The COVID-19 pandemic, along with the multilevel restrictive measures applied, has generated a situation in the biomedical and socioeconomic environment that is unpredictable and stressful. The spread of disease introduced real threats as well as unintentional and drastic changes in daily lifestyle with financial difficulties and uncertain future prospects. In addition to this, pandemic minimized the possibility of implementing functional coping strategies and stress management. This combination of stressors can lead to both acute and long-term adverse effects, both direct and indirect and ultimately transgenerational. All of these stressors have physical and mental health consequences [1].

In a greek study [1], the authors described the dramatic effects of the pandemic and aimed to improve the assessment of the emotional, behavioral, and social impact of COVID-19 across nations through a holistic approach.

The spread of the Sars-Cov 2 virus has affected most nations and their governments have faced a state of emergency based on limited scientific data. The most common strategy has been social distancing through forced quarantine and widespread closures, including schools. This led to physical isolation, economic instability, fear of contagion, and uncertainty about the future. These aspects have profoundly affected global mental health [2, 3].

Restrictive measures had a widespread impact on social, relational and emotional life; in fact, due to distance learning (DL), there was also an effect on students’ academic achievements and access to mental health services [4]. Previous research reveals that during Pandemic, as in any other disaster, there is an increase of post traumatic stress symptoms (PTSD), depression and anxiety [5] and suicidal risk [6]. The governmental measures also generated a worldwide economic crisis.

Inevitably, COVID-19 will have serious and potentially long-lasting implications for the mental and physical health of children and caregivers as well as their long-term development [7]; the literature indeed, points out that although developmental age subjects were not severely affected by the infection, the psychological impact was intense [8].

Children and adolescents lived a long physical distancing from peers, teachers, extended families and community and it is known that subjects in developmental age who experienced quarantine have a higher risk to develop PTSD and anxiety symptoms [9].

Quarantine can be an unpleasant experience for those who have to face it; in fact separation from loved ones, the loss of freedom, uncertainty over disease status, and boredom may have dramatic outcomes. Suicide, substantial anger and lawsuits were reported to have followed the imposition of quarantine in previous outbreaks [2].

According to literature, adolescence is a critical developmental stage in which peer relationship and experience outside the family are important to shape personal identity. The brain and the social environment sculpt each other throughout the teenage years to influence one’s social standing amongst peers. Reciprocal interactions between brain maturation and the social environment at this critical developmental stage may augment risk or promote resilience for mental illness and other health outcomes [10].

For adolescents, furthermore, the level of stress may be heightened [11] due to their increased desire for autonomy and peer connection [12], which are both hindered when they are forced to physically distance from friends and remain home. It is also necessary to consider adolescents’ underdeveloped cognitive mechanisms that on one hand inhibit, or at least restrict self-regulation [13] and, on the other hand favour an increase in mental health issues during this developmental stage [14].

The COVID-19 pandemic is having a psychological impact on specific populations [15, 16], indeed especially adolescents with a psychiatric history are at a particular risk. Adolescent girls and adolescents living in lower economic status families may be more vulnerable. Other studies show that more vulnerable populations (women, ethnic minorities, and low-income households) worry more when they have to face crises [17].

Likely, in the future, mental health professionals may face a “Syndemic” due to the spread of acute and post-traumatic stress disorder, emotional disorders, sleep disturbances, depressive syndromes, and eventually suicide [18].

It is also necessary to consider the negative impact of restrictive measures on global health. When children are confined to their homes without outdoor activities and interaction with same age friends [19], they are physically less active, have much longer social-media screen time, irregular sleep patterns, and less favourable diets, resulting in weight gain and loss of cardiorespiratory fitness. It is also important to take into account medium and long term consequences on global health. The ACE (Adverse Childhood Experiences) Study [20, 21] revealed a strong connection between traumatic and chronic experiences during childhood and adolescence and psychophysical disease in adulthood. In particular, a strong correlation was found between the exposure to household dysfunction or abuse during childhood and multiple risk factors for several of the leading causes of death in adults, including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.

Another study indicates that some adverse childhood experiences notably those related to parental health, may leave imprints on peripheral DNA methylation that persist to mid-life [22]. Methylation is precisely the major epigenetic mechanism regulating tissue-specific gene expression, genomic imprinting, and X chromosome inactivation.

These studies highlight how important the diagnosis and the treatment of COVID 19 trauma are in perspective of protective policies of the global health of the population.

This research aims to describe the psychological impact of the COVID 19 pandemic in adolescents. The questionnaires were completed starting from May the 5th, the date on which following the flattening of the contagion curve, the restrictive measures were relaxed and it was possible to attend one’s “relatives”, as well as leave the house to walk or play individual sports outdoors. The collection of protocols ended on June the 5th, two days after the end of the restriction that imposed travel only within one’s own region.

Results show that the pandemic had a significant impact, with psychological discomfort in 35% of the sample examined, in accordance with the literature [36]. A discomfort factor that emerged is the female gender which has already been found in the literature [17, 18, 19, 20, 21, 22, 23]. The analysis of the main components revealed a “distress entity” with anxiety, depressive, somatic symptoms going to the same stressing condition direction and testifying the traumatic impact of the pandemic on the interviewed subjects. Wang [29] also emphasizes the role of somatic symptoms as an additional trigger to global inflammation due to COVID 19 virus, suggesting the need to treat somatic and depressive symptoms to reduce inflammation.

