*2.3. Materials*

The demographic characteristics of sex, age, level of education, and COVID-19 exposure were collected. Subjects were asked to complete the following self-report measures: knowledge related to COVID-19; risk perception of COVID-19; the Depression, Anxiety, and Stress Scale–21 items (DASS-21) [45]; the COVID-19 Prevention, Recognition, and Home-Management Self-Efficacy Scale [46]; the self-reported preventive behavior and motivation to engage in preventive behavior scale [40]; and the Social Connectedness Scale (SCS) [47].

To assess the risk perception of COVID-19, ten items were designed for the purpose of this study, and participants responded to the items using a 5-point Likert scale. In this study, Cronbach's alpha was 0.66.

For this study, a specific questionnaire with six ad hoc items that evaluated the appropriate COVID-19 coping behaviors was developed. The scale showed minimally acceptable internal consistency with an alpha of 0.68.

Emotional distress was measured by the DASS-21 scale, which contains 21 items measuring three different domains: depression, anxiety, and stress. Depression (e.g., "I felt I was pretty worthless") includes dysphoria, hopelessness, devaluation of life, selfdepression, lack of interest/involvement, anhedonia, and inertia; anxiety (e.g., "I felt I was close to panic") refers to autonomic nervous system arousal, skeletal musculature effects, situational anxiety, and subjective experience of anxious affects; and stress (e.g., "I felt that I was using a lot of nervous energy") relates to the presence of nonspecific arousal levels, difficulty relaxing, nervous excitement, irritability, agitation, hyperactivity, and impatience. Participants were asked to respond to questions indicating "how often the situation described has occurred in the last seven days." All subscales are rated on a 4-point Likert scale ranging from 0 (never) to 3 (almost always). The depression, anxiety, and stress subscales had Cronbach's alphas of 0.82, 0.74, and 0.85, respectively [48]. In the present study, the Cronbach's alphas were 0.88 for DASS-Depression, 0.79 for DASS-Anxiety, 0.86 for DASS-Stress, and 0.92 for the total scale.

Two instruments were used to assess self-efficacy. The first was based on previous research on SARS [49], in which a single item was used to investigate "how confident do you feel about avoiding contagion." This item is based on a 5-point Likert scale ranging from 0 (not confident) to 5 (very confident).

The second instrument was the COVID-19 Prevention, Recognition and Home-Management Self-Efficacy Scale [46]. It contains 19 items "based on the WHO's recommended behaviors to protect oneself and others from the spread of COVID-19."

The items are grouped into three categories: (i) Prevention of COVID-19 spread and contagion (e.g., "I do not touch my eyes, nose, or mouth under any circumstances"), (ii) Early recognition of COVID-19 symptoms (e.g., "I identify if I have symptoms of COVID-19 quickly after they appear"), and (iii) Home management of patients with (or suspected) COVID-19 (e.g., "Keep the door to the room of the person with symptoms closed at all times"). Scale response options ranged from 0 (completely sure that I cannot do it) to 100 (completely sure that I can do it). The COVID-19 Prevention, Recognition and Home Management Self-Efficacy Scale had a Cronbach's alpha of 0.90 and an intraclass correlation coefficient of 0.75. In the present sample, the Cronbach's alphas were 0.74 for prevention, 0.85 for recognition, 0.88 for home management, and 0.90 for the total scale. The authors reported the internal scoring system as follows: scores below 55 indicated very low self-efficacy, scores ranging from 55 to 68 indicated low self-efficacy, scores ranging from 69 to 82 indicated moderate self-efficacy, scores ranging from 83 to 96 indicated high self-efficacy, and scores above 96 indicated very high self-efficacy.

Self-reported preventive behavior and motivation to engage in preventive behavior were investigated using a single item inspired by the study of [40]. Participants were asked, "In the past 7 days, to what extent did you engage preventive behaviors?". Six behaviors were presented: washing hands, maintaining social distancing, avoiding crowds, sneezing and coughing safely, wearing a mask, and going out only when allowed. Responses were given on a 5-point scale (1 = not at all to 5 = a great deal).

The SCS [47] measures the level of interpersonal closeness an individual feels in their social world (e.g., friends, peers, and society) and the level of difficulty in maintaining this sense of closeness. It consists of eight items using a 6-point Likert scale (1 = strongly agree to 6 = strongly disagree), and higher scores indicate a greater perceived sense of connectedness (e.g., I feel disconnected from the world around me). The SCS showed a very good internal consistency of 0.91 for social connectedness and an alpha of 0.77 for social assurance. In the present sample, Cronbach's alphas were 0.92 for social connectedness and 0.79 for social assurance. Cronbach's alpha of the total scale was 0.82.

#### **3. Data Analysis**

Statistical analyses were conducted using the Statistical Package for Social Science (SPSS; version 25.0; IBM SPSS, Armonk, NY). First, we tested the internal consistency of the instruments using Cronbach's alphas, and the results showed internal consistency with an alpha ranging from a minimum of 0.659 to a maximum of 0.924. Descriptive analyses with means and standard deviations were performed. We used independent samples *t*-tests to determine the differences between groups (conducted using SPSS). Pearson correlations were performed to explore the relationships between the main variables. Statistical significance was defined as *p* < 0.05. The distributions of all data were verified for normality. All statistical analyses were performed on de-identified data.

