The COVID-19 outbreak has resulted in governments implementing disease containment measures such as school closures, social distancing, and home quarantine.
To date, only a few studies have drawn attention to the psychological impact of lockdown on Italian children’s mental health. The present study aimed to investigate the psychological distress (anxiety and mood symptoms) and perceived changes in routine among Italian primary and middle school students during the COVID-19 quarantine.
This interview study was performed between the 18th of May and 7th of June 2020: it involved a sample of 82 children and adolescents living in Milan (Italy), attending primary and middle school (aged 6 to 14 years), and their parents.
Almost 30 % of the subjects reported having struggled to adjust to home learning. 36 responders completely changed their dietary habits during the lockdown: they were not eating the same amount of food and were consuming more junk food. Sleep habits were also affected by the lockdown measures: 28 % of the sample had difficulties sleeping and wished to sleep in their parents’ bed. Concerning psychological distress, 64 (78 %) children and adolescents had anxiety symptoms; 43.9 % of the students reported significant mood symptoms.
Children are not indifferent to the dramatic impact of the COVID-19 epidemic: our data confirm their difficulties in adapting to the quarantine measures. The effects of stress exposure may not manifest later on during the children’s development, and, for this reason, it would be interesting to follow up on these participants to improve our understanding of how long these outcomes may last.
In December 2019, the outbreak of a new strain of coronavirus disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) was first reported in Wuhan, (China) and spread across the world within a short time; the World Health Organization declared it as a pandemic (COVID-19) on March 12, 2020 .
This pandemic has resulted in governments implementing disease containment measures such as school closures, social distancing, and home quarantine.
In Lombardy, the most affected Italian region, the first school closure began the 21st of February 2020, and, on 5 March 2020, all schools in Italy were closed and students isolated at home for the rest of the academic year, with schooling shifted to home based distance-learning models. The closure of schools was the first mass intervention taken towards a target population. School activity was the first to be suspended and the last to be resumed, by not considering how to mitigate the negative impacts of lockdown. There is still significant controversy about the role of children in spreading the virus, also at school: evidence is emerging that children may be significantly less likely to become infected than adults, and do not appear to be super spreaders . On the one side, it is suggested that children may play and attenuating role both with respect to epidemiological and clinical dynamics. On the other side, some of these effects may be age dependent, with younger children more likely candidates for a lesser role in transmission . According to the United Nations Educational, Scientific and Cultural Organization  due to the COVID-19 schools have been suspended nationwide in 188 countries: affecting more than more than 1.5 billion children and adolescents worldwide, who found themselves isolated at home. Moreover, the lockdown and school closure may have negative consequences on children, affecting their social life, their education, and their mental health . The COVID-19 pandemic may worsen existing mental health problems and lead to more cases among children and adolescents because of the unique combination of uncertainty, anxiety, fear of becoming ill or seeing a loved one become sick, loss of our everyday routines, difficulties in maintaining social connection, and economic recession .
After the H1N1 and SARS epidemics, 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 .
A recent review highlighted that children and adolescents are probably more likely to experience high rates of depression and anxiety during and after enforced isolation ends . The authors found a clear association between loneliness and mental health problems, mostly depression, in children and adolescents. Loneliness was associated with future mental health problems up to 9 years later.
A Chinese survey  conducted during COVID-19 directly involved primary school students and reported higher rates of depressive (22.6 %) and anxiety (18.9 %) symptoms compared with the prevalence in other surveys.
Italy was the first European country to implement a national lockdown to contain the spread of severe coronavirus disease 19 (COVID-19) and related strict domestic quarantine policies.
To date, only a few studies [10,11,12,13] have drawn attention to the psychological impact of lockdown on Italian children’s mental health. A recent study has examined the psychological effects of the quarantine in youth from Italy and Spain. Data were collected through a survey completed by parents and found that their children had different symptoms such as: 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 %). Moreover, the results show that children of both countries used monitors more frequently, spent less time doing physical activity, and slept more hours during the quarantine (10). Similarly, another Italian study  suggested that during the lockdown children exhibited a marked delay in sleep timing and a mild worsening in sleep quality. They were less prone to respect daily routines or to keep track of the passage of time. An increase in emotional, conduct and hyperactive symptoms in children, together with regressive behaviours was reported, which was predicted by the change in sleep quality, boredom, and mothers’ psychological difficulties.
The social distancing and stay-at-home orders issued in cities across the globe obviously reduce the opportunities for physical activity among children, particularly for children in urban areas living in small apartments. Isolation and shielding could result in increased sedentary behaviours and food consumption, which are likely to impact weight and consequently health and sleep over time [14, 15].
During the pandemic, the prevalence of physically inactive students increased extensively, from 21.3 to 65.6 %. Overall screen time increased considerably during the pandemic and screen time during leisure was also prolonged, indicating that nearly a quarter of students engaged in long screen time for leisure .
