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nutrients
Article
Psychological Aspects and Eating Habits during
COVID-19 Home Confinement: Results of
EHLC-COVID-19 Italian Online Survey
Laura Di Renzo 1, Paola Gualtieri 1, Giulia Cinelli 2, 3, * , Giulia Bigioni 4, Laura Soldati 5,
Alda Attinà2, Francesca Fabiola Bianco 2, Giovanna Caparello 2, Vanessa Camodeca 2,
Elena Carrano 2, Simona Ferraro 2, Silvia Giannattasio 2, Claudia Leggeri 2, Tiziana Rampello 2,
Laura Lo Presti 6, Maria Grazia Tarsitano 7and Antonino De Lorenzo 1
1Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of
Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; laura.di.renzo@uniroma2.it (L.D.R.);
paola.gualtieri@uniroma2.it (P.G.); delorenzo@uniroma2.it (A.D.L.);
2School of Specialization in Food Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome,
Italy; alda.attina@gmail.com (A.A.); kikafabiola@gmail.com (F.F.B.); caparello.giovanna@gmail.com (G.C.);
vanessacamodeca@libero.it (V.C.); elena_carrano@libero.it (E.C.); ferrarosimona@hotmail.it (S.F.);
silviagiannattasio85@gmail.com (S.G.); claudialeggeri@gmail.com (C.L.); tizianarampello1@gmail.com (T.R.)
3Predictive and Preventive Medicine Research Unit, Bambino GesùChildren’s Hospital IRCCS,
00165 Rome, Italy
4Department of Physic, University of Rome Sapienza, P.zza Aldo Moro 5, 00185 Rome, Italy;
bigionigiulia@gmail.com
5Department of Health Sciences, University of Milan, Via A. Di Rudinì, 8, 20142 Milan, Italy;
laura.soldati@unimi.it
6Unitelma Sapienza, University of Rome Sapienza, Via Regina Elena, 295, 00161 Rome, Italy;
la.lopre@gmail.com
7Department of Experimental Medicine, University of Rome Sapienza, Rome 00161, Italy;
mariagrazia.tarsitano@uniroma1.it
*Correspondence: giuliacinelli88@gmail.com; Tel.: +39-329-185-8289
Received: 19 June 2020; Accepted: 16 July 2020; Published: 19 July 2020
Abstract:
The COVID-19 pandemic has had a huge impact on the population with consequences on
lifestyles. The aim of the study was to analyse the relationship between eating habits, mental and
emotional mood. A survey was conducted online during social isolation, from 24 April to 18 May
2020, among the Italian population. A total of 602 interviewees were included in the data analysis.
A high percentage of respondents experienced a depressed mood, anxious feelings, hypochondria
and insomnia (61.3%, 70.4%, 46.2% and 52.2%). Almost half of the respondents felt anxious due to
the fact of their eating habits, consumed comfort food and were inclined to increase food intake to
feel better. Age was inversely related to dietary control (OR =0.971, p=0.005). Females were more
anxious and disposed to comfort food than males (p<0.001; p<0.001). A strength of our study
was represented by the fact that the survey was conducted quickly during the most critical period
of the Italian epidemic lockdown. As the COVID-19 pandemic is still ongoing, our data need to be
confirmed and investigated in the future with larger population studies.
Keywords:
SarsCoV2; COVID-19; lockdown; psychological effects; emotional eating; lifestyle;
eating behaviours
Nutrients 2020,12, 2152; doi:10.3390/nu12072152 www.mdpi.com/journal/nutrients
Nutrients 2020,12, 2152 2 of 14
1. Introduction
The new form of coronavirus (Sars-CoV-2) has triggered a worldwide state of emergency [
1
].
In this pandemic scenario, the experts involved [
2
] are increasingly concerned by the psychological
implications that the epidemic has brought with it, especially for elderly people with compromised
immune systems and for the health of the workers employed on the front lines against this virus [
3
].
Previous studies have revealed a wide range of psychosocial impacts on individuals and on the overall
community during outbreaks of infections [
4
]. On a personal level, people experienced fear of getting
sick or dying, feelings of helplessness and stigma [
4
]. In particular, the fear of one’s own health and of
their loved ones, social distancing and the quarantine obligations have put a strain on the affective
and emotional sphere of every individual. This situation has severely undermined the psychological
stability of Italians as well as the worldwide population, causing adverse psychological effects.
The lockdown measures have had a great impact on everyday life [
2
], often associated with a
negative influence on psychological well-being. These circumstances have exasperated a series of
psychological and psychopathological conditions, including emotional exhaustion, irritability, anxiety,
increased anger, depressive symptoms as well as a post-traumatic stress disorder [
5
]. Psychological
theories, such as the behaviour immune system (BIS), argue that these emotional and cognitive
responses support proactively the immune system in the fight against the pathogen agents [6].
Until now, the information on psychological impact of the COVID-19 pandemic on the population
continues to be limited. Researchers, in fact, have mainly focused on identifying epidemiology
and clinical features of infected patients [
7
], virus genomics characterizations [
8
] and governmental
challenges in the healthcare and economic fields [
9
]. Besides these priorities, it is important not to
downplay the contribution of social and behavioural sciences in shaping and optimizing individual
and collective response to the crisis [
10
]. During an epidemic, people can react to official information
in an irrational way and, thus, governments should make people aware of the situation without raising
alarms [11].
Several studies have highlighted how a significant number of individuals have manifested a
series of psychological effects and the difficulties in adapting to the new lifestyle of the quarantine. In
China, the psychological impact and the state of mental health during the first phase of COVID-19
pandemic were assessed through the Event Scale (IES-R), while the impact of depression, anxiety
and stress were assessed by the Depression Anxiety and Stress Scale (DASS-21) [
12
]. Similarly, an
Italian study assessed the general population’s psychological distress during the pandemic through
an online survey. This showed that 38% of the population was affected by significant psychological
indispositions [
13
]. Further, many studies have compared the psychological outcomes between
quarantined and non-quarantined people [
14
]. One in particular demonstrated that the quarantine
effect could be a predictor of post-traumatic stress symptoms, even years after the event [
15
]. In Poland,
a significant percentage of individuals changed dietary habits and started eating and snacking more,
leading to weight gain in overweight and obese subjects [
16
]. Therefore, as widely demonstrated by
these studies, negative effects of post-traumatic stress symptoms, confusion and anger were reported.
The stress factors included uncertainty about the duration of the quarantine, fear of possible infections,
the ban on going to hospitals unless strictly necessary, frustration, boredom, infodemic, overall
uncertainty of the future, fear of significant financial losses and long-term repercussions that the
country will face.
It is pivotal to highlight how containment measures, including self-isolation and social distancing,
may have had a strong impact on the everyday life of the population and how the population’s
psychological well-being may have been negatively affected.
The “Eating Habits and Lifestyle Changes in COVID-19 lockdown” (EHLC-COVID19) project
on the Italian population has started to explore and analyse, in a diachronic perspective, the
multi-dimensional lifestyle behaviours, eating habits and mental and emotional responses during
home confinement [16].
