Is Temperament Predictive of COVID-19 Stress?

Attachment style and temperament affects perception of psychological distress.

Posted Jun 17, 2020

 Glen Carrie/Unsplash
Source: Glen Carrie/Unsplash

This post was written by Amanda Sorenson.

A recent study of psychological stress at the end of the first month of strict COVID-19 containment measures in Italy analyzes temperament and attachment style as potential mediators and predictors of the developing COVID-19 mental health burden. The study, “Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: An early report on the Italian general population” by Lorenzo Moccia et al., published in Brain, Behavior, and Immunity, is the first sizeable sample (500) of the early psychological impact of COVID-19 on the Italian population. In addition to assessing the scope of the mental health burden, the study investigated respondents’ temperament and attachment characteristics relative to their psychological response in an effort to identify potential intervention strategies.

Adverse psychological impact in response to the COVID-19 pandemic is expected. Psychological distress due to viral pandemic was first documented by Menniger in 1919, related to the Spanish flu epidemic. Studies released out of China, where the current pandemic originated, quantify evidence and patterns of psychological distress. In fact, findings in the Italian study indicate “that 38 percent of the general population is currently perceiving a form of psychological distress” (Moccia et al., 2020), and are similar to findings of online surveys of the Chinese population (Li et al., 2020).

The distinct feature of the Italian study is the hypothesis that

“…temperament and attachment may affect the degree of perceived psychological distress during the COVID-19 pandemic. Therefore, we aimed to evaluate the psychological impact of the COVID-19 outbreak on the Italian general population and to analyze the affective temperament and AAS as potential predictive factors influencing the extent of psychological burden.” (Moccia et al., 2020)

The theory postulates that the emotional reactivity of certain temperaments renders some individuals better able to cope with environmental stressors. Furthermore, intimate bonds with caregivers during infancy are a template for behavioral, cognitive, and emotional strategies that are activated by stress during adulthood.

The study used a questionnaire to collect demographic and epidemiological data and three standard tools to acquire psychological data: Kessler 10 Psychological Distress Scale (K10) to measure levels of distress; Italian Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire short version (TEMPS-A) to identify temperaments; and Attachment Style Questionnaire (ASQ) to identify adult attachment styles.

The five identified temperaments are

  • Cyclothymic, characterized by shifts in mood, energy, behavior, and thinking
  • Depressive, characterized by pessimism, self-criticism, gloomy, worrying, and pleasing others
  • Irritable, characterized by a tendency toward anger and reactivity to slight provocations
  • Hyperthymic, characterized by exceptionally or abnormally positive mood and disposition
  • Anxious, characterized by physiological and behavioral reactivity to mildly stressful stimuli

The five adult attachment styles are described as:

“(1) ‘Confidence,’ describing secure attachment; (2) ‘Discomfort with closeness’ and (3) ‘Relationships as secondary’, both measuring attachment avoidance; (4) ‘Need for approval,’ and (5) ‘Preoccupation with relationships,’ both assessing attachment anxiety.” (Moccia et al., 2020)

Psychological distress scale scores on the four-day online survey categorized 62 percent of respondents as having “no psychological distress,” 19.4 percent as “mild psychological distress,” and 18.6 percent as “moderate-to-severe psychological distress.” When compared to those who reported “no psychological distress,” cyclothymic, depressive, and anxious temperaments and the attachment “need for approval” were rated as risk factors for “moderate-to-severe psychological distress.” In contrast, “confidence” and “discomfort with closeness” attachment styles were protective against psychological distress. The study also showed anxious temperament as a risk factor for “mild psychological distress” when compared with “no psychological distress.”

Although gender as a risk or protective measure for psychological distress in COVID-19 was not the primary intent of the study, data showed that in comparison to women, males are

“… less likely to develop psychological symptoms in the face of a stressful event. Similarly, a recent survey conducted in China one month after the COVID-19 outbreak reported higher post-traumatic stress symptoms in women (Liu et al., 2020).” (Moccia et al., 2020)

The authors note that anxious temperament, identified in their study as a risk factor, is more prevalent in women.

Although there are some limitations to generalizing the findings of the study in that it lacks longitudinal follow-up, and the reliability of self-administered assessments may be partially biased, the authors are satisfied that

“… A relevant percentage of the Italian population might have experienced from mild to moderate-to-severe psychological distress symptoms during the early phase of the COVID-19 outbreak, and that both temperament and AAS features may predict the extent of mental health burden. Interventions promoting mental health among the general population should be rapidly implemented, bearing in mind individual background and characteristics.” (Moccia et al., 2020)

Amanda Sorenson has worked with faith-based organizations and authors in the development of discipleship and Christian living resources and is a student at the Wheaton College M.A. program in Humanitarian and Disaster Leadership.


Moccia, L., Janiri, D., Pepe, M., Dattoli, L., Molinaro, M., De Martin, V., Chieffo, D., Janiri, L., Fiorillo, A., Sani, G., & Di Nicola, M. (2020). Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: An early report on the Italian general population. Brain, Behavior, and Immunity.