School re-entry for children and adolescents with cancer: A qualitative study from the perspectives of school personnel.

The psychological consequences of COVID-19 have been substantial but have shown marked heterogeneity across individuals and across time. Early works documented increases in anxiety, depressive symptoms, and stress during the acute phases of the pandemic, while global burden estimates showed marked rises in depressive and anxiety disorders in 2020 (–). What remains less clear is how mental health trajectories have evolved during later phases, following the disruption of lockdowns and the formal end of the World Health Organization-declared Public Health Emergency of International Concern for the COVID-19 pandemic in May 2023 (). Emerging syntheses focused on later and post-emergency phases indicate that the burden did not simply disappear but instead followed heterogeneous trajectories of recovery, persistence, and renewed vulnerability across settings and subgroups (, ). Longitudinal evidence points in the same direction. In Italy, overall distress declined 14 months after the first pandemic peak, yet a substantial minority still reported elevated self-reported symptoms (). In Switzerland, depression, anxiety, and loneliness improved at the population level between 2021 and 2023, but higher-risk groups remained disadvantaged across follow-up (). In a five-country European cohort assessed up to early 2024, symptoms varied with contextual pressures well beyond the acute pandemic period, including broader social and economic stressors (). Together, these findings indicate that later-phase mental health cannot be reduced to a simple dichotomy between full recovery and continued crisis when considered at the aggregate level. Italy remains an informative setting for examining this issue. A large body of Italian research has focused on the first lockdown and its immediate psychological impact, consistently identifying younger age and female gender as key correlates of worse mental health outcomes (–). However, the later context differed substantially from the acute-shock conditions of 2020. By 2023-2024, strict nationwide restrictions no longer defined everyday life, yet cumulative strain, financial pressures, disruptions to work and study routines, and lingering health concerns persisted. Later evidence from Italy and other countries suggests that symptom reduction at the aggregate level can coexist with persistent burden in meaningful subgroups (, , ). From a public mental health perspective, this highlights the need to identify brief markers, beyond basic sociodemographic indicators, that can detect individuals who remain vulnerable and less resilient in post-emergency conditions.