**1. Introduction**

At the end of February 2020, Italy faced an outbreak of coronavirus disease 19 (COVID-19), which spread quickly across most of Europe. After a decrease in detected cases in the summer, Europe faced the emergence of a second wave of COVID-19. In this context, the Italian government established a partial lockdown based on a new tiered system, classifying some areas with the highest rates of COVID-19 as high-risk red zones and maintaining preventive measures such as wearing a mask and social distancing. Previous studies on compliance with preventive measures during past epidemics and pandemics (e.g., Ebola virus disease, cholera, avian flu, severe acute respiratory syndrome, equine influenza, and Zika virus) found that factors related to compliance were knowledge of the disease [1,2], perceived effectiveness of the preventive measures [1,3,4], social influence [1], perception of risk [5], concern for self and loved ones, and perceived severity compared to

Cricenti, C.; Borrelli, A.; D'Amato, S.; Santoro, M.; Vitale, M.; Ferracuti, S.; Giannini, A.M.; Quaglieri, A. Older Adolescents Who Did or Did Not Experience COVID-19 Symptoms: Associations with Mental Health, Risk Perception and Social Connection. *Int. J. Environ. Res. Public Health* **2021**, *18*, 5006. https://doi.org/10.3390/ ijerph18095006

**Citation:** Burrai, J.; Barchielli, B.;

Academic Editor: Paul B. Tchounwou

Received: 14 April 2021 Accepted: 5 May 2021 Published: 9 May 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

other epidemics [3,6,7]. Different studies have investigated the general population, e.g., [8], psychiatric population, e.g., [9,10], and family patterns, e.g., [11]. However, few studies have investigated adolescents and young adults with ages ranging from a minimum of 15 to a maximum of 22, who may constitute a target group with possible lower compliance to public health measures, particularly with physical distancing measures [12]. However, adolescents had to face new stressors such as the fear of being infected; worrying about their parents' work (i.e., financial situation); death; restrictions on their privacy; sudden separation from schoolmates, friends, and teachers [13–16].

These factors were linked to changes in lifestyle habits, increased use of social networks, and changes in eating habits [14,17,18] and experienced emotions, such as loneliness, boredom, and sadness [19,20]; however, adolescents seem to have adapted quickly to the current situation [21].

Furthermore, studies have investigated the impact of COVID-19 on adolescents' mental health and have found an increase in both pre-existing [22] and non-pre-existing cases of major psychopathological conditions, such as depression, anxiety, and Post-Traumatic Stress Disorder [16,23–27].

On the other hand, studies have investigated the psychosocial environment of adolescents related to pandemic situations. In particular, increased time spent at home with family seems to have influenced conflict with parents, harsh discipline, and parental control [28–30]. Regarding relationships with peers and considering the decrease in faceto-face contact, adolescents appear to have increased their communication through social networking, mainly through the use of video calls [21].

During adolescence, the relationship with peers has a relevant influence on adherence to the rules, as well as negative youth-adult relationships [31,32], dysfunctional family functioning (e.g., poor family communication), poor school bonding (poor peer cohesion) [33], low levels of self-control [34], and high sensation-seeking tendencies [35,36]. In contrast, rule compliance appears to be associated with factors, such as the legitimacy of authority, justice [37], and personal factors such as self-efficacy [38].

However, adherence to protective measures during the COVID-19 pandemic was different when considering adults and younger people. Masters and colleagues [39] investigated different generations, from "Generation Z" (18–23 years) to the "Silent Generation" (≥75 years), and showed that the adoption of preventive measures, in particular distancing, increased with age: Generation Z and millennials were the least likely to comply with distancing rules.

One of the reasons that appear to support low adherence to these behaviors is the idea that "there is no alternative," while the reason that most strongly motivates young people to comply with social distancing is the desire to protect others [40,41]. In addition, young people's low adherence to COVID-19 rules seems to be associated with low-risk perception, low perception of illness severity, low acceptance of moral rules, low selfcontrol, and peer influence, particularly the relationship with peers who do not comply with the rules [12,41–43].

In particular, with the gradual decrease in restrictive measures during the second wave, adolescents considered it no longer necessary to maintain social distancing [43].

Often, young people do not consider COVID-19 a potentially severe disease, and evidence suggests that young people are less vulnerable [44]. Indeed, the period of life between the ages of 10 and 24 years (i.e., adolescence) is often related to increased risktaking, the need for social connection and peer acceptance, and increased sensitivity to peer influence [42]. However, it seems important to investigate the underlying characteristics of this phenomenon. The likelihood of being infected and experiencing severe COVID-19 symptoms is underestimated by young people, although the spread of COVID-19 might depend on their behaviors. To date, compliance with the rules is still essential to prevent the spread of COVID-19; therefore, the understanding of those factors could mediate the assumption of risky behaviors.

On this basis, we explored the role of social connectedness in maintaining a stable relationship with peers and the dimensions of anxiety, stress, and depression on risk perception and risk behavior in older adolescents (i.e., 18–24 years). Additionally, we explored the difference between the perceived protective behaviors and the actual behaviors to protect oneself against COVID-19 infection. Based on these considerations, the main purpose of our study was to investigate whether the experience of COVID-19 symptoms: (I) influenced risk perception, depression, anxiety and stress; (II) affected self-efficacy in terms of prevention, recognition and home management of COVID-19; and (III) whether the COVID-19 pandemic impacted the sense of belongingness and "being a part of" since the sense of connectedness emerges during adolescence and extends throughout the lifetime.
