From discomfort to psychological stress: has the number of anxious men doubled?

Editorial note: This article was originally published in the past and has been updated according to scientific and informative criteria. It is for informational purposes only and does not replace medical advice. In case of psychological symptoms or persistent disorders, consult a healthcare professional.

IN BRIEF

• Significant increases in anxiety symptoms were observed globally during the initial phase of the pandemic and in the first year; estimates from large populations indicate appreciable increases compared to pre-pandemic levels.
• Evidence shows various risk factors: female sex, young age, disadvantaged socioeconomic conditions, social isolation, and contact with COVID-19 cases.
• The biological concept of stress (general adaptation syndrome / allostasis) helps understand how prolonged stress can translate into physical and mental symptoms.
• Available data primarily come from cross-sectional studies and meta-analyses; more longitudinal and representative data are needed to establish certain causal trajectories.
• For practice: social support measures, access to mental health services, and targeted public policies remain key interventions; each individual clinical decision requires professional evaluation.

Abstract: what does science say?

The body of research conducted since early 2020 indicates that the COVID-19 pandemic and associated containment measures coincided with an increase in the prevalence of anxiety and depressive symptoms in the general population. Estimates vary by country, period, and measurement method, but meta-analyses and analyses of large datasets suggest an appreciable increase compared to pre-pandemic levels, with the phenomenon concentrated among young people, women, and socioeconomically disadvantaged groups. From a biological perspective, the stress response (allostasis and allostatic load) explains how prolonged and repeated events can alter endocrine, immune, and behavioral functions. However, most evidence is observational and uses self-assessment tools; therefore, causal inferences remain limited and require longitudinal data and standardized diagnostic measures. [Summary by image: 100 words]

Main section

Why are we talking about an increase in anxiety after lockdown?

Early research conducted during and immediately after lockdown documented a widespread increase in anxiety symptoms. Global estimates and combined analyses show that, in the first year of the pandemic, the prevalence of anxiety disorders and depression increased significantly compared to the period before the emergency [1]. A comprehensive meta-analysis synthesis estimated that the average prevalence of anxiety symptoms in the general population during the pandemic was significantly higher than pre-pandemic data [2]. This evidence does not automatically imply a simple causal link; however, the temporal co-occurrence and plausible mechanisms (uncertainty, income loss, isolation, fear of infection) make a significant contribution of pandemic-related conditions to the worsening of the population's mental state plausible.

What evidence do we have: types of studies and main results

The literature includes cross-sectional studies on national populations, sample surveys, limited longitudinal studies, and several meta-analyses. Some studies collected millions of responses and provided synthetic prevalence estimates, documenting variations by age, gender, and socioeconomic context [3][4]. Studies conducted in Italy reported increases in anxiety and stress symptoms in the population during periods of restriction [5][6]. It is important to note that different methods (screening tools, cut-off thresholds, recruitment methods) produce different results; therefore, the figures should be interpreted as orders of magnitude and not as absolute values.

Who is most at risk and why

Demographic and social factors

Observational data indicate that the risk of reporting anxiety symptoms is higher among women and younger people, as well as among those with limited economic and housing resources. Systematic analyses show a higher prevalence in women for reasons that include both biological factors and social and role conditions [9]. Furthermore, job loss, reduced social networks, and overcrowded living situations have been associated with a higher likelihood of reporting anxiety symptoms [2].

Pandemic-related factors: isolation, exposure, and uncertainty

Forced social isolation, quarantine, and fear of contagion are correlated with worse psychological outcomes, particularly when the duration is prolonged or the home space is inadequate [6]. Exposure to death or illness in the family, as well as economic uncertainty, increase the perceived stress load and the likelihood of anxiety symptoms [5].

Useful biological concepts: stress, allostasis, and health

The general adaptation syndrome and the biology of stress

The classic model of the stress response (general adaptation syndrome) describes phases of alarm, adaptation, and, in case of failure, exhaustion [8]. More recently, the concept of allostasis and allostatic load takes into account the fact that biological systems (brain, hypothalamic-pituitary-adrenal axis, immune system) continuously modulate adaptive responses; if these are chronically activated, the result can be a 'load' that promotes functional alterations [7]. Such mechanisms provide biological plausibility for the link between prolonged stress (for example, that related to the pandemic) and physical and mental manifestations.

PRACTICAL SECTION

What it means in practice

For the reader: an increase in anxiety symptoms in a population does not automatically equate to an increase in clinical diagnoses that can be managed in the same way. In practical terms, the evidence suggests maintaining attention to signs of prolonged distress (insomnia, marked social avoidance, functional decline) and facilitating access to psychological support services. At the population level, policies that reduce isolation and uncertainty (economic support, clear information, accessible mental health services) are rationally prioritized, given the role of social factors in determining risk [1][2][5].

