The impact of COVID-19 perceived threat and restrictive measures on mental health in Italy, Spain, New York, and Hong Kong: An international multisite study.

In the early stages of the COVID-19 pandemic, Italy, Spain, New York, and Hong Kong stood out for the ir high rates of infections. Given this scenario, a web-based international multisite and cross-sectional study was conducted between April and May 2020 to investigate the psychological impact of the pandemic and the restrictions imposed by the governments in these countries. We expected similar patterns in European countries, and no significant differences in terms of psychological impairment between Hong Kong (with a previous experience related to SARS, but subjected to restrictions for a longer time) and the other areas. Participants were 1955 adults from the above-mentioned areas. We assessed anxiety (GAD-7), depression (PHQ-9), COVID-19-related threats, and perceived burden of restrictive measures. Two-explorative factor analyses (EFAs) with Promax rotation identified COVID-19-related factors: personal physical threat, personal economic threat, global economic threat, and restriction-related burden. ANOVAs studied locations' differences and two-separate hierarchical multiple regression analyses by location determined whether and how COVID-19-related variables were associated with anxiety and depression, adjusting for age and sex. Italy and Hong Kong showed higher anxiety than Spain (p < 0.05); Hong Kong scored higher on depression than Italy and Spain (p < 0.001), which highlighted the lowest mean-score. New York participants showed the poorest mental health conditions. Anxiety was predicted by restriction-related burden (ßNY = 0.242; ßHK = 0.116) and personal economic threat (ßNY = 0.246; ßHK = 0.145) in New York (Adj.R 2 = 0.125) and Hong Kong (Adj.R 2 = 0.079); by global economic threat (ß = 0.199) and restriction-related burden (ß = 0.124) in Italy (Adj.R 2 = 0.108); and by personal physical threat (ß = 0.144) in Spain (Adj.R 2 = 0.049). Depression was predicted by restriction-related burden (ßNY = 0.313; ßHK = 0.120) and personal economic threat (ßNY = 0.229; ßHK = 0.204) in New York (Adj.R 2 = 0.161) and Hong Kong (Adj.R 2 = 0.089); by global economic threat (ß = 0.209) in Italy (Adj.R 2 = 0.149); and no predictors emerged in Spain. Findings could contribute to understanding the specific impact of the pandemic on people's psychological health in each area, along with the factors that impacted mental health. This information may be useful to implementing prevention interventions in case of restrictions.

Dreaming or daydreaming during COVID-19 lockdown: A comparison between maladaptive and nonmaladaptive daydreamers

Starting from the idea that dreaming could be considered an index of the psychological health of individuals regarding the COVID-19 outbreak, a major risk of psychological maladjustment has been registered for maladaptive daydreamers (MDers;i.e., people with a compulsive fantasy activity associated with distress and psychological impairment). Nevertheless, there is a gap in literature about dreaming in MDers in general and particularly during the COVID-19 pandemic. The aim of this study was to investigate differences in dreaming and dream content between probable MDers and non-MDers during the COVID-19 lockdown in Italy. A total of 3,857 Italian adults (664 probable MDers), completed the Maladaptive Daydreaming Scale (MDS-16) and the Mannheim Dream Questionnaire (MADRE). Among them, 1,095 participants (222 probable MDers) decided to recount their dreams, subsequently analysed through a cluster analysis performed by T-LAB software. Significantly higher levels of dream recall, emotional intensity of dreams, nightmare frequency, nightmare distress, recurring nightmares about daytime, lucid dreams, interest toward dreams, problem solving and creative dreams, and dreams affecting daytime mood emerged in probable MDers compared to non-MDers. No differences were observed in the emotional tone of dreams. From the quali-quantitative analysis of dream narratives, similar themes emerged in probable MDers and non-MDers, except for a cluster named Dreaming the loss of others, where the non-MDers variable is highly represented. Our results highlight some significant differences between probable MDers and non-MDers with respect to dreaming activity. The massive use of dream activity as an affective regulator emerges for both probable MDers and non-MDers during lockdown. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Violence Risk Assessment and Risk Management: Case-Study of Filicide in an Italian Woman.

