**1. Introduction**

On 5 January 2020, the World Health Organization (WHO) issued the first disease outbreak news report about a severe acute respiratory syndrome cluster of unknown causes. Later, the WHO assessed that this disease, named COVID-19 and caused by coronavirus SARS-CoV-2, constituted a public health emergency of international concern, and could be characterized as a pandemic. As of March 2020, Italy was the second country globally in terms of registered cases and the first in terms of victims. To combat the rapid escalation of cases in Italy and curb the community spread, Italy's government declared a state of emergency. The first and most rigid containment measure imposed was a national quarantine or lockdown, restricting the movement of the population except for necessity and health circumstances. Italy was the first state in Europe to follow such lockdown measures: attending school and going to work was not allowed, except for well-grounded work-related reasons, and public gatherings were prohibited. The decree also provided the obligation to stay isolated at home for anyone infected [1].

The lockdown caused a sudden change in the population's habits and free movements. Consequently, mental health problems, including anxiety, fear, depressive symptoms, loneliness, and sleep problems, increased to some degree [2–4]. For example, a literature review that evaluated the effects of the COVID-19 pandemic on the population's mental health showed high rates of different symptomatology such as anxiety (ranging from 6.33% to 50.9%), depression (ranging from 14.6% to 48.3%) and posttraumatic stress disorder

**Citation:** Di Consiglio, M.; Merola, S.; Pascucci, T.; Violani, C.; Couyoumdjian, A. The Impact of COVID-19 Pandemic on Italian University Students' Mental Health: Changes across the Waves. *Int. J. Environ. Res. Public Health* **2021**, *18*, 9897. https://doi.org/10.3390/ ijerph18189897

Academic Editor: Paul B. Tchounwou

Received: 24 August 2021 Accepted: 17 September 2021 Published: 20 September 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/).

(ranging from 7% to 53.8%). Moreover, the prevalence of psychological distress ranged from 34.43% to 38% [5]. Studies conducted on the potential psychological impact on the Italian general public have showed that, during the lockdown, a high prevalence of individuals presented anxiety and depressive symptoms, posttraumatic stress symptomatology and sleep disturbances [6–8]. Furthermore, some non-governmental organizations registered an alarming rise in the death rate by suicide; between March and November 2020, 100 out of 200 suicides and suicide attempts in Italy were correlated with COVID-19 [9]. Hence, in the last year, a number of studies were conducted to explore the effect of the lockdown on mental health, suggesting a significant negative impact on individuals' health. However, even if the most stringent lockdown lasted some months, the Italian government continued to declare a series of containment measures to curb the community spread (Table 1). These measures changed quickly based on different indexes regarding the incidence rate, transmission numbers, hospital occupancy and other factors to assess the risk level in each region. Regions were classified into three areas —red, orange, or yellow—corresponding to three risk scenarios, for which specific restrictive measures were foreseen. Besides the three areas, the nation as a whole had to observe a night curfew (from 10 p.m. to 5 a.m.) and people were constantly obliged to wear a mask, including outdoors, and maintain a distance of at least one meter from other people [10]. To the best of our knowledge, less is known about the impact of such restrictions on individuals' mental health.



Source: https://www.gazzettaufficiale.it/ (accessed on 12 July 2021).
