**1. Introduction**

Over the past century, there have been several pandemics, with many devastating consequences. In a pandemic situation, when there is no pre-existing immunity to pandemic pathogens, no effective pharmacological treatment, and no vaccine, individuals' only preventive health measure is to practice good hygiene (e.g., wash hands) and social distancing [1]. Thus, in the wake of the global spread of SARS-CoV-2 and its associated disease (COVID-19), governments have implemented significant

containment measures, including quarantines and lockdowns and the closure of schools, offices, and non-essential shops [2].

Research on individual and community responses to restrictive measures in the context of previous infectious disease outbreaks (e.g., Severity Acute Respiratory Syndrome [SARS]; H1N1; Ebola; Middle East Respiratory Syndrome [MERS]; equine influenza) have studied the psychological effects of isolation, social distancing, and lack of physical contact. The findings have demonstrated a significant psychological impact on individual well-being, characterized by higher levels of Anxiety, Depression, and Stress [3–8]. Recent studies conducted during the COVID-19 pandemic have shown similar consequences of the lockdown on psychophysical wellness in the general population [9–15].

Most studies on well-being during the COVID-19 pandemic have focused on the mental health of the general population; far less attention has been given to more specific populations, such as patients with mental illness [16]. In this context, it is important for researchers to examine the psychiatric population, given its vulnerability. It has already been shown that both older adults and those who are immunocompromised (including psychiatric patients) are at greater risk for developing complications when infected with COVID-19 (e.g., comorbidity with other medical disorders, see, e.g., [17]).

In addition, the co-occurrence of mental illness and substance use disorders [18] as risk factor for COVID-19 infection, and risk adverse outcomes related to cardiovascular, pulmonary and metabolic disease associated to an extent with chronic use of alcohol and other drugs need to be taken into account [19].

Moreover, social isolation is part of the symptomatology of many psychiatric disorders. For this reason, at first it could be assumed that lockdown policies could reduce the stress related to compliance with social norms; on the other hand, it should be considered that the long-term outcomes could be an increase of rumination and decompensation due to a possible exacerbation of loneliness and despair relating to social isolation [20].

Furthermore, the psychiatric population may increase their suffering in reaction to forced isolation and compromise their ability to adequately understand the emergency and implement appropriate containment behaviors.

Very few studies have addressed the effects of comprehensive restrictive public health measures on psychiatric patients. To the best of our knowledge, during the SARS epidemic, only one study [21] investigated the effect of the epidemic on the clinical state of psychiatric inpatients with schizophrenia, finding them to present lower levels of Anxiety, Depression, and Fear compared to a control group of health staff. The authors explained these findings as indicative of the in-patients' greater denial of the importance and personal relevance of the epidemic.

With respect to the COVID-19 pandemic, contrasting results have emerged, showing a higher sensitivity in psychiatric patients due to pandemic-related Stress [22]. Hao et al. [22] studied the psychological impact of the pandemic on psychiatric patients and healthy controls during the peak of viral spread in China. The psychiatric patients (who had been diagnosed with Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder, and/or mixed Anxiety and Depressive Disorder) showed significantly higher levels of Post-Traumatic Stress Disorder (PTSD), Depression, Anxiety, Stress, and insomnia, compared to the healthy controls. More specifically, 31.6% of the psychiatric sample fulfilled the diagnostic criteria for PTSD, while 23.6% showed moderate to severe anxiety symptoms and 22.4% showed moderate to severe depressive symptoms. Finally, more than 25.0% of the psychiatric patients suffered from moderately severe to severe insomnia [22]. The authors suggested that the worse outcomes shown by their psychiatric patient group may have been caused by their lack of access to mental health services during the emergency.

During the COVID-19 pandemic, people with mental illness were also shown to demonstrate stronger emotional responses compared to the general population, as a result of their higher susceptibility to Stress [16]. Psychiatric patients were also found to experience higher levels of Distress, which could play a mediating role in elevating levels of Anxiety [23].

All of the abovementioned studies were conducted online, using samples of in-patients at hospitals and psychiatric units. To the best of knowledge, no prior study has assessed psychiatric patients in a rehabilitation community. In such communities, psychiatric patients have adjusted to conditions of less personal autonomy and community engagement; they no longer attend school and/or internships and they do not leave the facility to visit family and friends. Thus, the typical residential conditions are similar to a quarantine or lockdown situation.

The present study aimed at assessing the psychological and emotional impact of isolation on patients in these psychiatric communities, compared to healthy controls. In more detail, we wondered whether there might be significant differences between psychiatric patients and healthy controls during the COVID-19 lockdown in relation to Coping Style, Risk Perception, and Worry, as well as levels of Depression, Anxiety, and Stress. Furthermore, we sought to identify potential risk and protective factors for psychological distress, taking into account sociodemographic variables (i.e., age, gender, education), Worry, Risk Perception, and—particularly—the presence or absence of a psychiatric diagnosis.