#### **4. Results**

The analysis of demographic characteristics showed a statistically significant results for sex (*p* < 0.001) and occupation (*p* < 0.001) and no statistically significant result for age (*p* = 0.998).

With respect to the depression t (490) = −0.271, *p* = 0.787, anxiety t (490) = −1.02, *p* = 0.308 and stress t (490) = −1.554, *p* = 0.121 dimensions of the DASS-21, there were no statistically significant differences between groups; nevertheless, CE groups reported higher overall scores in all three dimensions of the scale compared to the NCE group. With respect to the items on "COVID-19 appropriate behaviors," there were no statistically significant results between groups.

With respect to the "How confident do you feel about avoiding contagion" item, there was a statistically significant difference between groups (Table 2). The results showed a significantly higher mean in the NCE group (M = 2.95, SD = 0.805) than in the CE group (M = 2.72, SD = 0.738), t (490) = 3.25, *p* < 0.01, d = 0.296.

With regard to the items investigating "Perceived risk of COVID-19", there was a statistically significant result on "How severe would it be if you contracted COVID-19" (Table 2). The NCE had a higher mean (M = 3.70, SD = 0.762) compared to the CE group (M = 3.50, SD = 0.686), t (490) = 3.04, *p* < 0.01, d = 0.277. The item "How badly do you feel about not being able to meet the people you used to date?" had a statistically significant result (Table 2). The results showed a higher mean in the CE group (M = 4.30, SD = 0.846) than in the NCE group (M = 4.08, SD = 0.997), t (490) = −2.59, *p* < 0.5, d = 0.236. The item "How badly do you feel about having to keep a safe distance from others" yielded a statistically significant result (Table 2). Pairwise comparisons showed a higher mean in the

CE group (M = 3.94, SD = 1.08) than in the NCE group (M = 3.62, SD = 1.14), t (490) = −3.17, *p* < 0.01, d = −0.289.



\* *p* < 0.05; \*\* *p* < 0.01; \*\*\* *p* < 0.001; CE = individuals with COVID-19 symptoms experience; NCE = individuals without COVID-19 experience. M = Mean; SE = Standard error.

> Concerning the COVID-19 Prevention, Recognition and Home-Management Selfefficacy Scale, there was a statistically significant result for recognition of COVID-19 symptoms (Table 2), with a higher mean in the CE group (M = 77.50, SD = 19.71) than in the NCE group (M = 73.22, SD = 22.31), t (477) = −2.21, *p* < 0.05, d = −0.201. Levene's test indicated unequal variances (F = 3.88, *p* = 0.049); thus, the degrees of freedom were adjusted from 490 to 477. The home management of people with COVID-19 symptoms dimension had a statistically significant result (Table 2) in which the CE group reported a higher mean (M = 80.16, SD = 18.26) than the NCE group (M = 73.61, SD = 20.51), t (490) = −3.67, *p* < 0.001,d= −0.334. The prevention of COVID-19 contagion and spread dimension yielded no statistically significant results between groups, t (490) = −0.179, *p* = 0.858.

> The social connectedness scale showed a statistically significant result concerning the "social connectedness" dimension (Table 2). The CE group reported a higher mean (M = 35.29, SD = 8.83) than the NCE group (M = 33.07, SD = 9.88), t (475) = −2.58, *p* < 0.05, d = −0.235. Levene's test indicated unequal variances (F = 5.69, *p* = 0.017); thus, the degrees of freedom were adjusted from 490 to 475. There was no statistically significant result for the "social assurance" dimension t (486) = 0.753, *p* = 0.452.

#### *4.1. Correlations between Variables in the CE Group*

Pearson correlations were calculated to explore the relationships between the main variables involved in the study. 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 prevention of COVID-19 contagion, r = −0.174, *p* < 0.05; with "Wash your hands with soap and water or alcohol-based solution," r = −0.186, *p* < 0.05; and with "Avoid gatherings of large groups of people," r = −0.166, *p* < 0.05, from the appropriate behavior scale. Additionally, "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 positively correlated with the DASS-Depression dimension, r = 0.185, *p* < 0.01.

We found that DASS-Depression scores were significantly and negatively correlated with the "social connectedness" dimension, r = −0.564, *p* < 0.01; and the "social assurance" dimension, r = −0.208, *p* < 0.01. DASS-Anxiety dimension scores were significantly and negatively correlated with the "social connectedness," r = −0.318, *p* < 0.01; and with the "How confident do you feel about avoiding contagion," r = −0.202, *p* < 0.01. DASS-Stress scores were significantly and negatively correlated with "How confident do you feel about avoiding contagion", r = −0.164, *p* < 0.05; "social connectedness," r = −0.325, *p* < 0.01; and "social assurance," r = −0.165, *p* < 0.05.