Nutrients 2020,12, 2152 3 of 14
The first survey launched with the EHLC-COVID19 and focused on eating habits, adherence to the
Mediterranean Diet (MD) and the changes in the lifestyle faced during the COVID-19 lockdown of the
Italian population [
17
]. This paper presents data from the second part of the EHLC-COVID19 survey
that aimed to analyse the psychological status during the COVID-19 pandemic and its correlation with
the eating habits in the Italian population.
2. Materials and Methods
2.1. Survey Methodology and Promotion
The EHLC-COVID19 project conducted research, using an electronic survey in Italian, to collect
data on the Italian population regarding eating habits, lifestyle and the behavioural and emotional
impact related to the COVID-19 pandemic.
The survey was designed by a steering group of scientists at the Section of Clinical Nutrition
and Nutrigenomics at the Department of Biomedicine and Prevention of the University of Rome Tor
Vergata. It was conducted during the lockdown period among the Italian population using an online
platform (Google Form) which was accessible by any device with an Internet connection. The survey
was concluded when the Italian ministerial ordinances started authorising again some public and
private activities. The questionnaire was uploaded and shared through the institutional mailing list,
social networks (Twitter, Instagram and Facebook), and the “PATTO in Cucina Magazine” website [
17
].
The online survey provided statistical collective parameters. The research objectives were entirely
successful, since this method facilitated the wide dissemination of the questionnaire without any type
of limit.
According to the latest Italian Annual Report on Internet Access, the selected methodology
conformed with the actual use of the Internet in Italy. In January 2020, 94% of internet visitors, aged
16 to 64, used their mobile phones to navigate the Web, while 99% of them used specifically social
networks and messaging services [18].
The survey included an introductory page describing the background, the aims and information
on the ethics of the survey. The inclusion criteria for the respondents were: people living in Italy, age
18–79 years, female or male. Individuals living outside of Italy were excluded. These criteria were
verified by answers given to the corresponding survey questions.
The structured questionnaire included 25 questions, divided into three different sections: (1)
personal and general data (including 6 questions: age, gender, information on region and province of
residence, level of education, and cohabitation situation at home); (2) anthropometrics information
(including 2 questions reported as weight and height); (3) lifestyle, eating habits changes, psychological
and emotional aspects caused by the social isolation during the pandemic period (including 17 questions
modified from validated tools [
19
–
23
]), to investigate and assess the emotional aspects such as anxiety,
depressed mood, hypochondria, level of concern, emotional eating, insomnia, dietary changes, as well
as the perception of diet control and appetite. No names or other personal information was requested.
The questions within the last section of the survey were extrapolated from the 14 item Hamilton
Anxiety Rating Scale [
19
,
20
], commonly used in the clinical context to evaluate anxiety symptoms, the
17 item Hamilton Depression Scale [
21
], developed to assess depression and from the 25 item Yale
Food Addiction Scale (YFAS), designed to identify those exhibiting signs of addiction towards certain
types of foods [
22
,
23
]. Only some of the questions, from the Italian version of the scales, were used and
edited by researchers to adapt them to the current period of social isolation, hence, no scoring scale was
calculated. The full version of the questionnaire, translated into English, is available in Appendix A.
The online survey was conducted in full agreement with the national and international regulations
in compliance with the Declaration of Helsinki (2000). All participants were fully informed about the
study requirements and were required to accept the data sharing and privacy policy before taking part
in the study. To maintain and protect the confidentiality of the participants, their personal information
and data were anonymous, according to the provisions of the General Data Protection Regulation
Nutrients 2020,12, 2152 4 of 14
(GDPR 679/2016). The anonymous nature of the web survey did not allow for tracing in any way
sensitive personal data. Therefore, the present web survey study did not require approval by the
Ethics Committee.
The participants completed the questionnaire directly connected to the Google Form, each
questionnaire was sent to the final database and downloaded as a Microsoft Excel sheet. The
participants’ answers were anonymous and confidential according to Google’s privacy policy [
24
]. The
participants would have been able to withdraw their participation in the survey at any stage before the
submission; non-completed responses were not saved.
2.2. Statistical Analysis
Descriptive statistics were employed to explore demographic, personal characteristics and
anthropometric parameters of the study sample. Data are represented as numbers and percentages
in parentheses (%) for categorical variables or mean and standard deviation (SD), as well as median
and interquartile range in square brackets [IQR] for continuous variables. The Shapiro–Wilk test
was carried out to evaluate variables distribution. All the variables had non-normal distribution.
The Spearman correlation coefficient was calculated to evaluate the correlation between continuous
variables. The Chi-square test was employed to assess the association of categorical variables. Instead,
Mann–Whitney U and Kruskal–Wallis tests were performed to compare continuous variables among
two or more groups, respectively. Finally, univariable and multivariable binary logistic regression
analyses were conducted to investigate the association between categorical variables (dependent) and
continuous or categorical ones (independent). Results were significant for p-value <0.05. Statistical
analysis was performed using SPSS ver. 21.0 (IBM, Chicago, IL, USA).
3. Results
3.1. Participants
The web survey was launched on the 24 April 2020 and concluded on the 18 May 2020, when the
lockdown in Italy ended (Appendix Bshows the geographical distribution of COVID-19 total positive
cases in Italy on 18 May 2020). Thereafter data were analysed. A total of 700 participants completed the
questionnaire. After the validation of the data, 602 respondents, aged between 18 and 79 years, were
included in the analysis. The female respondents represented the majority of the population (79.7%).
The territorial coverage spread over all Italian regions: 15.6% of respondents lived in Northern Italy,
40.0% in Centre Italy, and 44.4% in Southern Italy and Islands. According to the age distribution, the
sample reflected the population of Italian internet users (i.e., 98.7% of people older than 20 years) [
25
].
General characteristics and anthropometrics of the population are reported in Table 1. A positive
correlation between BMI and age was found (r=0.296, p<0.001). No difference was found in BMI
when comparing the different Italian regions (p=0.078), while males showed a significantly higher
BMI in comparison to females (Mann–Whitney U =20,331.50, p<0.001).
For what concerns cohabitation during the COVID-19 emergency, 192 (31.9%) participants declared
to live with their parents, 157 (26.1%) with their partner and children, 134 (22.3%) with just their partner
and 21 (3.5%) with just their children. Finally, 64 (10.6%) of them declared to live alone and 34 (5.6%)
with flatmates. Furthermore, 196 (31.9%) of the respondents affirmed to suffer from a disease (e.g.,
hypertension, oncological, cardiovascular or autoimmune diseases).
Nutrients 2020,12, 2152 5 of 14
Table 1. Population’s characteristics and anthropometrics.
