General Considerations
All 3 general linear models to assess differences in daily scores of analytical thinking, emotional tone, and somatosensory processes were significant, with specific and different patterns.
As already pointed out, we might discuss our results considering this pandemic as “the cause of individual and collective traumas” [11]. In fact, different people dealing with the same stressful event could develop various reactions: Some individuals could develop a nonpathological response, with emotional, cognitive, and physical symptoms resolving spontaneously after some days or weeks, the successful implementation of resilience and coping strategies, and a return to a previous baseline without long-lasting consequences. For these individuals, the stressful event remains only “potentially” traumatic. Other individuals, instead, develop more pathological reactions, ranging from adjustment disorders to PTSD, with trauma lived as “a complex emotional response to a stressful event, that overwhelms the individual’s capacity to cope” [11].
Various studies have analyzed individuals’ language use after a traumatic event (eg, Cohn et al [10]), but, to the best of our knowledge, this is the first study using these summary variables in a sample of Italian tweets during the first phases of the pandemic. First, in all our general models, we did not find any significant effect of the daily number of new hospital discharges on our variables of interest. Daily hospital discharges, compared to daily new cases and new deaths, was the only “positive” data considered. The absence of any effect could be due to the negativity bias, which is the human tendency to give more importance and attention to negative data—or entities in general—[29] such as COVID-19 deaths and new cases, while ignoring positive data, such as hospital discharges. The negativity bias has been demonstrated to be related to life stressors and PTSD [30,31], as individuals affected by PTSD tend to focus their attention on potential threats [32]. This could also explain the fact that, in each model, summary variables were related to the negative data. So, when experiencing a stressful event, such as the pandemic period, individuals may experience negativity bias, focusing more on negative data. Experiencing these data could be considered a stressful event. In particular, we found that increases in daily deaths and daily new cases, in other words the worst situation possible, increased negative emotional tone. This seems intuitive: Negative emotion words are habitually used when writing about a negative event, such as the situation described before, and have been linked with suicide and depression [9]. Moreover, negative alterations in mood experience, negative affect, and difficulty in experiencing positive emotions are typical reactions experienced after a stressful event and, in some cases, could be symptoms of PTSD [33].
The same interaction was found to have an effect on increased use of somatosensory words. This result also seems intuitive, as the use of sensory, body, and perceptual words in narratives related to traumatic events are common and often linked to PTSD and its symptoms, even in studies of more individual traumatic events such as traffic accidents [16,18].
Regarding analytical thinking, we found 2 opposite effects: Daily new cases were negatively linked with this linguistic marker, while new deaths were positively linked with it. High scores in the analytical thinking variable are related to a formal and logical thinking pattern, while a low score is related with a more narrative style, focused on the here and now [15]. Various studies have considered the use of cognitive words after traumatic events: More cognitive words are often present in trauma- or distress-related narratives [34]. Using cognitive words is linked to an individual’s effort to elaborate and integrate the event in their own memories [16], reflecting “an active search for meaning and understanding of the stressful event” [34]. In fact, using cognitive words, in particular causal and insight ones, when writing about a past event is linked to “the active process of reappraisal” [9]. So, using more cognitive words is associated with better physical health [35,36], fewer PTSD symptoms [37], and adaptive coping strategies [38]. On the contrary, some studies have shown a link between cognitive words and PTSD symptoms [39]. In fact, as some authors pointed out [39,40] using LIWC, it is difficult to understand how these words are used, for example referring to “organized or disorganized thoughts” or linked to “ruminative processes and fruitless attempts to assimilate what happened” [16]. After a traumatic event, indeed, individuals’ thoughts could be affected in different ways. For instance, PTSD symptoms include intrusive and upsetting memories or negative thoughts about themselves and the world or avoidance of thoughts related to trauma [33]. These different reactions and discordance about the meaning of cognitive words after traumatic events may account for these opposite effects. Even if more data and research are needed, we may cautiously think that, when confronted with new deaths data—the worst news—individuals may try to react using a formal and logical way of writing, trying to make sense of this negative information. Considering new cases data, so slightly less negative, people may try to avoid the data or react with a more narrative tone, feeling less the need to elaborate them.
