Latent Changes in Perceived Quality of Sleep Related to the COVID-19 Quarantine Measures in Italian University Students: Understanding the Role of Personality and Internalizing Symptoms

Antonella Somma, Sara Marelli, Giulia Gialdi, Alessandra Castelnuovo, Samantha Mombelli, Luigi Ferini-Strambi, Andrea Fossati


The present online retrospective study aimed at evaluating the perceived sleep quality before the start of the lockdown measures and during the lockdown in a sample of Italian university students (N = 307). Participants were administered the Italian translation of the Pittsburg Sleep Quality Index (PSQI), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Personality Inventory for DSM-5 36-item version (PID-5-36) in order to assess the relationships between sleep, dysfunctional personality domains and internalizing symptomatology. Latent difference factor (LDF) model was used to estimate latent change in PSQI scores; all analyses on the relationships between the PSQI and the dysfunctional personality domain measures and internalizing symptoms were carried out using latent factor scores. Our findings showed that selected dysfunctional personality traits were significantly associated with changes in perceived quality of sleep among adult university students during the lockdown in Italy. The relationship between PID-5-36 Negative Affectivity and changes in the perceived quality of sleep was only partially mediated by the severity of self-reported depression. The assessment of perceived depressive symptom severity and Negative Affectivity may prove clinically useful for carrying out preventive interventions on sleep quality.


Sleep quality; COVID-19 pandemic; Personality domains; Internalizing symptoms.

Full Text:



Altena, E., Baglioni, C., Espie, C. A., Ellis, J., Gavriloff, D., Holzinger, B., ... & Riemann, D. (2020). Dealing with sleep problems during home confinement due to the COVID‐19 outbreak: Practical recommendations from a task force of the European CBT‐I Academy. Journal of Sleep Research, e13052.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.

Bach, B., Kerber, A., Aluja, A., Bastiaens, T., Keeley, J. W., Claes, L., ... & Riegel, K. D. (2020). International Assessment of DSM-5 and ICD-11 Personality Disorder Traits: Toward a Common Nosology in DSM-5.1. Psychopathology, 53, 179-188.

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

Beck, A.T., Steer, R.A., Ball, R., Ranieri, W. (1996). Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. Journal of Personality Assessment. 67(3): 588–97.

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. The Lancet, 395, 912-920.

Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.

Cellini, N., Canale, N., Mioni, G., & Costa, S. (2020). Changes in sleep pattern, sense of time and digital media use during COVID‐19 lockdown in Italy. Journal of Sleep Research.

Clark, L. A., & Watson, D. (1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7(3), 309–319.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ Lawrence Erlbaum Associates, Publishers.

Cuijpers, P., Smit, F., Penninx, B. W., de Graaf, R., ten Have, M., & Beekman, A. T. (2010). Economic costs of neuroticism: a population-based study. Archives of General Psychiatry, 67(10), 1086-1093.

Curcio, G., Tempesta, D., Scarlata, S., Marzano, C., Moroni, F., Rossini, P. M., ... & De Gennaro, L. (2013). Validity of the Italian version of the Pittsburgh sleep quality index (PSQI). Neurological Sciences, 34(4), 511-519.

D'Agostino, A., Demartini, B., Cavallotti, S., & Gambini, O. (2020). Mental health services in Italy during the COVID-19 outbreak. The Lancet Psychiatry, 7(5), 385-387.

Di Giacomo, D. (2020). Public Health emergencies and quarantine: virtual patient engagement as challenge and opportunity for Mental Health strategy. Mediterranean Journal of Clinical Psychology, 8(2).

Finch, W. H., & Shim, S. S. (2018). A comparison of methods for estimating relationships in the change between two time points for latent variables. Educational and Psychological Measurement, 78(2), 232-252.

Grandner, M. A., Kripke, D. F., Yoon, I. Y., & Youngstedt, S. D. (2006). Criterion validity of the Pittsburgh Sleep Quality Index: Investigation in a non-clinical sample. Sleep and Biological Rhythms, 4(2), 129-136.