Whole Sample
(n=602)
Northern Italy
(n=94)
Centre Italy
(n=241)
Southern Italy and
Islands (n=267)
Age 36.0 [20.0] 36.0 [18.0] 33.0 [23.0] 38.0 [17.0]
38.2 ±12.9 38.1 ±12.5 37.3 ±14.1 39.1 ±11.9
Age Groups
18–30 years 212 (35.2%) 33 (35.1%) 107 (44.4%) 72 (27.0%)
31–50 years 279 (46.3%) 45 (47.9%) 86 (35.7%) 148 (55.4%)
51–65 years 91 (15.1%) 13 (13.8%) 37 (15.4%) 41 (15.4%)
>66 years 20 (3.3%) 3 (3.2%) 11 (4.6%) 6 (2.2%)
Gender
Female 480 (79.7%) 82 (87.2%) 182 (75.5%) 216 (80.9%)
Male 120 (19.9%) 12 (12.8%) 58 (24.1%) 50 (18.5%)
Not specified 2 (0.3%) 0.0 (0%) 1 (0.4%) 1 (0.4%)
Educational Level
Compulsory school
44 (7.3%) 9 (9.6%) 11 (4.6%) 24 (9.0%)
High school degree
215 (35.7%) 23 (24.5%) 76 (31.5%) 116 (43.4%)
Graduate school
degree 243 (40.4%) 41 (43.6%) 107 (44.4%) 95 (35.6%)
Post-graduate
school degree 100 (16.6%) 21 (22.3%) 47 (19.5%) 32 (12.0%)
Weight (kg) 66.0 [21.0] 64.5 [16.3] 66.0 [22.0] 67.0 [21.0]
69.6 ±16.4 67.6 ±16.8 70.3 ±16.6 69.6 ±16.2
Height (cm) 165.0 [11.3] 165.5 [9.5] 165.0 [13.0] 165.0 [10.0]
166.4 ±8.6 166.5 ±7.6 167.2 ±8.5 165.8 ±8.9
BMI (kg/m2) 24.0 [6.4] 23.1 [5.6] 24.0 [6.3] 24.6 [6.7]
25.0 ±5.2 24.3 ±5.6 25.1 ±5.3 25.2 ±4.9
Class of BMI
Underweight 13 (2.2%) 2 (2.1%) 7 (2.9%) 4 (1.5%)
Normal weight 344 (57.1%) 62 (66.0%) 137 (56.8%) 145 (54.3%)
Overweight 161 (26.7%) 20 (21.3%) 64 (26.6%) 77 (28.8%)
Obesity I 61 (10.1%) 7 (7.4%) 23 (9.5%) 31 (11.6%)
Obesity II 13 (2.2%) 1 (1.1%) 5 (2.1%) 7 (2.6%)
Obesity III 10 (1.7%) 2 (2.1%) 5 (2.1%) 3 (1.1%)
Values are expressed as median and IQR in square brackets (M [IQR]) as well as mean and standard deviation
(
M±SD
) for continuous variables or as number and percentage (n(%)) for categorical variables. The Shapiro–Wilk
test was performed to evaluate variables distribution. Variables are considered non-normally distributed for
p<0.05
.
BMI, body mass index.
3.2. Emotional State during the COVID-19 Emergency
With regards to the emotional state, a high percentage of the respondents declared to have felt
anxious and depressed during the COVID-19 lockdown. Figure 1shows the percentage of positive
answers to the questions extrapolated from the Hamilton Depression Rating Scale. The figure includes
also the percentage of positive answers concerning insomnia.
Considering the different Italian regions, a difference was found for physical manifestation of
anxiety (p=0.046; percentage of positive answers: North 55.3%, Centre 52.7%, South and Islands
63.3%) and tension (p=0.017; percentage of positive answers: North 84.0%, Centre 71.4%, South and
Islands 79.8%). Moreover, a difference among age groups was found for depressed mood, anxious
feelings and insomnia (p=0.001, p<0.001 and p=0.014, respectively). In particular, the univariable
binary logistic regression showed that age was inversely correlated to these emotional states (depressed
mood: OR =0.980, p=0.002; anxious feelings: OR =0.966, p<0.001; insomnia: OR =0.980, p=0.001).
With regards to gender, the percentage of females declaring to feel depressed and anxious, to
experience physical manifestations of anxiety, tension and insomnia problems during the COVID-19
Nutrients 2020,12, 2152 6 of 14
emergency was significantly higher than the males one (at the Chi-Square analysis
p<0.001
for
all the variables). Females were also more prone to take drugs or supplements for their anxious
feelings
(p=0.006)
. Surprisingly, a higher percentage of males in comparison to females affirmed
to have felt breathing difficulties and other symptoms such as tachycardia or perception of fainting
(
p=0.028; p=0.035
). No difference between males and females was found for hypochondria
(p=0.475)
.
Results are shown in Figure 2. Further, 24.1% of the respondents declared to have stopped working
during the pandemic, while 36.9% affirmed to have had difficulties in concentration in their daily work.
Nutrients 2020, 12, x FOR PEER REVIEW 6 of 16
Nutrients 2020, 12, x; doi: FOR PEER REVIEW www.mdpi.com/journal/nutrients
3.2. Emotional State during the COVID-19 Emergency
With regards to the emotional state, a high percentage of the respondents declared to have felt
anxious and depressed during the COVID-19 lockdown. Figure 1 shows the percentage of positive
answers to the questions extrapolated from the Hamilton Depression Rating Scale. The figure
includes also the percentage of positive answers concerning insomnia.
Figure 1. Percentage of positive answers to the questions extrapolated from the Hamilton Depression
Rating Scale about depressed mood, anxious feelings, the physical manifestations of anxiety
(tachycardia, headache, sweating), hypochondria, tension and fatigability (on alert, ready to cry,
trembling, restless, unable to relax), breathing difficulties (sighing, choking sensation, chest pressure,
dyspnoea), tachycardia and feeling faint (palpitation, chest pain), use of drugs and supplementation
for anxious mood. The figure also includes the percentage of positive answers about insomnia.
Considering the different Italian regions, a difference was found for physical manifestation of
anxiety (p = 0.046; percentage of positive answers: North 55.3%, Centre 52.7%, South and Islands
63.3%) and tension (p = 0.017; percentage of positive answers: North 84.0%, Centre 71.4%, South and
Islands 79.8%). Moreover, a difference among age groups was found for depressed mood, anxious
feelings and insomnia (p = 0.001, p < 0.001 and p = 0.014, respectively). In particular, the univariable
binary logistic regression showed that age was inversely correlated to these emotional states
(depressed mood: OR = 0.980, p = 0.002; anxious feelings: OR = 0.966, p < 0.001; insomnia: OR = 0.980,
p = 0.001).
With regards to gender, the percentage of females declaring to feel depressed and anxious, to
experience physical manifestations of anxiety, tension and insomnia problems during the COVID-19
emergency was significantly higher than the males one (at the Chi-Square analysis p < 0.001 for all the
variables). Females were also more prone to take drugs or supplements for their anxious feelings (p
= 0.006). Surprisingly, a higher percentage of males in comparison to females affirmed to have felt
breathing difficulties and other symptoms such as tachycardia or perception of fainting (p = 0.028; p
= 0.035). No difference between males and females was found for hypochondria (p = 0.475). Results
are shown in Figure 2. Further, 24.1% of the respondents declared to have stopped working during
the pandemic, while 36.9% affirmed to have had difficulties in concentration in their daily work.