As for the use of ET as assessment tool, in a systematic review, it was considered as a valid and feasible distress screening test useful in situations of “Any significant emotion difficulty” [37]. ET has generated consistent findings and has proved to be an instrument with good criterion validity and reliability for the detection of emotional distress in cancer patients [38, 39]. Its accuracy is comparable to HADS and BDI-II, and its implementation is highly encouraged [33, 34, 39].

The driving effect of the “distress entity” had a negative impact on the DL. Also this data is in agreement with the neuro-scientific literature according to which emotional difficulties negatively affect cognitive performance [40]. McEwen [41] argues that the long-term consequences of prolonged distress can have disastrous effects on cognitive functioning, including damage to the memory and hippocampal neuroplasticity as well as an increased risk of developing symptoms [41].

The analyzes also revealed a correlation between negative feelings about DL and the level of exposure; having symptoms or an infected friend/family member/relative contributed to experiencing DL negatively. The analysis of the collected data also reveals the presence of resources in students, such as the joy of learning despite the difficulties of the DL.

The DL was a leading theme during the debates about the effects of the pandemic on subjects in developmental age; the analysis of the data shows that the suffering for DL was proportional to the distress perceived by students in general and not a factor in its own right. This distress, however, did not impact on the joy of living and learning.

The intensity and pervasiveness of the distress entity in response to the pandemic, combined with the consequent negative experience of the DL could hypothesize that the COVID 19 pandemic would be added to Adverse Childhood Experiences [20].

Despite all of these limitations, the research project achieved its goal of conducting a screening of students’ psychological status. Adherence was good, considering the emergency circumstances under which the questionnaire was administered. This research could be a snapshot of how adolescents coped with the pandemic and distance learning.

The statistical analysis showed a spread of distress. The symptoms that emerged could be comparable to those of a highly stressful condition. The data are congruent with the hypothesis that the pandemic affected the entire population in their mental health. Futhermore adolescents with their low emotion regulation and reactivity have an increased risk of developing many common forms of psychopathology, including generalized anxiety, eating disorders, depression, and social anxiety [42].

Research on adolescent psychiatric disorders in times of pandemic is needed because such a global situation could be prolonged or repeated [43].

Online learning on the other hand does not seem to have an impact on adolescents’ mental health, while emotional difficulties and psychological symptoms do. This shows that adolescents can be resilient and adaptive when needed, as long as they are equipped with the necessary tools and support [23].

These findings encouraged parents and teachers to assist adolescents in finding ways to maintain their social networks, monitor youth for signs of emotional distress, provide positive and supportive home and learning environments, and engage with mental health professionals early [23].

Our goal is that the research will give policymakers greater awareness of the plight of adolescents during the pandemic, in order to make balanced decisions, considering the social and emotional impact brought on by restrictive measures, especially school closures.

The results suggest designing a psychological care project for the following years in order to improve psychological support for students and psychoeducation for teachers and parents.

First of all, it is important to re-test students non-anonymously to identify individuals with chronic psychological distress and plan protective strategies, to reduce the sense of social isolation, which is a risk factor for suicide second cause of death among young people [44].

As in an article draw appropriate guidelines for psychological intervention following the epidemic directed to patients with COVID 19, their relatives but also to professional health care personnel, emphasizing the importance of psychological intervention performed by psychotherapists and psychiatrists trained on trauma, in order to curb the psychological consequences of forced quarantine or difficult work environments in an emergency situation [45].

Psychological interventions in high schools can be carried out both on individuals and classes, responding to the needs expressed by students through the survey.

It is also necessary to design cycles of meetings aimed at parents and teachers, in order to enhance the ability of adults to grasp the signs of distress and respond in a supportive and effective way. The meetings will also be open to politicians, psychologists and doctors from the community.

All meetings were performed on line by trained psychologist, in collaborations with doctors, through Google Meet School platform.

Improving the diagnosis and treatment of pandemic trauma is necessary to protect not only mental health [20, 21] but also global health [22].

CM, MP, IF designed the study. CM, recorded videos directed to students, parents and teachers in order to describe the pourpose of the research, the tools used and how to fill in the questionnaire. MP and IF decided the tool (EMOTION THERMOMETER and PSYCHO-COVID 19). DV prepared the informed consent forms for adult students and parents of underage students, sent the questionnaire to the students who had joined the research and collected the data through the platform used by the school. MP performed the statistical analyses. VT wrote the part relating to the description of the PSYCHO-COVID 19 questionnaire and the studies on the reliability and validity of the tool. CM, MP, EG, wrote the manuscript. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.

Every partecipant filled an informed consent (parents in case of underage students), after watching the videos in which the school psychologist explained the purpose of the research illustrating the tools and methods of compilation.

We acknowledge the students who in such a dramatic moment agreed to take part in the research. Wa acknowledge EMDR National association, that creates a team that built the research design, identified the tools and carried out the data collection.

This research received no external funding.

The authors declare no conflict of interest.