*4.2. Correlations between Variables in the NCE Group*

We found that "How badly do you feel about wearing a mask and not being able to see the full expression on other people's faces" was significantly and negatively correlated with the "social assurance" dimension, r = −0.229, *p* < 0.01; and significantly and positively correlated with the DASS-Anxiety, r = 0.171, *p* < 0.01, and DASS-Stress dimensions, r = 0.211, *p* < 0.01. We found that DASS-Depression was significantly and negatively correlated with the "social connectedness" dimension, r = −0.515, *p* < 0.01; the "social assurance" dimension, r = −0.307, *p* < 0.01; the "Recognition of COVID-19 symptoms," r = −0.205, *p* < 0.01; and with the "Home management of people with COVID-19 symptoms," r = −0.253, *p* < 0.01. The DASS-Anxiety dimension was significantly and negatively correlated with the "social connectedness" dimension, r = −0.346, *p* < 0.01; and with the "social assurance" dimension r = −0.245, *p* < 0.01. DASS-Stress dimension was significantly and negatively correlated with the "Recognition of COVID-19 symptoms," r = −0.132, *p* < 0.01; "Home management of people with COVID-19 symptoms," r = −0.184, *p* < 0.01; the "social connectedness" dimension, r = −0.387, *p* < 0.01; and the "social assurance" dimension, r = −0.216, *p* < 0.01.

#### **5. Discussion**

The main goal of this study was to better understand the condition of older adolescents during the long-term COVID-19 pandemic, considering that the extraordinary measures adopted by national governments to face the pandemic had unprecedented effects on adolescents' daily lives. In this regard, social distancing and isolation strategies have been the worldwide primary measures to prevent the risk of infection [50]. Although these measures benefit the entire community, they lead to stress, anxiety, and a sense of helplessness in everyone; for this reason, their psychological effects cannot be overlooked [51].

Our results showed significant differences in the variables of risk perception, selfefficacy, and measures of belongingness among older adolescents who experienced (CE) or did not experience (NCE) COVID-19.

With respect to the DASS-21 questionnaire, the CE and NCE groups showed no statistically significant differences. However, measures of distress along the three axes revealed "moderate" depression and "mild" anxiety for both the CE and NCE groups, "moderate" stress for the CE group and "mild" stress for the NCE group. The lack of a significant difference reported in this study could be explained by the fact that COVID-19 has long-term effects (e.g., the future perspective becomes confusing, fearful, uncertain, and distressing). In this regard, the risk and fear of contagion have changed social and interpersonal relationships, socialization opportunities, education and training systems, and physical activities, especially for younger people; furthermore, home confinement leads to uncertainty and anxiety in both children and adolescents [52]. This is true regardless of whether adolescents had direct COVID-19 experience.

Furthermore, the CE group showed a higher mean difference than the NCE group on social connectedness (one of two measures of belongingness, based on H. Kohut's [53] self-psychology theory), which focuses on the emotional distance or connection between the self and other people. Social connectedness concerns those aspects of belonging that Kohut [53] described as an "intense and pervasive sense of security" and a sense of being "human among humans." We can hypothesize that having experienced COVID-19 may increase the proximity (interest in health status) of friends and relatives; for this reason, this may have an impact on "feeling part of something."

Regarding the second measure of belongingness (i.e., social assurance), no differences between groups were found. With respect to the correlation analysis conducted, the DASS-21 depression dimension showed a negative correlation with both measures of belongingness (social connectedness and social assurance) for both the CE and NCE groups. Likewise, the anxiety and stress dimensions of the DASS-21 showed a negative correlation with social connectedness and social assurance for both the CE and NCE groups. Therefore, we can hypothesize that as anxiety, stress and depression increase, older adolescents

feel more emotionally distant from friends, relatives, and society and feel less a "part of something." These data seem to be explained by prolonged isolation due to restricted home confinement, forced removal from school friends and relatives, confusing or contradictory communication on the pandemic, and the uncertainties of personal and family futures that may have led to increased anxious, stressed, and depressed responses.

Moreover, older NCE adolescents had a higher mean on the dimension of avoiding COVID-19 infection (i.e., "How confident do you feel about avoiding contagion") and scored higher than CE adolescents on the severity of being infected with COVID-19 (i.e., "How severe would it be if you contracted COVID-19"). Indeed, higher perceived selfefficacy to take preventive measures is associated with greater perceived severity of the COVID-19 disease. These data agree with the literature as risk perception is significantly related to COVID-19 severity and coronavirus self-efficacy [54]; furthermore, this result seems to agree with evidence suggesting young people are less vulnerable to the effects of COVID-19 [44]. These differences could be explained by previous knowledge of COVID-19's consequences in the CE group. The NCE group did not have direct experience with COVID-19 and therefore did not know what to expect. The NCE group perceives itself to be more effective at avoiding COVID infection as it has not yet had any experience and feels "protected" from the risk of infection. The results just discussed are also in line with further scientific literature. Indeed, people who believe that they are more vulnerable perceive a higher risk of infection and fear the virus and are also more likely to adopt preventive behaviors. This suggests that developing people's ability to cope with the impact of COVID-19 may increase the adoption of preventive behaviors. These findings suggest that risk perception, along with other factors, may influence the levels of individuals' preventive behaviors [1].