52.2%
19.3%
81.2%
83.1%
77.1%
46.2%
57.8%
70.4%
61.3%
0.0% 25.0% 50.0% 75.0% 100.0%
Insomnia
Use of drugs/supplements for anxious feelings
Tachycardia and feeling faint
Breathing difficulties
Tension and fatigability
Hypochondria
Physical manifestations of anxiety
Anxious feelings
Depressed mood
Emotional State during the COVID-19 Emergency
Figure 1.
Percentage of positive answers to the questions extrapolated from the Hamilton Depression
Rating Scale about depressed mood, anxious feelings, the physical manifestations of anxiety (tachycardia,
headache, sweating), hypochondria, tension and fatigability (on alert, ready to cry, trembling, restless,
unable to relax), breathing difficulties (sighing, choking sensation, chest pressure, dyspnoea), tachycardia
and feeling faint (palpitation, chest pain), use of drugs and supplementation for anxious mood. The
figure also includes the percentage of positive answers about insomnia.
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Figure 2. Percentages of positive answers to questions related to the emotional state during the
COVID-19 emergency, in males and females. A Chi-square analysis was performed to compare male
and female percentages. * p < 0.05; ** p < 0.01; *** p < 0.001.
3.3. Emotional Eating Behaviour during the COVID-19 Emergency
With regards to the emotional eating behaviour during the COVID-19 isolation, almost half of
the respondents declared to have felt anxious due to the fact of their eating habits. They admitted to
having used food as a means of comfort in response to their anxious feelings and to being prone to
increasing their food intake to feel better. Figure 3 shows the percentage of positive answers to the
questions concerning emotional eating behaviour, including those extrapolated from the Yale Food
Addiction Scale.
Figure 3. Percentage of positive answers to the questions about emotional eating behaviour. *
Questions extrapolated from the Yale Food Addiction Scale.
0.0%
25.0%
50.0%
75.0%
100.0%
Insomnia***
Use of drugs/supplements for
anxious feelings**
Tachycardia and feeling faint*
Breathing difficulties*
Tension and faticability***Hypochondria
Physical manifestations of
anxiety***
Anxious feelings***
Depressed mood***
Emotional State in Males and Females
during the COVID-19 Emergency
Males Females
20.3%
57.8%
55.1%
48.7%
14.0%
44.0%
0.0% 20.0% 40.0% 60.0% 80.0% 100.0%
Exclusion of foods that lead to anxious feelings*
Anxious feelings due to current eating habits*
Need to increase food intake to feel better*
Use of food to respond to anxious feelings
Control over eating
Dieting before COVID-19
Emotional Eating Behaviour during the COVID-19
Emergency
Figure 2.
Percentages of positive answers to questions related to the emotional state during the
COVID-19 emergency, in males and females. A Chi-square analysis was performed to compare male
and female percentages. * p<0.05; ** p<0.01; *** p<0.001.
Nutrients 2020,12, 2152 7 of 14
3.3. Emotional Eating Behaviour during the COVID-19 Emergency
With regards to the emotional eating behaviour during the COVID-19 isolation, almost half of
the respondents declared to have felt anxious due to the fact of their eating habits. They admitted to
having used food as a means of comfort in response to their anxious feelings and to being prone to
increasing their food intake to feel better. Figure 3shows the percentage of positive answers to the
questions concerning emotional eating behaviour, including those extrapolated from the Yale Food
Addiction Scale.
Nutrients 2020, 12, x FOR PEER REVIEW 7 of 16
Nutrients 2020, 12, x; doi: FOR PEER REVIEW www.mdpi.com/journal/nutrients
Figure 2. Percentages of positive answers to questions related to the emotional state during the
COVID-19 emergency, in males and females. A Chi-square analysis was performed to compare male
and female percentages. * p < 0.05; ** p < 0.01; *** p < 0.001.
3.3. Emotional Eating Behaviour during the COVID-19 Emergency
With regards to the emotional eating behaviour during the COVID-19 isolation, almost half of
the respondents declared to have felt anxious due to the fact of their eating habits. They admitted to
having used food as a means of comfort in response to their anxious feelings and to being prone to
increasing their food intake to feel better. Figure 3 shows the percentage of positive answers to the
questions concerning emotional eating behaviour, including those extrapolated from the Yale Food
Addiction Scale.
Figure 3. Percentage of positive answers to the questions about emotional eating behaviour. *
Questions extrapolated from the Yale Food Addiction Scale.
0.0%
25.0%
50.0%
75.0%
100.0%
Insomnia***
Use of drugs/supplements for
anxious feelings**
Tachycardia and feeling faint*
Breathing difficulties*
Tension and faticability***Hypochondria
Physical manifestations of
anxiety***
Anxious feelings***
Depressed mood***
Emotional State in Males and Females
during the COVID-19 Emergency
Males Females
20.3%
57.8%
55.1%
48.7%
14.0%
44.0%
0.0% 20.0% 40.0% 60.0% 80.0% 100.0%
Exclusion of foods that lead to anxious feelings*
Anxious feelings due to current eating habits*
Need to increase food intake to feel better*
Use of food to respond to anxious feelings
Control over eating
Dieting before COVID-19
Emotional Eating Behaviour during the COVID-19
Emergency
Figure 3.
Percentage of positive answers to the questions about emotional eating behaviour. * Questions
extrapolated from the Yale Food Addiction Scale.
No difference was found for the emotional eating behaviour in the different Italian regions. In the
regression analysis no correlation was found between age and the different emotional eating behaviour
(need to increase food intake: p=0.441; use of food to respond to anxious feelings: p=0.441; anxious
feelings due to the eating habits: p=0.327; foods exclusion: p=0.454; dieting before COVID-19: p=
0.495). On the contrary, age resulted to be inversely correlated to the control overfeeding (OR =0.971, p
=0.005).
With regards to gender, in comparison to males, a higher percentage of females was on a diet
before the COVID-19 emergency (p=0.005). Moreover, females declared to be more prone to emotional
eating, needing to increase their food intake to feel better or using food as a response to their anxious
state (p<0.001; p<0.001). Finally, due to the fact of their eating habits, they also felt more anxious
when compared to males during the COVID-19 lockdown (p<0.001). No difference was found for
the control of over-eating (p=0769) and exclusion of foods that lead to anxious feelings (p=0.096).
Results are shown in Figure 4.
Nutrients 2020,12, 2152 8 of 14
Nutrients 2020, 12, x FOR PEER REVIEW 8 of 16
Nutrients 2020, 12, x; doi: FOR PEER REVIEW www.mdpi.com/journal/nutrients
No difference was found for the emotional eating behaviour in the different Italian regions. In
the regression analysis no correlation was found between age and the different emotional eating
behaviour (need to increase food intake: p = 0.441; use of food to respond to anxious feelings: p =
0.441; anxious feelings due to the eating habits: p = 0.327; foods exclusion: p = 0.454; dieting before
COVID-19: p = 0.495). On the contrary, age resulted to be inversely correlated to the control
overfeeding (OR =0.971, p = 0.005).
