STATEMENT
The studies involving human participants were reviewed and
approved by the Ethics Board of the Miguel Hernández
University of Elche. Written informed consent to participate
in this study was provided by the participants’ legal
guardian/next of kin.
AUTHOR CONTRIBUTIONS
MO designed the study and the survey. AM managed and
analyzed the data. ED designed the Italian survey and collected
the data. CM participated in the Italian survey adaptation and
collected data. JE designed this study and wrote the draft of this
article. All the authors reviewed the draft and contributed to the
final version of the manuscript.
FUNDING
This work was supported by the Ministry of Science and
Innovation of Spain and the European Regional Development
Fund (PSI2017-85493-P).
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Conflict of Interest: The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could be construed as a
potential conflict of interest.
Copyright © 2020 Orgilés, Morales, Delvecchio, Mazzeschi and Espada. This is an
open-access article distributed under the terms of the Creative Commons Attribution
License (CC BY). The use, distribution or reproduction in other forums is permitted,
provided the original author(s) and the copyright owner(s) are credited and that the
original publication in this journal is cited, in accordance with accepted academic
practice. No use, distribution or reproduction is permitted which does not comply
with these terms.
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