{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:03:39Z","timestamp":1785409419178,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministero dell\u2019Universit\u00e0 e della Ricerca","award":["FRES2021_0000023"],"award-info":[{"award-number":["FRES2021_0000023"]}]},{"award":["FRES2021_0000023"],"award-info":[{"award-number":["FRES2021_0000023"]}],"id":[{"id":"https:\/\/ror.org\/0341vw408","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Celiac disease (CeD) requires lifelong adherence to a strict gluten-free (GF) diet. During the COVID-19 pandemic, the prevailing clinical assumption was that food supply disruptions and dietary management difficulties would be the primary sources of patient distress. This exploratory cross-sectional study directly tested this assumption in an Italian CeD cohort. Methods: COVIMPACT is an exploratory observational, web-based study conducted in Italy (data collected: July\u2013September 2024; participants retrospectively reported their experiences during the COVID-19 pandemic period 2020\u20132022). Participants with a confirmed CeD diagnosis were recruited through patient associations and online networks. A structured 26-item questionnaire addressed socio-demographic, nutritional, psychological, and healthcare-access domains. Descriptive statistics, chi-square bivariate analyses (Cram\u00e9r\u2019s V as effect size), and binary logistic regression were performed using R (v4.1) and Python. Results: Among 118 participants (78% female; median age 36 years; IQR 12\u201342), 27% reported self-perceived psychological distress. Against expectation, difficulties in accessing GF products and changes in gluten consumption showed no clear associations with distress. Instead, social exclusion showed the strongest association (Firth OR = 5.55, 95% CI: 1.80\u201317.09, p = 0.003), while reduced physical activity (Firth OR = 5.28, 95% CI: 1.86\u201314.99, p = 0.002, full model; Firth OR = 5.54, p = 0.001, reduced model) and negative economic impact (Firth OR = 3.77, 95% CI: 0.89\u201315.97, p = 0.071, trend) were additional associated factors. Female sex showed a non-significant trend (Firth OR = 4.21, p = 0.082). All estimates carry wide confidence intervals (EPV = 4.1) and should be treated as hypothesis-generating. Conclusions: These preliminary findings suggest that social exclusion and physical inactivity may be more strongly associated with self-perceived distress than dietary challenges in contexts where GF food access is structurally protected. Results are exploratory, hypothesis-generating, and should not be generalised beyond this selected Italian cohort.<\/jats:p>","DOI":"10.3390\/nu18111731","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T12:09:07Z","timestamp":1779970147000},"page":"1731","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Social and Behavioral Correlates of Self-Perceived Psychological Distress in Celiac Disease During the COVID-19 Pandemic: An Exploratory Cross-Sectional Study (COVIMPACT)"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0960-2924","authenticated-orcid":false,"given":"Alessandra","family":"Marenna","sequence":"first","affiliation":[{"name":"European Biomedical Research Institute of Salerno (EBRIS), 84121 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1854-292X","authenticated-orcid":false,"given":"Francesco","family":"Monaco","sequence":"additional","affiliation":[{"name":"European Biomedical Research Institute of Salerno (EBRIS), 84121 Salerno, Italy"},{"name":"Department of Mental Health, Azienda Sanitaria Locale Salerno, 84121 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8301-3401","authenticated-orcid":false,"given":"Annarita","family":"Vignapiano","sequence":"additional","affiliation":[{"name":"European Biomedical Research Institute of Salerno (EBRIS), 84121 Salerno, Italy"},{"name":"Department of Mental Health, Azienda Sanitaria Locale Salerno, 84121 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1473-2240","authenticated-orcid":false,"given":"Francesco","family":"Valitutti","sequence":"additional","affiliation":[{"name":"European Biomedical Research Institute of Salerno (EBRIS), 84121 Salerno, Italy"},{"name":"Pediatric Unit, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7440-7319","authenticated-orcid":false,"given":"Paolo","family":"Ciambelli","sequence":"additional","affiliation":[{"name":"Department of Industrial Engineering, University of Salerno, 84084 Fisciano, Italy"},{"name":"Narrando Srl, 84125 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2753-4785","authenticated-orcid":false,"given":"Riccardo","family":"Panella","sequence":"additional","affiliation":[{"name":"European Biomedical Research Institute of Salerno (EBRIS), 84121 Salerno, Italy"},{"name":"Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, 2450 Copenhagen, Denmark"},{"name":"Resalis Therapeutics Srl, 10121 Turin, Italy"},{"name":"Pharmacology and Toxicology Section, Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5643-8584","authenticated-orcid":false,"given":"Corrado","family":"Vecchi","sequence":"additional","affiliation":[{"name":"European Biomedical Research Institute of Salerno (EBRIS), 84121 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7077-3506","authenticated-orcid":false,"suffix":"Jr.","given":"Luca","family":"Steardo","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8127-3788","authenticated-orcid":false,"given":"Giulio","family":"Corrivetti","sequence":"additional","affiliation":[{"name":"European Biomedical Research Institute of Salerno (EBRIS), 84121 Salerno, Italy"},{"name":"Department of Mental Health, Azienda Sanitaria Locale Salerno, 84121 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2134-0261","authenticated-orcid":false,"given":"Alessio","family":"Fasano","sequence":"additional","affiliation":[{"name":"European Biomedical Research Institute of Salerno (EBRIS), 84121 Salerno, Italy"},{"name":"Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA"},{"name":"Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1056\/NEJMoa1400697","article-title":"Introduction of gluten, HLA status, and the risk of celiac disease in children","volume":"371","author":"Lionetti","year":"2014","journal-title":"N. 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