With regards to gender, in comparison to males, a higher percentage of females was on a diet
before the COVID-19 emergency (p = 0.005). Moreover, females declared to be more prone to
emotional eating, needing to increase their food intake to feel better or using food as a response to
their anxious state (p < 0.001; p < 0.001). Finally, due to the fact of their eating habits, they also felt
more anxious when compared to males during the COVID-19 lockdown (p < 0.001). No difference
was found for the control of over-eating (p = 0769) and exclusion of foods that lead to anxious feelings
(p = 0.096). Results are shown in Figure 4.
Figure 4. Percentages of positive answers to questions related to the emotional eating behaviour
during the COVID-19 emergency in males and females. A Chi-square analysis was performed to
compare male and female percentages. ** p < 0.01; *** p < 0.001.
3.4. Eating Control and Emotional State
The multivariable binary logistic regression analysis was performed to evaluate which factors
could have been predictors of the ability to control over-eating during the pandemic. The results of
the univariable analysis are shown in Table S1. The final step of the backward approach is shown in
Table 2. The increased control of over-eating during the lockdown was associated with lower age,
lower BMI, not feeling anxious, dieting before COVID-19 and being less prone to increase food intake
to feel better.
Table 2. Adjusted association between respondents’ characteristics and control over-eating.
Dependent
Variable Independent Variables Coefficient
(B)
95% CI
p OR
Lowe
r
Bound
Uppe
r
Bound
Control over-
eating
Age −0.034 0.945 0.989 0.004 0.967
BMI −0.113 0.833 0.958 0.002 0.893
Dieting before COVID-19 0.830 1.375 3.822 0.001 2.293
0.0%
25.0%
50.0%
75.0%
100.0%
Exclusion of foods that
lead to an anxious feelings
Anxious feelings due to
the current eating
habits***
Need to increase food
intake to feel better***
Use of food to respond to
anxious feelings***
Control over eating
Dieting before COVID-19**
Emotional Eating Behaviour in Males and Females
during the COVID-19 Emergency
Males Females
Figure 4.
Percentages of positive answers to questions related to the emotional eating behaviour during
the COVID-19 emergency in males and females. A Chi-square analysis was performed to compare
male and female percentages. ** p<0.01; *** p<0.001.
3.4. Eating Control and Emotional State
The multivariable binary logistic regression analysis was performed to evaluate which factors
could have been predictors of the ability to control over-eating during the pandemic. The results of the
univariable analysis are shown in Table S1. The final step of the backward approach is shown in Table 2.
The increased control of over-eating during the lockdown was associated with lower age, lower BMI,
not feeling anxious, dieting before COVID-19 and being less prone to increase food intake to feel better.
Table 2. Adjusted association between respondents’ characteristics and control over-eating.
Dependent Variable Independent Variables Coefficient (B)
95% CI
pOR
Lower
Bound
Upper
Bound
Control over-eating
Age −0.034 0.945 0.989 0.004 0.967
BMI −0.113 0.833 0.958 0.002 0.893
Dieting before COVID-19 0.830 1.375 3.822 0.001 2.293
Depressed mood −0.549 0.314 1.062 0.077 0.577
Anxious feelings −0.820 0.239 0.812 0.009 0.440
Need to increase food
intake to feel better −1.036 0.206 0.611 <0.001 0.355
Multivariable binary logistic regressions between control over-eating (dependent variable) and respondents
characteristics (independent co-variables). A separate univariable binary logistic regression analysis was conducted
for each characteristic and the final multivariable model was determined through a backward approach. Variables
included in the model: age, BMI, dieting before COVID-19, depressed mood, anxious feelings and need to increase
food intake to feel better. The table shows only the final step of the regression. Statistical significance for p<0.05 (in
bold). BMI, body mass index; OR, odds ratio.
4. Discussion
There are different studies and surveys created all over the world that demonstrate that the
COVID-19 lockdown has affected the population’s psychological wellness [
26
–
28
]. The choice of
quarantine from public health institutions has generated positive effects on the hindrance of the
Nutrients 2020,12, 2152 9 of 14
spread of the virus but contemporarily led to many symptoms of emotional uncomfortableness and
psychological disorders in the population [
29
]. The severe quarantine restrictions, such as social
distancing, school and several work activities closing, the ban on group gatherings and physical
activities in open spaces and dedicated facilities, abruptly turned upside down the traditional lifestyle.
It generated consequences on the psychological and emotional state globally [
2
]. The second part of
the EHLC-COVID19 project [
18
] started in this period of social constrain to evaluate consequences on
mood and nutrition habits of 602 individuals.
The respondents to the questionnaire were mainly females from the different Italian regions,
young individuals and a large portion of them cohabiting within their family. The lockdown has
undoubtedly had effects on the mood of the participants of the survey: 61.3% of the respondents said
that they have had, for various reasons, a lowering of their mood. The majority of the participants
in the survey referred to anxious feelings and depressed moods as well as exhaustion and tension
with tachycardia and breath difficulties. The low mood was not directly connected to a clinical
diagnosis of a depressive state but to an emotional state. Nonetheless, the symptoms of depression,
besides the evaluation of the mood tone, were also connected to behavioural and cognitive evaluations
(hypersomnia/hyposomnia, hyperphagia/hypophagia, lack of concentration, attention, etc.) [
30
].
Moreover, 36.9% of the interviewees claimed to have reduced their concentration in their working
activity. The majority of respondents (70.4%) reported having experienced anxious feelings, yet it is
unsure whether this state was pathological or simply related to the lockdown. Anxiety is a natural
emotional state that causes people to perceive themselves to be in danger when they can no longer
manage to implement their forecasting system [
31
]. In the time of the COVID-19, anxiety can be
considered a natural consequence and not necessarily an indicator of endogenous disturbance, it is
rather reactive and connected to the perceived danger. The anxious symptomatology, where present,
was expressed with mild or moderate symptoms and nobody claimed to have had crippling/disabling
experiences; when present, rather than appearing with specific physical symptoms and in a somatised
form (tachycardia, tremor, sweating, etc.) it seemed to express itself as an inability to relax and as a
state of nervousness and restlessness. On the other hand, 46.2% had health concerns and a fear of get
sick. In almost all the interviewees, the need to use specific drugs or supplements for the management
of anxiety was not reported. This may be a result of the low intensity of the symptoms as well as the
interpretation of this state as a normal consequence of the situation experienced, not only by the specific
subject but by the overall population. This underlies the belief that, where “collective” emotional states
and situations of shared danger are experienced, there is the perception of being in the “norm”. As
such, individuals feel like they belong to a group which therefore makes them feel less isolated and
capable of being able to count on the protection from others.