BACKGROUND: At an international level, the risk assessment and management process of violent offenders follows a standard method that implies well-defined theoretical models and the use of scientifically validated tools. In Italy, this process is still highly discretionary. The aim of this study is to highlight the advantages deriving from the use of risk assessment tools within the framework of a single case study; Methods: Recidivism risk and social dangerousness of an Italian woman perpetrator of filicide were assessed through the administration of the Level of Service/Case Management Inventory (LS/CMI) instrument supported by Historical Clinical Risk-20 Version 3 (HCR-20 V3); Results: The administration of LS/CMI showed that, in this single case, the subcomponents represent a criminogenic risk/need factor are: Family/Marital, Companions, Alcohol and Drug Problem and Leisure; while constituting strengths: employment and the absence of a Pro-criminal Orientation and an Antisocial Pattern; Conclusions: Data collected through LS/CMI indicated life areas of a single case, which should be emphasised not only to assess the risk of re-offending and social dangerousness but also for a social rehabilitation programme more suited to the subject. This study demonstrates that the LS/CMI assessment tool is suitable for the Italian context.

Longitudinal associations between stress and sleep disturbances during COVID-19.

The psychological consequences of COVID-19 pandemic may include the activation of stress systems, that involve the hypothalamic-pituitary-adrenal axis which influences many physiological functions, including sleep. Despite epidemiological studies evidenced greater prevalence of stress symptoms and sleep disturbances during COVID-19, longitudinal evidence investigating the effects of stress on sleep disturbances during the pandemic is lacking. We collected measures of perceived stress and sleep disturbances during the first wave of COVID-19 (March 2020) and at 8-10 months follow up in a sample of 648 adults (M = 33.52, SD = 12.98 years). Results showed that 39.4% of participants reported moderate to extremely severe stress in March 2020. Prevalence of sleep disturbances was 54.8% in March 2020 and 57.4% at follow-up. Structural equation modelling highlighted that perceived stress in March 2020 significantly predicted sleep disturbances at follow up (ß = 0.203; p < 0.001), even after controlling for baseline sleep disturbances. Results remained significant even after controlling for the effects of covariates including age, sex, depression and anxiety symptoms, and referring to psychological services (ß = 0.179; p < 0.05). Findings confirm the high prevalence of stress symptoms during the COVID-19 pandemic and provide first longitudinal evidence for the effects of perceived stress on sleep disturbances during the pandemic.

Predictors of Postpartum Depression among Italian Women: A Longitudinal Study.

INTRODUCTION: Postpartum depression is commonly experienced by mothers worldwide and is associated with anxiety disorders, parenting stress, and other forms of distress, which may lead to a complex illness condition. Several studies have investigated the risk factors for this disorder, including biological and socio-demographic variables, medical and obstetric factors, and psychological and relational dimensions. The present study aimed to describe the psychological status of mothers up to 12 months postpartum, and to investigate the predictors of depressive symptoms at 12 months postpartum, considering obstetric factors along with psychological and relational variables. METHODS: A sample of 137 women completed a questionnaire composed of a sheet on anamnestic and obstetric information and the following scales: Wijma Delivery Experience Questionnaire; State-Trait Anxiety Inventory; Edinburgh Postnatal Depression Scale; Parenting Stress Index (Short Form); Dyadic Adjustment Scale; and Multidimensional Scale of Perceived Social Support. Data were collected at four assessment times: 2-3 days, 3 months, 6 months, and 12 months postpartum. RESULTS: Findings showed that the highest percentage of women with clinically significant symptoms of anxiety (state and trait) and depression was found at 12 months postpartum, which indicated that this was the most critical time. The quality of childbirth experience and trait anxiety at three months postpartum emerged as significant predictors of postpartum depression at 12 months. CONCLUSION: Our findings highlight the importance of providing stable programs (such as educational programs) to mothers in the first year postpartum. Furthermore, because the quality of the childbirth experience is one of the most important predictors of PPD at 12 months postpartum, effort should be made by healthcare professionals to guarantee a positive experience to all women to reduce possible negative long-term consequences of this experience.