To date, the majority of knowledge available from research related to the health needs and experiences of young children has been based on the perspectives of parents and/or paediatric health professionals. A growing number of researchers in the health care field have begun to capture the children’s perspectives through interviews [16, 17].
For this reason, we decided to directly involve children and adolescents with video-interviews to convey their experiences and to more fully understand their needs.
To our knowledge, this is the first study that directly investigates the effects of the COVID-19 lockdown on children’s and adolescents’ perceived changes in routine and mental health from their own perspective. In particular, the added value of the study is the fact that it directly involved students with video-interviews, letting them share their needs and opinions.
The present study aims to analyse the impact of the quarantine on students’ life in Milan, one of the Italian cities most affected by COVID-19. In particular, we focused our attention on their perception of changes in routine during the lockdown: distance learning, eating and sleeping habits. Psychological distress such as anxiety and mood symptoms, disease concern, regressive behaviours, and fears were examined. We hypothesized that quarantine period and school closure could have a negative impact on perceived changes in routine and on children’s emotional and behavioral well-being. Moreover we aimed to explore what are the things that children missed the most and what they expected to do as soon as quarantine gets over, in order to highlight their priorities.
This interview study was performed between the 18th of May and 7th of June 2020, for a total of 3 weeks. 18th of May was a meaningful date in Italy: it corresponded to the beginning of the second phase of the lockdown. From May 18th shops reopened (as well as cafès and restaurants) and people were allowed to go outside without the previously required form justifying their reasons, and meeting up with friends was permitted. During this period students were still attending their online classes.
This cross-sectional study used structured interviews, conducted by two psychologists (GS and FS, Doctors of Clinical and Psychology). Interviews were about 10 to 20 min in duration for each student and respondents’ answers where recorded by researchers on a questionnaire form (ad hoc created) during the interviews. Students and their parents were at home during the interviews, conducted with a video-meeting platform (Zoom).
Scientific literature related to the psychological impact of quarantine was reviewed and ad-hoc interviews were created in order to investigate changes in routine of children and adolescents and psychological reactions due to the coronavirus lockdown.
To be included in the study participants have to be primary or middle school students (data were collected from across all eight school year levels) living in Milan (Lombardy, Italy). Those children and their parents were recruited via different channels (newsletter, website, and social networks) of the Laboratory for Mother and Child Health of the Mario Negri Institute in Milan. Participants were excluded if they were not able or were not willing to attend the Zoom video.
Before conducting the interviews with study participants, a pilot study was conducted to test the interview design with four students (two males and two females of different grades): at the end participants were asked whether the questions were clear and made them comfortable. The parent was involved at the beginning of the interview in order to introduce the child and reply to a few quick questions: COVID-19 cases within the family context, developmental disorders of the child (such as specific learning disorder/special educational needs), residency, and type of school attended by the child (private/state school).
Socio-demographic variables such as age, gender, school grade, house and family situation (information on people living with the respondent during the lockdown), and average screen time per day. Socioeconomic data, such as household income and the number of rooms in the house, were not collected.
How can we make the interview as safe as possible?
Remote interviews have become common since the coronavirus pandemic began. But what if your interview is in person?
First, you can ask whether a phone or video interview would be OK. The employer might be flexible.
If you do need to go in person, here are some questions you could ask ahead of time:
What changes have you made to safety protocols because of COVID-19?
Many employers are taking new steps to keep their employees safe from COVID-19. For example, some have put extra cleaning measures in place. Some are providing gloves, masks, and other protective gear. And other employers have changed employees’ schedules so that fewer people are working at any one time.
Because of safety concerns, the Equal Employment Opportunity Commission (EEOC) has said that employers are allowed to take certain steps during the pandemic, like taking employees’ temperatures. But workplace anti-discrimination laws, like the Americans with Disabilities Act, still apply.
An interviewer should be able to tell you about any changes to workplace safety protocols related to the pandemic, or refer you to someone who can.
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How Did the Pandemic Affect Your Career Goals?
Translation: What are you looking for in your next role and are we the right fit?
“Hiring managers want to know that youre not just interested in a role because youre escaping a bad employer or leaving a job you hated, even if that might be the case,” Meegoda says. So be sure youre answering this question with the role youre interviewing for in mind. Did you realize that you want to work on a product that is more in line with your environmental values? Great! Feel free to mention that—provided the role youre interviewing for has such a product. Did you decide to finally take the plunge on that career change youve been dreaming about for years? This could be a great opportunity to share your journey and pitch your transferable skills.
And it doesn’t have to be anything drastic. You might say, “This last year made me realize just how quickly the economy can change and that reinforced my desire to continue to grow within my career and learn new skills as fast as possible,” Meegoda says, and go on to mention how you’d like to develop professionally or what new skills you’d like to focus on honing.