However, with regards to the gender, we discovered that the pandemic has caused, in females,
a depressive mood, anxious state, the manifestation of anxiety, tension and insomnia; their use of
drugs and supplements increased significantly contrary to that of males, who instead suffered from
psychosomatic effects like tachycardia and breath difficulties. This was probably because the anxious
individual has a higher physiological response to stressful stimuli and is more frequent in the female
gender [
32
]. In addition, the results have shown an inverse correlation between the age of respondents
and the presence of depressed mood, anxious feelings and insomnia.
The survey also investigated the relationship between the psychological state and emotional
eating. Emotional eating refers to the drive to eat as a reaction to negative feelings or stress. Negative
emotions like anxiety, stress and depression could be a leading cause for the insurgency of emotional
hunger [
33
,
34
]. Almost a half of the respondents (44.0%) followed a dietary diet, before the outbreak
of the pandemic, highlighting a natural predisposition to “dieting” by the female population. The
lockdown seems to have influenced the ability to control the relationship with food. Isolation, lack of
stimuli, boredom and changing food routines had effects on 86.0% of respondents who reported that
they were unable to sufficiently control their diet. We could suppose that there was a variation of caloric
intake of each meal due to the quantity and quality of food daily consumed in the quarantine period,
Nutrients 2020,12, 2152 10 of 14
and a major number of highly elaborated homemade foods and of superior caloric content [
17
,
35
].
We know that there are no foods or natural remedies that can prevent COVID-19 infections [
36
];
nevertheless, an anti-inflammatory diet could be useful to strengthen the immune system and contrast
inflammatory cascade and oxidative stress [
37
]. Butler et al. [
38
] suggested that the type of diet
can influence both the host’s response and the pathogen’s virulence. In particular, there could be
a correlation between the consumption of high palatable foods, like ultra-processed ones, and an
impairment of the temporal coordination of the innate and adaptive immunity. Such impairment
has been shown to increase the probability of infection by COVID-19, as well as of a more severe
clinical course.
The enhanced exposure to food caused by the increase of boredom and having more time available
to cook and consume the meal, also enhanced by the fact that the only freedom allowed was to go
grocery shopping, induced people who least succeed in managing their diet to amplify the relationship
between food intake and emotions. Despite this awareness, “containment” actions have not been put
into practice. Many individuals have chosen not to limit themselves, except on rare occasions.
It emerges also that there is a difference in gender regarding emotional hunger. Females display a
higher state of eating anxiety compared to males. The results show that females had more alimentation
anxiety and felt the need to increase food intake in comparison to males. This is probably caused by
the female physiology which is more subject to emotional hunger and to symptoms of depression [
39
].
We could assess a correlation between anxiety, depressive mood and food dependency which could
lead to a food addiction, referring to the idea that in some sensible subjects some highly palatable
edibles foods would generate a process comparable to addiction [
40
]. More specifically the definition
of this condition is complex and highly debated: it encompasses emotional, behavioural, cognitive and
physiological aspects [
41
]. Consumption of palatable food can have positive and strengthening effects.
It can sensibly normalise stress response with the optimizing and comforting effects [
42
]. Specific
nourishments, mainly those rich in fats and/or sugars, may induce behaviour similar to “addiction”
and, in certain conditions, generate neuronal changes. These consumption models are associated to
enhanced risks of comorbidity conditions as obesity, early weight gain, depression, anxiety, substance
abuse as well as relapse and treatment problems [43].
On the one hand, the lockdown has allowed more room for imagination and exploration with
food both in terms of recipes and human relations (for example cooking and eating together more often
than before), on the other hand, some individuals have experienced an increase of boredom, general
inactivity and seeking out new stimuli in food.
Lastly, by analysing different variables that include age, BMI and anxiety mood, it was possible
to observe that during the quarantine the younger population with lower BMI had suffered less the
increase in food control and decrease of food intake. This should be further investigated with deeper
studies and among a larger sample of people. It should take into consideration whether there are
differences among the different Italian regions, as the COVID-19 infection has had a diverse spread
between Northern, Central and Southern Italy.
From a psychological point of view, resilience is the ability to face and overcome a dramatic event
or a difficult period. The lockdown caused by the COVID-19 pandemic has heavily influenced our life
by completely changing our routines and isolating us from our loved ones. Italians have demonstrated
courage and strong resilience to maintain a normal lifestyle and discreet eating habits, even when
sanitary and economic situations were hard to handle.
A strength of our study was represented by the fact that the survey was conducted quickly in the
most critical period of the lockdown in Italy. As the COVID-19 pandemic is still ongoing, our data need
to be confirmed and investigated in the future with larger population studies. The main limitations of
this study are related to the lack of test scoring and of some data we could have collected which may
have increased the psychological strain, such as COVID-19 diagnosis and economic status. Hence,
further study on psychological status, eating habits and positivity in relation to COVID-19 should
be conducted.
Nutrients 2020,12, 2152 11 of 14
Supplementary Materials:
The following are available online at http://www.mdpi.com/2072-6643/12/7/2152/s1,
Table S1: Univariable logistic regression between respondents’ characteristics and control over feeding.
Author Contributions:
Conceptualization, L.D.R.; Data curation, G.C. (Giulia Cinelli) and G.B.; Formal analysis,
G.C. (Giulia Cinelli); Investigation, F.F.B., V.C., E.C., S.F., S.G., T.R. and L.L.P.; Methodology, L.D.R.; Project
administration, L.D.R.; Software, A.A. and S.G.; Supervision, A.D.L.; Validation, G.C. (Giulia Cinelli), A.A.
and S.G.; Writing—original draft, L.D.R., G.C. (Giulia Cinelli), G.C. (Giovanna Caparello), E.C., S.G. and C.L.;
Writing—review and editing, P.G., G.C. (Giulia Cinelli), L.S., C.L. and M.G.T. All authors have read and agreed to
the published version of the manuscript.
Funding: This research received no external funding.
Acknowledgments:
The authors thank Paola Medde for her help in interpreting the results on the emotional
status. The authors thank Fulvia Mariotti for the editorial and English language revisions.
Conflicts of Interest: The authors declare no conflict of interest.
Appendix A
Table A1. The 28 item structured questionnaire used for the survey.
Questions Answers
Personal Data
1. Age Age in number
2. Gender Female/Male/NS
3. Place of residence Region
4. Hometown Province
5. Educational level
Elementary school diploma/Superior school
diploma/Master Degree
Post degree diploma
6. Who do you live with?
Alone/With roommates/With friends/With
cohabitant/With parents
With children/With spouse/cohabitant
and children
Anthropometrics Data 7. Weight Weight in kg
8. Height Height in cm
Emotional state, eating habits and
emotional eating behaviors
9. In this social isolation period, is your mood depressed?
Yes/No
10. In this social isolation period are you focused on
your work?
Yes/No/At the moment I am not working due to
the pandemia
11. In this social isolation period, are you experiencing
anxious feelings? Yes/No
12. In this social isolation period, are you feeling
“hypochondriac” (afraid of getting sick)? Yes/No
13. In this social isolation period, are you experiencing
manifestations of anxiety (i.e., headache, sweating)? Yes/No
14. In this social isolation period, are you experiencing
manifestations of tension, fatigability, on alert, ready to cry,
trembling, restless, unable to relax?