The Relationship Between Resilience and Sleep Quality During the Second Wave of the COVID-19 Pandemic: A Longitudinal Study.

PURPOSE: Previous studies showed poor sleep quality during the first Italian lockdown consequent to the quick spread of the virus. Poor sleep quality remained stable during the so-called "second wave", which started in Autumn 2020. This study aimed to compare sleep quality between the two waves of contagions and to examine the effect of resilience, together with sociodemographic and COVID-related variables, on sleep quality during the second wave. PATIENTS AND METHODS: A total of 648 participated in this longitudinal study through an online survey during the first lockdown consequent to the COVID-19 and during the second wave. The Medical Outcomes Study-Sleep Scale (MOS-SS) and the Resilience Scale (RS) were administered. Sociodemographic and COVID-related information were also collected. RESULTS: The results showed sleep quality slightly increased in the second wave, even though with a small effect size. Correlational analysis showed that resilience is inversely correlated with sleep quality measured in the two waves. Sleep quality during the second wave was positively correlated with sleep quality in the first lockdown. Likewise, the results of multiple regression revealed that the sleep quality in the first lockdown and resilience were significant predictors of sleep quality during the second wave. CONCLUSION: These findings highlighted that the prevalence of poor sleepers remained high during the second wave. Together with the sleep quality in the first lockdown, resilience represents an important factor related to sleep quality during the second wave. Interventions to improve sleep quality among the general population should take into account these findings.

Are we dreaming or are we awake? A quali-quantitative analysis of dream narratives and dreaming process during the COVID-19 pandemic

The COVID-19 pandemic and the restrictive measures taken against the spread of the contagion can be considered as traumatic events having a major impact on mental health. Dreams after undergoing traumatic experiences could "replay" traumatic scenes or have a para-therapeutic role that facilitates connections between a traumatic event and associated emotions. However, the studies carried out thus far in the field of sleep and dreams during the COVID-19 pandemic have mostly focused on sleep disorders, emotional tones, and contents of dreams. The aim of the present study was to explore, from a qualitative-quantitative perspective, the contents of dreams and the functions of dreaming during the COVID-19 pandemic. A sample of 1,095 subjects who decide to recount their dreams, during the early phase of the COVID-19 outbreak, was involved. A part of the Mannheim Dream questionnaire was also examined, considering both dream recall and the attitudes toward the dreams-both meaningful and transformative-as indicators of the dreaming process. A cluster analysis was performed on dream narratives through the T-Lab software. In all, 4 thematic clusters emerged: Escape From the Threat;The Work of Mourning, Unrecalled Dreams;COVID-19: As Manifest Content. The factorial mapping organized 3 vectors of meaning, representative of the function of dreaming: Remembering, Repeating, and Working Through;From Traumatic Content to Problem-Solving Strategy;From the Safe-Guardian of Sleep to the Safe-Guardian of Dream Waking continuity. The dreaming process shows functions of integration and processing of memories but also that a decrease in dream recall can act as a defense and have a crucial role in mental life. Clinical implications are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Dreams and Nightmares during the First and Second Wave of the COVID-19 Infection: A Longitudinal Study.

