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Objective: This study aimed to evaluate the impact of the COVID-19 emergency on patients with IBD's psychological distress, understanding the role of patient engagement as a mediator. Methods: An online questionnaire was created, measuring perceived risk susceptibility toward COVID-19, perceived stress, and patient engagement. The questionnaire was distributed to a purposive sample of IBD patients who belonged to the Italian Association for patients with IBD (AMICI Onlus) in April 2020. Structural equation models were implemented. Results: The effect of the perceived risk susceptibility toward COVID-19 contagion on the perceived stress is fully mediated by patient engagement (β = 0.306, p < 0.001). Moreover, the patient engagement mitigates the perceived stress (β = -0.748, p < 0.001) in our sample of IBD patients, and it is negatively influenced by the perceived risk susceptibility toward COVID-19 (β = -0.410, p < 0.001). Conclusion: Patient engagement is the key factor that explains how the perceived risk susceptibility toward COVID-19 affects the perceived psychological distress in patients with IBD, underlining that the perceived risk of contagion increases their perceived level of stress through a decrease of patient engagement., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Castellini, Palamenghi, Savarese, Barello, Leone, Previtali, Armuzzi and Graffigna.)

The COVID-19 pandemic is exerting a high pressure on healthcare systems all over the world. Italy, in particular, being one of the first Western countries to be struck by the contagion, has seen the number of recovered -and deceased- patients increase alarmingly, thus increasing the workload and the demands for healthcare professionals. This situation has the potential to put several healthcare operators at risk of developing high levels of work-related distress and burnout due to the exposure to emotionally difficult situations, uncertainty, and personal risk. A sample of 532 Italian physicians, nurses, and other professionals answered an online survey addressing their levels of burnout (through the Maslach Burnout Inventory) and frequency of experienced psycho-somatic symptoms, along with some ad hoc items regarding job demands. Results show that levels of burnout and experienced symptoms are correlated with the increased demands due to the COVID-19 pandemic, while finding a meaning in one's own work is correlated with personal gratification. Urgent measures to address concerns regarding the wellbeing of health workers are a necessary key point of the response to the current pandemic., (Copyright © 2020 Barello, Palamenghi and Graffigna.)