In addition, the CE group showed higher levels of bad moodiness than the NCE group and, in particular, with some measures of prevention of COVID-19 infection (e.g., "How badly do you feel about not being able to meet the people you used to date" and "How badly do you feel about having to keep a safe distance from others"). Therefore, we assumed that the CE group could consider COVID-19 infection as less serious and be more bothered by mandatory avoidance behaviors.

This is confirmed by a strong positive correlation found in the CE group between the item "How badly do you feel about wearing a mask and not being able to see the full expression on other people's faces" and the depression dimension of the DASS-21 and strong negative correlations with the COVID-19 contagion prevention item and appropriate COVID-19 coping behaviors (i.e., "Wash your hands with soap and water or alcohol-based solution" and "Avoid gatherings of large groups of people"). Thus, we can hypothesize that since CE individuals consider COVID-19 to be less severe, they may experience more discomfort in strictly adhering to protective measures and that having direct experience with the disease may have generated a false perception of invulnerability.

With respect to the COVID-19 Prevention, Recognition and Home-Management Selfefficacy Scale, the older adolescent CE group had higher means for symptom recognition and home management of COVID-19. These data are quite clear; indeed, those who experienced COVID-19 felt more capable of recognizing the symptoms of infection (e.g., fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, etc.) and in the home management of those infected with COVID-19 including the following: avoiding all contact with other family members, sleeping alone and staying in a dedicated room, limiting movement in house's spaces in order to avoid meeting other people, periodically measuring oxygen saturation, taking medication to control symptoms, etc. Such differences could be explained by the information that is available to an individual on COVID-19. The NCE group has less information (only the information generally acquired from media), so they may feel less effective at handling the consequences of COVID-19. Although the Protection Motivation Theory (PMT) states that self-efficacy is considered a robust predictor of various health-related behaviors [55,56], no significant differences were found between the CE and NCE groups

in appropriate COVID-19 behaviors as measured by different survey items (e.g., "Always keep a distance of at least three feet between myself and others"). This can be explained by the coping-appraisal process (i.e., one of the three processes of PMT), which suggests coping as the sum of evaluations of the effectiveness and self-efficacy of responses minus any physical or psychological "costs" of adopting the recommended preventive response. Thus, our results, having been collected during the second wave, may reflect the habit of implementing certain types of protective behaviors regardless of having had experience with COVID-19.

The results showed strong correlations between "Recognition of COVID-19 symptoms" and "Home management of people with COVID-19 symptoms" and the stress and depression dimensions of the DASS in the NCE group. Self-efficacy seems to influence people's perception of themselves and may often be inconsistent with reality, resulting in a self-image that is too positive or too negative.

Stress is related to low self-efficacy, that is, beliefs about the inability to master new or challenging tasks, perform a particular behavior, or exercise control over events [57,58]. In the present study, people's self-efficacy in the prevention, detection of symptoms, and home management of COVID-19, when they had not experienced COVID-19, may have triggered a pattern in which perceived inefficacy is closely related to stress and depression. In fact, self-efficacy is an important dispositional resource that mitigates threat appraisals, state anxiety, and cortisol secretion [59].

These results offer an opportunity to reflect on the population examined here since young people tend to frequent crowded places; if they do not comply with the health measures recommended by the government, they risk spreading COVID-19. These results could highlight the importance of prosocial aspects in the management of preventive measures in adolescents for social policies. The importance of active involvement in understanding compliance with anti-COVID rules, rather than the imposition of enforcement, emerges.

However, the study has some limitations. First, it is limited by the use of online surveys and the use of self-reported questionnaires, which may have influenced the findings through well-known biases, including method biases and social desirability biases. Additionally, the study was limited by the relatively small sample size and was conducted using the online convenience sampling strategy without random sample selection. In addition, the study could not investigate comparisons between CE and NCE (i.e., regarding sex and education level) due to numerically significant differences in the sample, and using an observational design limits the generalizability of the results.

#### **6. Conclusions**

To the best of our knowledge, this study is the first to provide data on a population of older adolescents who have or have not experienced COVID-19. To prevent the spread of COVID-19, adolescents experienced unprecedented disruptions in their daily lives, leading them to isolation and loneliness. Adolescence is a stage of life in which excitement and risk-taking are experienced; thus, some adolescents may feel invulnerable and not follow guidelines regarding distancing and personal hygiene. These factors mean that adhering to social distancing rules can be especially difficult for youth and must be assertively addressed with adolescents.

Valuing adolescents' peer support system is essential. For them, it can be very important and helpful to talk to their peers about their feelings and common problems they face. It has also been found that among adolescents, compliance with restrictive measures is considered both a proactive behavior and a social responsibility, especially if supported by prosocial reasons to prevent others from getting sick; this must be the focus of raising awareness of anti-COVID-19 compliance among adolescents.

**Author Contributions:** Conceptualization, J.B., B.B., C.C., and A.Q.; methodology, A.Q.; formal analysis, A.Q. and J.B.; data curation, A.B., S.D., M.S., and M.V.; writing—original draft preparation, J.B., B.B., C.C., and A.Q.; writing—review and editing, S.F. and A.M.G.; supervision, S.F. and A.M.G.; All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of Department of Psychology, Faculty of Medicine and Psychology, "Sapienza" University of Rome (protocol number 0002195/18-12-2020).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy considerations.

**Conflicts of Interest:** The authors declare no conflict of interest.