Gualano, M. R., Lo Moro, G., Voglino, G., Bert, F., & Siliquini, R. (2020). Effects of Covid-19 lockdown on mental health and sleep disturbances in Italy. International Journal of Environmental Research and Public Health, 17(13), 4779.

Hancock, G.R., & Mueller, R.O. (2001). Rethinking construct reliability within latent variable systems. In R. Cudeck, S. du Toit, & D. Sörbom (Eds.), Structural equation modeling: Present and future-A Festschrift in honor of Karl Jöreskog (pp. 195-216). Lincolnwood, IL: Scientific Software International.

Hintsanen, M., Puttonen, S., Smith, K., Törnroos, M., Jokela, M., Pulkki-Råback, L., ... & Venn, A. (2014). Five-factor personality traits and sleep: Evidence from two population-based cohort studies. Health Psychology, 33(10), 1214-1223.

Hu, L.-T, & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55.

Kaparounaki, C. K., Patsali, M. E., Mousa, D. P. V., Papadopoulou, E. V., Papadopoulou, K. K., & Fountoulakis, K. N. (2020). University students’ mental health amidst the COVID-19 quarantine in Greece. Psychiatry Research.

Kerber, A., Schultze, M., Müller, S., Rühling, R. M., Wright, A. G., Spitzer, C., … & Zimmermann, J. (2020). Development of a short and ICD-11 compatible measure for DSM-5 maladaptive personality traits using ant colony optimization algorithms. Available from:

Kim, C. S., Lynch, J. B., Cohen, S., Neme, S., Staiger, T. O., Evans, L., ... & Dellit, T. H. (2020). One academic health system’s early (and ongoing) experience responding to covid-19: recommendations from the initial epicenter of the pandemic in the United States. Academic Medicine.

Krueger, R. F., & Markon, K. E. (2014). The role of the DSM-5 personality trait model in moving toward a quantitative and empirically based approach to classifying personality and psychopathology. Annual Review of Clinical Psychology, 10, 477-501.

Leyfer, O. T., Ruberg, J. L., & Woodruff-Borden, J. (2006). Examination of the utility of the Beck Anxiety Inventory and its factors as a screener for anxiety disorders. Journal of Anxiety Disorders, 20(4), 444-458.

Li, Y., Qin, Q., Sun, Q., Sanford, L. D., Vgontzas, A. N., & Tang, X. (2020). Insomnia and psychological reactions during the COVID-19 outbreak in China. Journal of Clinical Sleep Medicine, 16(8), 1417-1418.

Liu, S., Yang, L., Zhang, C., Xiang, Y. T., Liu, Z., Hu, S., & Zhang, B. (2020). Online mental health services in China during the COVID-19 outbreak. The Lancet Psychiatry, 7(4), e17-e18.

Marelli, S., Castelnuovo, A., Somma, A., Castronovo, V., Mombelli, S., Bottoni, D., ... & Ferini-Strambi, L. (2020). Impact of COVID-19 lockdown on sleep quality in university students and administration staff. Journal of Neurology.

Mazza, C., Ricci, E., Biondi, S., Colasanti, M., Ferracuti, S., Napoli, C., & Roma, P. (2020). A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. International Journal of Environmental Research and Public Health, 17(9), 3165.

Mulder, R. T., Horwood, J., Tyrer, P., Carter, J., & Joyce, P. R. (2016). Validating the proposed ICD‐11 domains. Personality and Mental Health, 10(2), 84-95.

Muthén, B. O. (1989). Latent variable modeling in heterogeneous populations. Psychometrika, 54(4), 557-585.

Muthén, L.K. and Muthén, B.O. (1998-2017). Mplus User’s Guide. Eighth Edition. Los Angeles, CA: Muthén & Muthén.

National Institute of Mental Health (2020). Mental Health Impact of COVID-19 Pandemic on NIMH Research Participants and Volunteers. Retrieved from:

Nunnally, J.C. & Bernstein, I.R. (1994). Psychometric Theory., New York: McGraw-Hill.

