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Objectives It important to quantify the true burden of coronavirus disease 2019 (COVID-19) in different countries, to enable informed decisions about imposing and relaxing control measures. COVID-19 surveillance data fails in this respect, as it is influenced by different definitions, control policies and capacities. This article aims to quantify excess mortality and estimate the distribution between COVID-19 and non-COVID-19 causes of death. Study design Observational study and mathematical modelling. Methods Publicly available data from multiple institutional sources were used and an in-depth analysis was carried out of deaths from all causes between 2015 and 2020 in Italy at the national, regional and local level. Excess mortality over time and space was first explored, followed by an assessment of how this related to COVID-19 surveillance and, ultimately, assuming a fixed male:female ratio, a model was developed and applied to estimate the proportions of COVID-19 and non-COVID-19 excess mortality in 2020. Results In Italy, the mortality rate doubled in March and April 2020 compared with data from 2015-2019 (+109%), with excess mortality reaching >600% in large municipalities in northern areas. Notified COVID-19 deaths accounted for only 43·5% (regional range: 43–62%) of excess mortality. It is estimated that more than two-thirds of excess deaths that were not captured by surveillance are non-COVID-19 deaths, which could be a result of the excess burden on the health systems, in addition to reduced demand and supply of other non-COVID healthcare services. Conclusions The impact of COVID-19 during the early stages of the pandemic is much larger than official figures have reported. Monitoring excess mortality helps to capture the full effect of the COVID-19 pandemic, which differs between regions in Italy. In addition, the COVID-19 pandemic has also resulted in significant indirect effects on the well-being of the population., Highlights • Excess mortality in Italy in 2020 was quantified and the distribution estimated between COVID-19 and non-COVID-19 causes. • All-cause deaths doubled in March-April 2020, compared with 2015-2019, with excess mortality >600% in large municipalities in the north of Italy. • Notified COVID-19 deaths accounted for only 43·5% of excess mortality (regional range: 43-62%). • The COVID-19 burden is larger than the official reported figures. • A large number of excess deaths may be due to causes other than COVID-19 and linked to decreased demand and supply of non-COVID-19 healthcare services.

"Background. Research on mood disorders has progressively focused on the study of seasons and on the mood in association with them during depressive or manic episodes yet few studies have focused on the seasonal fluctuation that characterizes the patient's clinical course both during an illness episode and during euthymic periods. Methods. 113 euthymic outpatients 46 affected by major recurrent depression and 67 affected by bipolar disorder were recruited. We evaluated the impact of clinical “rhythmical” factors: seasonality, sleep disturbance, and chronotype. Patients completed the SPAQ + questionnaire, the MEQ questionnaire, and the medical outcomes study (MOS) sleep scale. We used t-test analyses to compare differences of clinical “rhythmical” and sociodemographic variables and of differences in the assessment scales among the diagnostic groups. Results. Patients reporting a family history for mood disorders have higher fluctuations throughout seasons. Sleep disturbance is more problematic in unipolars when compared to bipolars. Conclusions. Sleep, light, and seasonality seem to be three interconnected features that lie at the basis of chronobiology that, when altered, have an important effect both on the psychopathology and on the treatment of mood disorders.. . "