The last interesting result we retrieved is the effect of the phase of managing the pandemic on emotional tone and analytical thinking variables. In particular, both emotional tone and analytical thinking were lower during the outbreak, then increased in the first and second phases. As explained, the initial phase of the pandemic in Italy was characterized by different restrictions and measures taken by the government in order to counteract the spread of the virus. These measures differed, in particular, between the outbreak and the first and second phases. As the first indigenous cases were confirmed at the end of February, but maybe the gravity of the situation was still not clear, different day-to-day actions and initiatives were taken in each part of Italy: Universities and schools were closed first only in northern regions and initially only for some days; 11 municipalities in Lombardy and Veneto were in strict lockdown; some major public events, such as the Carnival of Venice, were postponed or cancelled; in other regions, considered at minor risk, schools remained open with some events confirmed, such as Series A soccer matches with the presence of fans in southern Italy. However, contradictory messages hit the population: Fake news stating the closure of all Italian schools circulated at the end of February, while some ads and initiatives reassured people, even in the northern areas, to continue to live their normal lives; all of this contributed to creating a climate of uncertainty. The first and second phases, instead, were characterized by national-level and long-term measures, with a strict lockdown and suspension of nonnecessary activities in all Italian regions, which gradually loosened at the beginning of May. These 2 phases marked a tragic and dramatic situation but were more stable and predictable in their restrictions. These differences between the very first and the other phases could account for the differences retrieved in our summary variables. Uncertainty about future events, as people may experience during the outbreak phase about future restrictions and development of the emergency, is common in threat contexts and could elicit negative emotions, such as anxiety and fear [41]. After the situation became more stable in the subsequent phases, with less uncertainty, emotional tone may increase. This emotional tone pattern confirms other results retrieved in the COVID-19 pandemic and in other trauma contexts: Sadiković and colleagues [42] found decreased worry, fear, and boredom over 5 weeks after the first COVID-19–confirmed case in Serbia. Cohn and colleagues [10] found that, immediately after the September 11 attacks, emotional tone measured in a sample of online journals was low, returning slowly to baseline after 1 week. Experiencing negative emotions is a typical reaction after an emotional upheaval and uncertain and threatening situation, even representing a specific criterion for PTSD disorder [33]; experiencing positive emotions after a crisis acts as a buffer against depression in resilient individuals [14], and positive emotions in trauma narratives are linked to better adaptation or less severe PTSD symptoms [37,43]. So, after the initial, negative reaction, the situation changed, becoming more predictable and less uncertain, and people enact their resilience and coping strategies, using more positive emotions to overcome the emotional upheaval and resulting again in a more positive way of expressing themselves.
The uncertainty of the outbreak situation—with different restrictions and even contradictory circulating messages—may also have had an impact on people's analytical thinking and use of words: Reasoning and trying to make sense of events are difficult in such contexts [41]. People might have reacted with a more logical thinking style, trying to find meaning from the situation only during the first and second phases when things were more stable, the gravity and seriousness of the emergency became clearer, and a consistent view was reached. This result seems in contrast with the one obtained by Cohn and colleagues [10], who highlighted a rapid increase in cognitive word use immediately after the attacks; their level returned to baseline after some days and then decreased again. We have to point out that our study and the study by Cohn et al [10] used different writing samples (tweets vs journal entries) and also different words in the analysis: Even if theoretically tapping the same construct, such as a sort of thinking style, analytical thinking is based on function words while the cognitive processing index used by Cohn and colleagues [10] reflects words such as because, think, and question. However, we think that these differences in results could be due to the reasons already explained: September 11 was a punctual, intense, and disruptive outbreak, leading to a rapid need to make sense of what was happening. This pandemic outbreak phase, instead, was very different, with a slower unravelling and uncertainty that persisted for weeks and weeks.
As COVID-19 could be considered “the cause of individual and collective traumas” [11], we discussed our results considering previous studies both concerning individual (for example, traffic accidents or relationship breakups [18,34]) and collective trauma (for example, the September 11 attacks [10]). With heterogeneous yet similar consequences for individuals, more research is needed to highlight pandemic-specific psycholinguistic trauma at both individual and collective levels.
Implications and Future Work
We think that our study could have relevant implications for actionable policies in the health care context and for future related works expanding our research questions.
These results prove the feasibility and importance of infodemiological indicators and psycholinguistic analysis to monitor mental health–related variables in a fast and cost-effective way. While traditional psychology instruments and measures (such as self-reported questionnaires and surveys) provide a one-time measure of the variable of interest in a limited sample, this method could provide longitudinal and population-level data. Considering all the limitations and influences, this method could be used as active surveillance of the impact of a pandemic and the related daily sharing of information on people’s mental health, providing dynamic knowledge to inform relevant health policies. Knowing in advance or in real time which type of information—as new daily cases, new daily deaths, or the phase of the pandemic—could have an impact and how it impacts emotions, analytical thinking, and the mental health of a population could allow the implementation of ad hoc and concrete responses. As a pandemic is constantly and heavily affecting our daily lives and mental health [11,12,13], we think that monitoring psychological health and intervening to prevent costly consequences or improve well-being with tailored psychological interventions are essential.
Future studies are needed to approach this active surveillance approach as a useful and concrete instrument for institutions and health policy.
Moreover, as our study contributes to the growing field of infodemiology in the pandemic context, further research could expand our research questions, analyzing and controlling for other factors that could influence word use in tweets in this pandemic period, such as geotagging, days, and seasonal weather [44,45], as well as age, gender, working status, and other sociodemographic and spatial-temporal characteristics.