Oltmanns J.R. (2019). Personality Disorders, Maladaptive Personality Traits, and Sleep Problems: Findings and Future Directions. In: Križan Z. (eds) Sleep, Personality, and Social Behavior. Springer, Cham.

Oltmanns, J. R., & Widiger, T. A. (2019). Evaluating the assessment of the ICD-11 personality disorder diagnostic system. Psychological Assessment, 31(5), 674–684.

Remuzzi, A., & Remuzzi, G. (2020). COVID-19 and Italy: What next?. The Lancet, 395(10231), 1225-1228.

Rodriguez, A., Reise, S. P., & Haviland, M. G. (2016). Evaluating bifactor models: calculating and interpreting statistical indices. Psychological Methods, 21(2), 137-150.

Scarmozzino, F., & Visioli, F. (2020). Covid-19 and the Subsequent Lockdown Modified Dietary Habits of Almost Half the Population in an Italian Sample. Foods, 9(5), 675.

Settineri, S., & Merlo, E. M. (2020a). Fear of Contamination. Mediterranean Journal of Clinical Psychology, 8(1).

Settineri, S., Merlo, E. M. (2020b). Commentary: A Contagious Other? Exploring the Public’s Appraisals of Contact with “Mental Illness”. Mediterranean Journal of Clinical Psychology, 8(1).

Sica, C., & Ghisi, M. (2007). The Italian versions of the Beck Anxiety Inventory and the Beck Depression Inventory-II: Psychometric properties and discriminant power. In M. A. Lange (Ed.), Leading-edge psychological tests and testing research (p. 27–50). Nova Science Publishers.

Somma, A., Gialdi, G., & Fossati, A. (2020). Reliability and construct validity of the Personality Inventory for ICD-11 (PiCD) in Italian adult participants. Psychological Assessment, 32(1), 29- 39.

Somma, A., Gialdi, G., Krueger, R. F., Markon, K. E., Frau, C., Lovallo, S., & Fossati, A. (2020). Dysfunctional personality features, non-scientifically supported causal beliefs, and emotional problems during the first month of the COVID-19 pandemic in Italy. Personality and Individual Differences.

Suzuki, T., Samuel, D. B., Pahlen, S., & Krueger, R. F. (2015). DSM-5 alternative personality disorder model traits as maladaptive extreme variants of the five-factor model: An item-response theory analysis. Journal of Abnormal Psychology, 124(2), 343-354.

Tang, W., Hu, T., Hu, B., Jin, C., Wang, G., Xie, C., ... & Xu, J. (2020). Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19 epidemic in a sample of home-quarantined Chinese university students. Journal of Affective Disorders, 274, 1-7.

Tull, M. T., Edmonds, K. A., Scamaldo, K., Richmond, J. R., Rose, J. P., & Gratz, K. L. (2020). Psychological Outcomes Associated with Stay-at-Home Orders and the Perceived Impact of COVID-19 on Daily Life. Psychiatry Research. Advanced online publication.

van de Laar, M., Verbeek, I., Pevernagie, D., Aldenkamp, A., & Overeem, S. (2010). The role of personality traits in insomnia. Sleep Medicine Reviews, 14(1), 61-68.

Veeramachaneni, K., Slavish, D. C., Dietch, J. R., Kelly, K., & Taylor, D. J. (2019). Intraindividual variability in sleep and perceived stress in young adults. Sleep Health, 5(6), 572-579.

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R. S., ... & Ho, C. (2020b). A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, Behavior, and Immunity, 87, 40-48.

World Health Organization (2019). ICD-11 clinical descriptions and diagnostic guidelines for mental and behavioural disorders. Geneva: WHO.

Xiao, H., Zhang, Y., Kong, D., Li, S., & Yang, N. (2020). The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 26, e923549-1- e923549-8.



  • There are currently no refbacks.