Yes/No
15. In this social isolation period are you experiencing
breathing difficulties, choking sensation, chest
pressure, dyspnea?
Yes/No
16. In this social isolation period are you experiencing
tachycardia, palpitations, chest pain, feelings of fainting? Yes/No
17. In this social isolation period are you taking any
supplements (i.e., valerian, passionflower) and/or
medications (i.e., benzodiazepines) to treat your
manifestations of anxiety?
Yes/No
18. Have you been diagnosed with medical conditions? Yes/No
19. In this social isolation period, are you
experiencing insomnia? Yes/No
20. In this social isolation period, when you experience
manifestations of anxiety, do you comfort yourself
with foods?
Yes/No
21. In this social isolation period, when you experience
manifestations of anxiety did you avoid any food? Yes/No
22. Before this social isolation period, were you on a diet?
Yes/No
23. In this social isolation period, do you continue to
follow your diet? Yes/No
24. In this social isolation period, are you feeling guilty for
your eating habits? Yes/No
25. In this isolation period, are you eating more to get
feeling better, to reduce negative emotions or to increase
pleasant feelings?
Yes/No
Nutrients 2020,12, 2152 12 of 14
Appendix B
Nutrients 2020, 12, x FOR PEER REVIEW 13 of 16
Nutrients 2020, 12, x; doi: FOR PEER REVIEW www.mdpi.com/journal/nutrients
21. In this social isolation period, when you
experience manifestations of anxiety did you
avoid any food?
Yes/No
22. Before this social isolation period, were
you on a diet? Yes/No
23. In this social isolation period, do you
continue to follow your diet? Yes/No
24. In this social isolation period, are you
feeling guilty for your eating habits? Yes/No
25. In this isolation period, are you eating
more to get feeling better, to reduce negative
emotions or to increase pleasant feelings?
Yes/No
Appendix B
Geographical distribution of COVID-19 total positive cases in Italy on 18 May 2020. Data derived
from the Health Ministry of Italy [44].
Figure A1.
Geographical distribution of COVID-19 total positive cases in Italy on 18 May 2020. Data
derived from the Health Ministry of Italy [44].
References
1.
Lima, C.K.T.; Carvalho, P.M.D.M.; Lima, I.D.A.A.S.; Nunes, J.V.A.D.O.; Saraiva, J.S.; De Souza, R.I.;
Da Silva, C.G.L.; Neto, M.L.R. The emotional impact of Coronavirus 2019-nCoV (new Coronavirus disease).
Psychiatry Res. 2020,287, 112915. [CrossRef] [PubMed]
2.
Brooks, S.K.; Webster, R.K.; Smith, L.E.; Woodland, L.; Wessely, S.; Greenberg, N.; Rubin, G.J. The psychological
impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet
2020
,395, 912–920. [CrossRef]
3.
Psychiatry Advisor. Mental Health Concerns Aris Amid COVID-19 Epidemic. Available online:
https://www.psychiatryadvisor.com/home/topics/general-psychiatry/mental-health- concerns-arise- amid-
COVID-19-epidemic (accessed on 4 June 2020).
4.
Hall, R.C.; Hall, R.C.; Chapman, M.J. The 1995 Kikwit Ebola outbreak: Lessons hospitals and physicians can
apply to future viral epidemics. Gen. Hosp. Psychiatry 2008,30, 446–452. [CrossRef] [PubMed]
5.
Wilder-Smith, A.; Freedman, D.O. Isolation, quarantine, social distancing and community containment:
Pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J. Travel
Med. 2020,27, 20. [CrossRef]
6.
Schaller, M. The behavioural immune system and the psychology of human sociality. Philos. Trans. R. Soc.
Biol. Sci. 2011,366, 3418–3426. [CrossRef]
Nutrients 2020,12, 2152 13 of 14
7.
Huang, C.; Wang, Y.; Li, X.; Ren, L.; Zhao, J.; Hu, Y.; Zhang, L.; Fan, G.; Xu, J.; Gu, X.; et al. Clinical features
of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020,395, 497–506. [CrossRef]
8.
Lu, R.; Zhao, X.; Li, J.; Niu, P.; Yang, B.; Wu, H.; Wang, W.; Song, H.; Huang, B.; Zhu, N.; et al. Genomic
characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor
binding. Lancet 2020,395, 565–574. [CrossRef]
9. Rubin, G.J.; Wessely, S. The psychological effects of quarantining a city. BMJ 2020,368, 313. [CrossRef]
10.
Van Bavel, J.J.; Baicker, K.; Boggio, P.S.; Capraro, V.; Cichocka, A.; Cikara, M.; Crockett, M.J.; Crum, A.J.;
Douglas, K.M.; Druckman, J.N.; et al. Using social and behavioural science to support COVID-19 pandemic
response. Nat. Hum. Behav. 2020,4, 460–471. [CrossRef]
11.
Gao, J.; Zheng, P.; Jia, Y.; Chen, H.; Mao, Y.; Chen, S.; Wang, Y.; Fu, H.; Dai, J. Mental health problems and
social media exposure during COVID-19 outbreak. PLoS ONE 2020,15, e0231924. [CrossRef]
12.
Wang, C.; Pan, R.; Wan, X.; Tan, Y.; Xu, L.; Ho, C.S.; Ho, R.C. Immediate Psychological Responses and
Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among
the General Population in China. Int. J. Environ. Res. Public Health 2020,17, 1729. [CrossRef] [PubMed]
13.
Moccia, L.; Janiri, D.; Pepe, M.; Dattoli, L.; Molinaro, M.; De Martin, V.; Chieffo, D.; Janiri, L.; Fiorillo, A.;
Sani, G.; et al. Affective temperament, attachment style, and the psychological impact of the COVID-19
outbreak: An early report on the Italian general population. Brain Behav. Immun.
2020
,87, 75–79. [CrossRef]
[PubMed]
14.
Liu, X.; Kakade, M.; Fuller, C.J.; Fan, B.; Fang, Y.; Kong, J.; Guan, Z.; Wu, P. Depression after exposure to
stressful events: Lessons learned from the severe acute respiratory syndrome epidemic. Compr. Psychiatry
2012,53, 15–23. [CrossRef] [PubMed]
15.
Wu, P.; Fang, Y.; Guan, Z.; Fan, B.; Kong, J.; Yao, Z.; Liu, X.; Fuller, C.J.; Susser, E.; Lu, J.; et al. The
Psychological Impact of the SARS Epidemic on Hospital Employees in China: Exposure, Risk Perception,
and Altruistic Acceptance of Risk. Can. J. Psychiatry 2009,54, 302–311. [CrossRef] [PubMed]
16.
Sidor, A.; Rzymski, P. Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland.
Nutrients 2020,12, 1657. [CrossRef]
17.
