**1. Introduction**

Coronavirus disease (COVID-19), which started in Wuhan, China, in December 2019, became a pandemic in a few months, leading to extraordinary risks to human beings [1]. Despite the majority of infected subjects having a moderate illness and about 10–15% of

Briguglio, G.; Mento, C.; Muscatello, M.R.A.; Alibrandi, A.; Larese Filon, F.; Spatari, G.; Teodoro, M.; Fenga, C. Quality of Life, Insomnia and Coping Strategies during COVID-19 Pandemic in Hospital Workers. A Cross-Sectional Study. *Int. J. Environ. Res. Public Health* **2021**, *18*, 12466.

**Citation:** Italia, S.; Costa, C.;

Academic Editors: Paolo Roma, Merylin Monaro and Cristina Mazza

https://doi.org/10.3390/ijerph182312466

Received: 22 October 2021 Accepted: 25 November 2021 Published: 26 November 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

patients developing grave complications [2], until 21 October 2021, about 4.9 million deaths were declared, with over 241 million cases confirmed globally [3].

In Italy, the epidemiological situation during the first wave, since February 2020, differently concerned the country with a significant burden of disease in the North rather than the South; in particular, Lombardy, Piedmont, Emilia Romagna, and Veneto were the most affected northern regions [4]. The Italian government handled this critical situation by implementing preventive measures and adopting a national lockdown on 10 March 2020 [5]. Consequently, Italians lived in social isolation for about two months; only indispensable activities were allowed and leaving home was consented to only for health reasons, purchasing vital products, and reaching the workplace, when permitted [6]. The pandemic altered everybody's lives and work behaviors, particularly those healthcare workers (HCWs) who were involved on the frontline with increased exposure to SARS-CoV-2 infection, lack of validated guidelines, and shortage of resources including personal protective equipment [7]. In addition, these workers have often decided to live far from their loved ones to keep them safe from an additional risk of contagion [8].

In previous research, outbreaks of other contagious diseases led to adverse health outcomes in HCWs impacting physical, social, emotional, or spiritual wellbeing, globally reducing the quality of life [9–11]. Despite life quality being a broad-range concept, the WHO defines it as the subjective perception of own position in life in the specific cultural context and in relation to personal expectations, standards, and concerns [12]. The literature describes five dimensions that define life quality in terms of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression [13]. The current COVID-19 pandemic has created circumstances with overwhelming stressors on HCWs, through increased working loads, high risk of exposure to SARS-CoV-2, and overall disruptions of daily life, leading to increased anxiety, stress, depression, burnout and sleep disorders [14], especially insomnia [15], and to a drastic reduction in the perceived quality of life [16,17].

The considerable psychological impact of the COVID-19 pandemic has undoubtedly influenced feelings and behaviors [18,19], requiring the adoption of coping strategies to play a buffering role on stress and have a preventive effect on mental health [20]. Different coping strategies are used depending on external factors (such as cultural and workplace context or geographical area) [21] and individual components (e.g., rage, terror, or sadness) [22].

Though it has been demonstrated that the trend of contagion has differently affected the mental health status of HCWs working in areas with dissimilar incidences of COVID-19 cases [23,24], it is also true that regional differences in stress perception and coping strategies also depend on cultural factors, home/work interface, social support, and economic environment [25,26]. In a Chinese study, comparing subjects coming from Hubei and from non-endemic provinces, health workers in the endemic region showed lower anxiety levels about the COVID-19 epidemic [23]. In a multicentre prospective cohort epidemiological study, the regional origin explained a small fraction of differences in perceived job stress [27], while other factors seem to play major roles in affecting this aspect. For example, family is a fundamental source of support, particularly in developing areas where social services are scarce [28]. Under these premises, we mainly aimed to assess the quality of life, insomnia, and analyze the different coping strategies adopted among hospital personnel during the first wave of the COVID-19 pandemic in Italy. More specifically, we examined the differences in sociodemographic characteristics and work-related factors in two different Italian metropolitan areas with similar epidemiological trends, located in the North and in the South of Italy, respectively. We intended to identify eventual work-related and sociodemographic predictors of worse outcomes, suggesting insights on the best tailored preventive and organizational measures in the workplace.
