Anxiety, Anhedonia, and related food consumption at the beginning of the COVID-19 quarantine in populations of Spanish-speaking Ibero-American countries: An online cross-sectional survey study

Abstract

The COVID-19 pandemic threatens global health (Chen Wang, Pan, et al., 2020). It is causing fear among the population, which in turn may has a deleterious influence on mental health (Xiang et al., 2020). Similar effects on mental health were observed during the previous influenza outbreak (A H1N1v). For instance, during that outbreak, nearly 30% of the general population recognized being concerned about the possibility of catching the virus (Rubin et al., 2010). Similarly, a recent study in China showed an increase of depression, anxiety, and stress symptomatology due to the COVID-19 pandemic (Cuiyan Wang, Pan, et al., 2020). Another study on Turkish population showed similar results, nearly 45% of participants scored above the cut-off point for anxiety during the pandemic (Özdin & Bayrak Özdin, 2020).

Due to the rapid spread of the virus and in order to protect public health, the governments of several countries have been forced to take protective measures. These actions have included the closure of cities, stores, schools, and declaration of quarantines and confinement to enforce physical distancing. Lockdown is one of the oldest and most effective tools to control communicable diseases outbreaks (Wilder-Smith and Freedman, 2020). However, just recently, we start to understand its effect on people's life. For example, it has been observed that a greater availability of unstructured time due to the order of “stay at home” is associated with increased stress (Pearl, 2020).

This situation has raised widespread concern about individual vulnerabilities that may lead to increased food consumption, sedentary behavior, and the possibility of gaining weight during the current pandemic (Pearl, 2020). In this way, studies in Italy (Cicero et al., 2021)and Belgium (Drieskens et al., 2021) showed that lockdown was associated with a deterioration of diet quality. Therefore, it seems like during confinement, people are less prompt to maintain a healthy and varied diet and perform regular physical activity.

In this respect, a study in Italy showed that nearly 46% of the participants reported eating more during the lockdowns. Notably, authors reported an increase of the consumption of chocolate, ice cream, desserts, and salty snacks, which was individuals attributed to higher anxiety levels (Scarmozzino & Visioli, 2020). These results are consistent with other studies that show that people tend to regulate their emotions through food when confronting situations that bring on high-stress and anxiety (Braden et al., 2018; Ling & Zahry, 2021). Moreover, it has been shown that anxiety is associated with sweet craving (Penaforte et al., 2019) and increased visual attention to hedonic food (Motoki et al., 2019). It has also been shown that feeling anxious prompt to people to consumed comfort/palatable food and to increase food intake in order to feel better (Renzo et al., 2020). Thus, anxiety and boredom evoked by quarantine could be considered risk factors for consuming more food and food of poorer quality.

On the other hand, reward sensitivity is a crucial factor in food intake and decision-making (Neuser et al., 2020). Anhedonia (i.e., the decrease in the ability to feel pleasure) is associated with blunted reward sensitivity (Liu et al., 2016). Food is a potent natural reward and food choice includes biological determinants of hunger, appetite, and taste (Singh, 2014). Nevertheless, anhedonia as an elusive symptom of depression may have a crucial role in appetite dysregulation (Coccurello, 2019). In this way, anhedonia as a potential common substrate between anxiety and depression could also play a role in the genesis of eating (Grillo, 2016; Spano et al., 2019) and eating emotional disorders (Carriere et al., 2019; Tuncer & Çetinkaya Duman, 2020). Therefore, we could hypothesize that increased food consumption, mainly consisting on unhealthy food is associated with anxiety and anhedonia.

To the date this study was planned, there were few reports analyzing the relation between food consumption and anxiety and anhedonia in the general population of Spanish-speaking countries in the context of the lockdown at the beginning of the COVID-19 pandemic. The main aim of this study was to determine the relationship between anxiety and anhedonia symptomatology and the consumption of palatable food, fruits and vegetables at the beginning of the COVID-19 pandemic in 12 Spanish-speaking Ibero-American countries.