Di Renzo, L.; Gualtieri, P.; Pivari, F.; Soldati, L.; Attin
à
, A.; Cinelli, G.; Leggeri, C.; Caparello, G.; Barrea, L.;
Scerbo, F.; et al. Eating habits and lifestyle changes during COVID-19 lockdown: An Italian survey. J. Transl.
Med. 2020,18, 1–15. [CrossRef]
18.
Digital 2020 Global Digital Overview. Available online: https://datareportal.com/reports/digital-2020- global-
digital-overview (accessed on 6 June 2020).
19. Hamilton, M. The Assessment of Anxiety States by Rating. Br. J. Med Psychol. 1959,32, 50–55. [CrossRef]
20. Thompson, E. Hamilton Rating Scale for Anxiety (HAM-A). Occup. Med. 2015,65, 601. [CrossRef]
21. Hamilton, M. A Rating Scale for Depression. J. Neurol. Neurosurg. Psychiatry 1960,23, 56–62. [CrossRef]
22.
Gearhardt, A.N.; Corbin, W.R.; Brownell, K.D. Preliminary validation of the Yale Food Addiction Scale.
Appetite 2009,52, 430–436. [CrossRef]
23.
Manzoni, G.M.; Rossi, A.; Pietrabissa, G.; Varallo, G.; Molinari, E.; Poggiogalle, E.; Donini, L.M.; Tarrini, G.;
Melchionda, N.; Piccione, C.; et al. Validation of the Italian Yale Food Addiction Scale in postgraduate
university students. Eat. Weight Disord. Stud. Anorex. Bulim. Obes.
2018
,23, 167–176. [CrossRef] [PubMed]
24.
Google Privacy and Terms. Available online: https://policies.google.com/privacy?hl=en (accessed on 12 June
2020).
25.
Istat. Multiscope on Families: Aspect of Everyday Life—General Part. Available online: https://www.istat.it/
it/archivio/91926 (accessed on 10 June 2020).
26.
Cao, W.; Fang, Z.; Hou, G.; Han, M.; Xu, X.; Dong, J.; Zheng, J. The psychological impact of the COVID-19
epidemic on college students in China. Psychiatry Res. 2020,287, 112934. [CrossRef] [PubMed]
27.
Scarmozzino, F.; Visioli, F. COVID-19 and the Subsequent Lockdown Modified Dietary Habits of Almost
Half the Population in an Italian Sample. Foods 2020,9, 675. [CrossRef] [PubMed]
28.
Ammar, A.; Brach, M.; Trabelsi, K.; Chtourou, H.; Boukhris, O.; Masmoudi, L.; Bouaziz, B.; Bentlage, E.;
How, D.; Ahmed, M.; et al. Effects of COVID-19 Home Confinement on Eating Behaviour and Physical
Activity: Results of the ECLB-COVID19 International Online Survey. Nutrients
2020
,12, 1583. [CrossRef]
[PubMed]
29.
Inchausti, F.; Macbeth, A.; Hasson-Ohayon, I.; DiMaggio, G. Psychological Intervention and COVID-19:
What We Know So Far and What We Can Do. J. Contemp. Psychother. 2020. [CrossRef]
Nutrients 2020,12, 2152 14 of 14
30.
Van Strien, T.; Konttinen, H.M.; Homberg, J.; Engels, R.C.M.E.; Winkens, L.H. Emotional eating as a mediator
between depression and weight gain. Appetite 2016,100, 216–224. [CrossRef]
31.
Kim, S.-Y.; Adhikari, A.; Lee, S.Y.; Marshel, J.H.; Kim, C.; Mallory, C.; Lo, M.; Pak, S.; Mattis, J.; Lim, B.K.;
et al. Diverging neural pathways assemble a behavioural state from separable features in anxiety. Nature
2013,496, 219–223. [CrossRef]
32.
Akiskal, K.K.; Akiskal, H.S. The theoretical underpinnings of affective temperaments: Implications for
evolutionary foundations of bipolar disorder and human nature. J. Affect. Disord.
2005
,85, 231–239.
[CrossRef]
33.
Litwin, R.; Goldbacher, E.; Cardaciotto, L.; Gambrel, L.E. Negative emotions and emotional eating: The
mediating role of experiential avoidance. Eat. Weight. Disord. Stud. Anorex. Bulim. Obes.
2016
,22, 97–104.
[CrossRef]
34.
Konttinen, H.M.; Männistö, S.; Sarlio-Lähteenkorva, S.; Silventoinen, K.; Haukkala, A. Emotional eating,
depressive symptoms and self-reported food consumption. A population-based study. Appetite
2010
,54,
473–479. [CrossRef]
35.
Ruiz-Roso, M.B.; Padilha, P.D.C.; Mantilla-Escalante, D.C.; Ulloa, N.; Brun, P.; Acevedo-Correa, D.;
Peres, W.A.F.; Martorell, M.; Aires, M.T.; Cardoso, L.D.O.; et al. COVID-19 Confinement and Changes of
Adolescent’s Dietary Trends in Italy, Spain, Chile, Colombia and Brazil. Nutrients
2020
,12, 1807. [CrossRef]
36.
Halbreich, U.; Kahn, L.S. Atypical depression, somatic depression and anxious depression in women: Are
they gender-preferred phenotypes? J. Affect. Disord. 2007,102, 245–258. [CrossRef]
37.
Off-Label Use of Medicines for COVID-19. WHO. 2020. Available online: https://www.who.int/news-room/
commentaries/detail/off-label-use-of-medicines-for-covid-19 (accessed on 12 June 2020).
38.
Butler, M.J.; Barrientos, R.M. The impact of nutrition on COVID-19 susceptibility and long-term consequences.
Brain Behav. Immun. 2020,87, 53–54. [CrossRef]
39.
Iddir, M.; Brito, A.; Dingeo, G.; Del Campo, S.S.F.; Samouda, H.; La Frano, M.R.; Bohn, T. Strengthening the
Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations
during the COVID-19 Crisis. Nutrients 2020,12, 1562. [CrossRef]
40.
Carter, J.C.; Van Wijk, M.; Rowsell, M. Symptoms of ‘food addiction’ in binge eating disorder using the Yale
Food Addiction Scale version 2.0. Appetite 2019,133, 362–369. [CrossRef] [PubMed]
41.
Fletcher, P.C.; Kenny, P.J. Food addiction: A valid concept? Neuropsychopharmacology
2018
,43, 2506–2513.
[CrossRef] [PubMed]
42.
Parylak, S.L.; Koob, G.F.; Zorrilla, E.P. The dark side of food addiction. Physiol. Behav.
2011
,104, 149–156.
[CrossRef] [PubMed]
43.
Corwin, R.; Grigson, P.S. Symposium overview—Food addiction: Fact or fiction? J. Nutr.
2009
,139, 617–619.
[CrossRef] [PubMed]
44.
Health Ministry. Available online: http://www.salute.gov.it/imgs/C_17_notizie_4776_0_file.pdf (accessed on
10 June 2020).
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