Social and Behavioral Correlates of Self-Perceived Psychological Distress in Celiac Disease During the COVID-19 Pandemic: An Exploratory Cross-Sectional Study (COVIMPACT)

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–September 2024; participants retrospectively reported their experiences during the COVID-19 pandemic period 2020–2022). 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 (Cramér’s 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 12–42), 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: 1.80–17.09, p = 0.003), while reduced physical activity (Firth OR = 5.28, 95% CI: 1.86–14.99, p = 0.002, full model; Firth OR = 5.54, p = 0.001, reduced model) and negative economic impact (Firth OR = 3.77, 95% CI: 0.89–15.97, 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.