**1. Introduction**

Coronavirus-19 (COVID-19) is a virus first identified in 2019 that has led to an ongoing health emergency worldwide, with high infection rates and mortality [1]. The World

**Citation:** Bruno, G.; Panzeri, A.; Granziol, U.; Alivernini, F.; Chirico, A.; Galli, F.; Lucidi, F.; Spoto, A.; Vidotto, G.; Bertamini, M. The Italian COVID-19 Psychological Research Consortium (IT C19PRC): General Overview and Replication of the UK Study. *J. Clin. Med.* **2021**, *10*, 52. https://doi.org/10.3390/ jcm10010052

Received: 30 November 2020 Accepted: 22 December 2020 Published: 25 December 2020

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2020 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/).

Health Organization recognized the outbreak as a Public Health Emergency of International Concern in January 2020, and as a pandemic in March 2020. Infection can cause systemic organ disease and some categories of people are more at risk in developing severe health consequences, such as those over 70 years old, pregnant women, and those who have pre-existing health conditions (e.g., cardiovascular disease) [2]. However, everyone can be infected and the long-term health consequences—also in its milder presentations—are still not fully understood.

Given the high transmissibility of COVID-19, to contain contagion many countries have adopted restrictive measures such as lockdown, quarantine, social distancing, and limits to movements and travel. These measures have serious economic as well as social implications. Therefore, these aspects of the pandemic extend beyond the health domain. The lives of millions of people have been affected, potentially increasing anxiety, loneliness, and distress. Some of these behavioral responses have been noted and commented in the media. Moreover, the measures have produced various responses, ranging from resistance, stockpiling of food supplies, denial, and beliefs in conspiracy theories. Some behavioral changes have the potential to affect the course of the pandemic itself [3].

The impact of the pandemic can be analyzed from social, psychological, and economic perspectives. Some authors have claimed that we are in the presence of a mental health emergency [4]. Over time fear, anxiety, worry, and depression have grown among people [5]. According to some, the psychological impact of COVID-19 may be greater than the threat represented by the physical disease itself, especially for vulnerable individuals [6]. A growing number of studies have highlighted psychological symptoms and issues in the clinical and general population [7–9].

A focus on the clinical population and on specific risk categories (e.g., young adults, pregnant women, health professionals, caregivers, the elderly) is useful to highlight the needs of these groups [10–12]. However, at the same time, it is important to direct attention to the general population to identify psychological and behavioral patterns.

Several studies have been conducted during the acute phase when contagions reached their peak. The effect of stressors and the psychological symptoms may persist or evolve over periods or months [13]. This is the case when people experience fear (for self and for significant others), stigmatization, and severe psychological symptoms [14].

Italy was one of the first countries to face the COVID-19 emergency and in an especially intense manner. In China, the city of Wuhan was put under quarantine on the 9th of January 2020. Already on/by the 21st of February 16 cases were confirmed in Lombardia and two in Veneto (two Italian regions in the North). Cases grew quickly leading to shortfalls of hospital beds, especially in intensive care units (ICU). The impact on the individual, social, and economic life in Italy was significant. In Italy, as in other countries, the pandemic did not affect all regions equally. Thus, national statistics can be misleading. An analysis by region is important for at least two reasons: first, the north of Italy is divided in eight regions but there are large differences in the impact even between these. Second, in Italy the national health service has a regional structure, and different measures were taken by different regions, (e.g., different testing effort, quarantine policy, individual mobilities, the progression of social distancing, and local capacity of medical infrastructure) [15]. Third, the timeline of the virus varied by region. Lombardia was the first region to be affected and remained also the region with most cases over time. This is a wealthy region with high population density and its capital Milan is the second largest city in Italy.

In March 2020, a longitudinal, multi-country project was launched by the COVID-19 Psychological Research Consortium (C19PRC) in the UK and then enlarged to other countries [16]. The present study represents the opening article of the Italian C19PRC project. Data was collected in Italy from 13 to 28 July 2020, after the contagion peak (end of March) and after the end of the strict national lockdown (18 May). Many commercial and social activities had restarted, and people were allowed to move beyond their own towns. In mid-July, the number of contagions had a stable and decreasing trend, but there were still preventive measures in place (e.g., social distancing, hygiene practices, masks). There was an awareness in the population that a second wave of contagions was possible in all regions.

This study focused on four Italian regions selected because of their geographical location, from the north (Lombardia, Veneto), center (Lazio), and south (Campania), and because of their infection rate when the survey was launched–at the beginning of July 2020– from higher (Lombardia = 95,118 cases, Veneto = 19,432) to medium-lower (Lazio = 8389, Campania = 4788) [17]. Indeed, when data was collected, from 13 to 18 July, in Italy a total of 243,230 cases of COVID-19 had been registered, with 35,042 deaths. The regions that registered the highest number of contagions were Lombardia and Veneto, while in the center and south the outbreak was more contained.

According to the Italian Ministry of Health, the health services and policies are the same in the Italian regions, but some independent regional choices are allowed. In the North, Lombardia ran fewer tests than Veneto and Emilia Romagna. These regions adopted proactive testing modalities and treatment strategies, testing a large number of people and treating positive patients with mild symptoms at home. Therefore, we chose to compare Lombardia and Veneto. Veneto is geographically next to Lombardia, they both have a mix of large cities and small towns and, with respect to population, Lombardia is the largest (10 million) and Veneto is the 5th largest region in Italy (nearly 5 million). The other two regions also include some large cities (Rome in Lazio and Naples in Campania) and are relatively large (5.8 million each). From 17 May 2020 the government passed responsibility to single regions under the overall supervision of the Ministry of Health [18]; different measures in different regions were motivated by the underlying infections and death trends.

Data from a substantial sample of the general population are useful to plan effective interventions. A range of variables have to be assessed due to the complexity of the psychological, social, and cultural context of the pandemic. Some of them are: demographics; socioeconomic status; political opinions; belongingness in the community; public health knowledge; news broadcasting; risk perceptions; hygienic and preventive practices; decision making (e.g., whether to vaccinate or not). Among the psychological ones, post-traumatic stress, loneliness, anxiety, and depression should be assessed as well as self-esteem, personality, and resilience.
