*2.3. Measuring Instruments*

Symptoms of depression, anxiety, and stress were assessed using the Portuguese version of the DASS-21 [30,31]. The scale consists of 21 items distributed in three factors with a 4-point Likert-type response scale from 0 to 3 (0: did not apply to me at all, 1: some of the time, 2: a good part of time, 3: most of the time). The scores were calculated by adding the items' response of each subscale and the participants were classified using the cutoff points proposed by Lovibond & Lovibond [33], multiplying the sum of the responses by two (Depression: Normal—0 to 9, Mild—10 to 13, Moderate—14 to 20, Severe—21 to 27, and Extremely severe ≥ 28; Anxiety: Normal—0 to 7, Mild—8 to 9, Moderate—10 to 14, Severe—15 to 19, and Extremely severe≥20; Stress: Normal—0 to 14, Mild—15 to 18, Moderate—19 to 25, Severe—26 to 33, and Extremely severe ≥ 34).

The degree of psychological impact related to the pandemic was identified using the Portuguese version of the IES-R [32]. The IES-R is composed of 22 items distributed in three factors (avoidance, intrusion, and hyperarousal) with a Likert-type response scale of 5 points (0—not at all, 1—slightly, 2—moderately, 3—very and 4—extremely). IES-R calculated by the sum of responses to all items on the scale) and the recommendation by Wang et al. [22] (Normal—0 to 23; Mild—24 to 32; Moderate—33 to 36; Severe—≥37) were proposed to estimate the prevalence of psychological impact and its degree of involvement. Next, the cutoff points were transposed, considering the corresponding percentiles, for each factor of the scale so that one can also estimate the prevalence and the degree of involvement for the three factors of the IES-R separately (Avoidance and Intrusion: Normal—0 to 8; Mild—9 to 11; Moderate—12 to 13; Severe—≥14; Hyperstimulation: Normal—0 to 6; Mild—7 to 8; Moderate—9 to 10; Severe—≥11).
