“Ripple effect”: Psychological responses and coping strategies of Italian children in different COVID-19 severity areas

Revista de Psicología Clínica con Niños y Adolescentes Vol. 7 nº. 3- Septiembre 2020 - pp 49-58 doi: 10.21134/rpcna.2020.mon.2054 Copyright© 2020 RPCNA www.revistapcna.com - ISSN 2340-8340 Revista de Psicología Clínica con Niños y Adolescentes “Ripple effect”: Psychological responses and coping strategies of Italian children in different COVID-19 severity areas Ziqin Liang, Elisa Delvecchio, Livia Buratta, & Claudia Mazzeschi University of Perugia, Italy Abstract COVID-19 has affected learning and the outdoor activities of more than 862 million children or adolescents worldwide. This study investigated the mental health of Italian children and explored their psychological response and coping strategies in different COVID-19 epidemic severity areas, with the aims of alleviating the impacts of COVID-19, promoting targeted intervention, and reducing the risk of future psychological problems. 1074 parents of children aged 6 to 12 years old participated in an ad-hoc online survey. Among them, 40.3% were from the high-risk areas in the North, and 59.7% were from the medium/low-risk areas in the center of Italy. The results showed that, compared to the children in medium- or low-risk areas, children in the North scored significantly higher for symptoms of anxiety, moods, and cognitive changes, showing a “ripple effect” trend. Moreover, children in the northern areas used fewer task-oriented strategies and more emotion- and avoidance-oriented strategies than those in the central areas. Specifically, children in the northern areas were more likely to show acceptance and seek affection from others, while those in the central areas used more humor when their parents talked about quarantine or coronavirus. These findings provide relevant evidence and a reference point for crisis management in children’s mental health. Keywords: psychological response; coping strategies; children; ripple effect; COVID-19. Resumen El COVID-19 ha afectado el aprendizaje y las actividades al aire libre de más de 862 millones de niños o adolescentes en todo el mundo. Este estudio investigó la salud mental de los niños italianos y exploró su respuesta psicológica y las estrategias de afrontamiento en diferentes áreas de gravedad de la epidemia de COVID-19, con el objetivo de aliviar los impactos de la misma, promover la intervención específica y reducir el riesgo de futuros problemas psicológicos. 1074 padres de niños entre 6 a 12 años de edad participaron en una encuesta ad-hoc online. De ellos, el 40,3% procedían de las zonas de alto riesgo del norte y el 59,7% de las zonas de riesgo medio/bajo del centro de Italia. Los resultados mostraron que, en comparación con los niños de las áreas de riesgo medio o bajo, los niños del norte obtuvieron una puntuación significativamente más alta en cuanto a los síntomas de ansiedad, cambios cognitivos y de estado de ánimo, mostrando una tendencia de “efecto dominó”. Además, los niños de las zonas del norte utilizaron menos estrategias orientadas a las tareas y más estrategias orientadas a las emociones - y la evitación - que los de las zonas centrales. Concretamente, los niños de las zonas del norte eran más propensos a mostrar aceptación y a buscar el afecto de los demás, mientras que los de las zonas centrales usaban más el humor cuando sus padres hablaban de la cuarentena o del coronavirus. Estos hallazgos proporcionan evidencia relevante y un punto de referencia para el manejo de crisis en la salud mental de los niños. Palabras clave: respuesta psicológica; estrategias de afrontamiento; niños; efecto dominó; COVID-19. The coronavirus 2019 (COVID-19) pandemic was declared as an international public health emergency on January 30, 2020 (World Health Organization, 2020), and the virus rapidly spread to countries around the world. On January 31, the Italian government declared a state of emergency. On February 21, a 38-year-old man living in Lombardy was confirmed as the first local human-to-human transmission case in Italy. On the same day, two positive cases were occurred in the Veneto region. The following day, the government announced the blockade and isolation of towns around those areas in the North, and restrictive measures in the first “red zone” were implemented. On February 23, schools were closed in six regions, all in northern Italy. On March 4, schools and universities closed. The quarantine zone was expanded on March 8, and it was announced that quarantine measures were implemented in 14 regions, covering the vast majority of Corresponding author: Elisa Delvecchio. Department of Philosophy, Social Sciences and Education, University of Perugia. Piazza Giuseppe Ermini, 06123 Perugia PG, Italy. E.mail: “Ripple effect”: Psychological responses and coping strategies of Italian children in different COVID-19 severity areas 50 COVID-19 Psychological impact in italian children northern Italy. The next day, the government issued a Decree to extend the restrictions that had taken effect locally to include the rest of Italy, and in which the outdoor activities of residents were limited across the country. With the exception of shops selling the basic necessities and basic services, all other shops were closed, all sports activities were cancelled, and unnecessary or strategic production activities were halted; almost everyone was required to work from home, and schools and universities across the country suspended classes, resulting in children having to stay at home (Government, 2020). Since COVID-19 usually presents as a mild disease for children, and the mortality rate of children is relatively low in comparison to that of the elderly (Götzinger et al., 2020), children were often ignored during the outbreak. UNICEF stated, “The COVID-19 pandemic has caused the poorest and most vulnerable groups in society to suffer the most serious impact” (United Nations News, 2020), reminding everyone that children may be the most affected group. This effect not only occurs during the pandemic but may remain after it has ended. When an individual perceives a threat in the environment, this automatically triggers the individual’s stress responses, such as tension, anxiety, and depression (Cohen et al., 2007). The negative emotional state caused by stress directly affects the individual’s physiological processes and behavioral response patterns (Koolhaas et al., 2011). Children are mostly in an important phase of their development during which they undergo psychological growth and the formation of their personality, and this is a sensitive stage during which to respond to stressful events. During the COVID-19 quarantine, the implementation of school closure measures reduced children’s information sources; parents and social media became their main sources of information (Saxena & Saxena, 2020). Furthermore, the quality and quantity of information provided about the epidemic may affect their disaster responses and ability to recover (Pfefferbaum et al., 2015). As (...truncated)