When to seek professional help

If symptoms interfere with daily life, the ability to work, or interpersonal relationships, it is advisable to consult a doctor or specialist. Effective interventions available include evidence-based psychological therapies (e.g., cognitive-behavioral therapy) and, when necessary, pharmacological evaluations. Therapeutic choices must be personalized and discussed with qualified professionals.

KEY POINTS TO REMEMBER

• Anxiety increased in the general population during the acute phase of the pandemic, but estimates vary by method and period [1][2].
• Women, young people, and individuals with disadvantaged socioeconomic conditions showed a higher prevalence of anxiety symptoms [2][9].
• The biology of stress (allostasis/allostatic load) provides a framework for understanding the somatic and mental effects of prolonged stress [7][8].
• Most evidence is observational: longitudinal data and representative studies are needed to better establish causal links.
• Timely access to psychological support and policies that reduce isolation and uncertainty are reasonable public health measures.

Limitations of the evidence

The main limitations of the available research include: prevalence of cross-sectional studies and online self-assessments, heterogeneity in measurement tools, not always representative sampling, and poor temporal uniformity among surveys. These characteristics prevent strong causal inferences: observational studies show associations and temporal patterns but do not prove definitive cause-and-effect mechanisms. Typical methodological problems are participant selection (response bias), the prevalent use of screening scales instead of standard clinical diagnoses, and geographical and temporal heterogeneity. The variability of the context — local policies, epidemic waves, economic support — strongly influences the results and requires caution in interpreting and applying the data to clinical practice or policy choices [2][3][6].

EDITORIAL CONCLUSION

The literature produced since the beginning of the pandemic indicates an increase - in many areas and at specific stages - of anxiety symptoms in the population. The importance of distinguishing between observational evidence and causal evidence remains confirmed: we know that extraordinary events (lockdown, job loss, bereavement) are associated with worse psychological outcomes, but the extent and persistence of these effects vary. Supporting social networks, facilitating access to mental health care, and promoting well-designed longitudinal studies are fundamental measures to reduce the collective psychological burden and guide evidence-based interventions.

Note on data cited in the text

The text refers to surveys conducted by the Mario Negri Institute (large-scale survey, April 2020) and statements reported in an interview (Maurizio Bonati). For this institutional survey, a verifiable public DOI is not available in peer-reviewed literature; where necessary, the institutional reference has been indicated without attributing unverified content. [Mario Negri Institute survey, April 2020 — DOI not available]

SCIENTIFIC RESEARCH

Below is a list of the main research cited in the text (bibliography verified with DOI). Entries are numbered in order of citation in the text and include complete references; DOIs are listed separately below as verifiable links.

1. Santomauro DF, Mantilla Herrera AM, Shadid J, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID‑19 pandemic. Lancet. 2021;398(10312):1700–1712. doi:10.1016/S0140-6736(21)02143-7.
2. [Umbrella/meta‑analysis] Estimation of the prevalence of anxiety during the COVID‑19 pandemic: A meta‑analysis of meta‑analyses. BMC Public Health. 2024;24:2831. doi:10.1186/s12889-024-19729-7.
3. Santabárbara J, Lasheras I, Lipnicki DM, et al. Prevalence of anxiety during the COVID‑19 pandemic: A systematic review and meta‑analysis of over 2 million people. Curr Psychol. 2022;40:6259–6270. doi:10.1007/s12144-021-01492-2.
4. Salari N, Hosseinian‑Far A, Jalali R, et al. Prevalence of stress, anxiety, depression among the general population during the COVID‑19 pandemic: a systematic review and meta‑analysis. Global Health. 2020;16:57. doi:10.1186/s12992-020-00589-w.
5. Rossi R, Socci V, Pacitti F, et al. COVID‑19 pandemic and lockdown measures impact on mental health among the general population in Italy. Front Psychiatry. 2020;11:790. doi:10.3389/fpsyt.2020.00790.
6. Pancani L, Marinucci M, Aureli N, Riva P. Forced social isolation and mental health: a study on 1,006 Italians under COVID‑19 lockdown. Front Psychol. 2021;12:663799. doi:10.3389/fpsyg.2021.663799.
7. McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev. 2007;87(3):873–904. doi:10.1152/physrev.00041.2006.
8. Selye H. A Syndrome produced by diverse nocuous agents. Nature. 1936;138:32. doi:10.1038/138032a0.
9. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45(8):1027–1035. doi:10.1016/j.jpsychires.2011.03.006.

EDITORIAL NOTE

This article has been updated to integrate available scientific literature and to improve clarity and transparency. The text is for informational purposes only and does not replace clinical advice. For personal questions, consult a healthcare professional.