Recent literature shows that the Coronovirus-19 (COVID-19) pandemic has provoked significant changes in dreaming. The current study intends to provide an update about dream variable changes during the second wave of COVID-19. A total of 611 participants completed a web survey from December 2020 to January 2021. Statistical comparisons showed that subjects had lower dream-recall frequency, nightmare frequency, lucid-dream frequency, emotional intensity, and nightmare distress during the second than the first wave of the pandemic. Dreams had a higher negative tone during the second than first wave. We revealed significant differences concerning post-traumatic growth, sleep-related post-traumatic stress disorder (PTSD) symptoms and sleep measures between groups obtained as a function of the changes in the oneiric frequency between the first and second waves. We also found significant correlations between qualitative/emotional dream features and COVID-19-related factors (job change, forced quarantine, having COVID-19 infected relatives/friends, or asking for mental health help). Overall, we found that the second wave affected fewer quantitative features of dream activity and there was less emotional intensity. Moreover, we confirmed the relationship between nightmares and the high risk of PTSD when subjects were grouped as a function of the increasing/decreasing frequency. Finally, our findings are partly coherent with the continuity hypothesis between oneiric and waking experiences.

Dreaming during lockdown: a quali-quantitative analysis of the Italian population dreams during the first COVID-19 pandemic wave.

This study aims to explore the emotional experiences related to the lockdown during the first pandemic wave, analysing the dreams of the Italian population. Through an online survey spread throughout the country, participants completed the Depression Anxiety Stress Scale-21 (DASS-21), the Resilience Scale (RS) and were asked to narrate a dream they had during the lockdown. The dreams were qualitatively analysed through the thematic content analysis. Logistic regression analyses were then conducted to verify the relationship among the categories that emerged and between these categories and the DASS-21 and RS scores. In the dreams 8 categories were identified (Places, Characters, Relationships, Actions, Danger, Death, Processes, and Emotions) composed of specific sub-categories, which seem to compose a sort of narrative structure of the dream. Some sub-categories were found to be predictor of depression and resilience or with exposure to COVID-19. Dreams can be a valid tool both to understand the experiences of the population during the pandemic and to evaluate those at risk of developing distress in clinical practice.

"Fear can hold you, hope can set you free". Analysis of Italian prisoner narrative experience of the COVID-19 pandemic.

PURPOSE: This study aims to explore the psychological effects of lockdown during the early stages of the COVID-19 pandemic on people living in an Italian prison. The suspension of family visits and most activities, along with the difficulties in applying social distancing to this vulnerable population was associated with increased psychological distress. Riots broke out over two days in more than 22 prisons across Italy at the beginning of March 2020, highlighting the negative psychological impact of the pandemic and the country's emergency policies. DESIGN/METHODOLOGY/APPROACH: The research involves 17 men (Italians and foreigners) detained in a Lombardy prison from 1 March to 4 May 2020, corresponding to the lockdown phase in Italy. The qualitative content analysis (CA) of 27 posts, written by participants during that period and published on the blog "L'Oblò", were analysed. The analysis allowed the identification of topics and subtopics that are related to two major categories of content: cognitions and emotional connotations about the COVID-19 lockdown in prison. FINDINGS: Analysis showed that blog post content was predominately negative in terms of emotional connotations. The most frequent coded negative emotional connotations were: missing, worry, psychological pain and fear, whilst the most frequent coded positive emotional connotations were: hope and gratitude for the support they received from prison workers. The rest of the blog content was coded as "cognitions". Cognitions were coded as descriptions of lockdown effect on detention; prison during the COVID-19 emergency; the pandemic situation in general; and comparison between inside and outside prison. ORIGINALITY/VALUE: The current study is original as it describes through blog CA the psychological condition of prisoners during the first COVID-19 pandemic lockdown in the most affected region in Italy.

Fears, beliefs, and quality of life of patients with cancer vs the general population during the coronavirus disease 2019 (COVID-19) pandemic in Lombardy.

AIM: To understand how patients with cancer reacted to the coronavirus disease 2019 (COVID-19) pandemic and whether their quality of life (QoL) was affected. METHODS: In June 2020, 111 patients with cancer treated in the supportive care unit of a Comprehensive Cancer Center in Milan and 201 healthy controls from the general population were enrolled and assessed both quantitatively and qualitatively for fears and COVID-19-related beliefs as well as for QoL. RESULTS: Fear of COVID-19 was significantly lower among patients (41% vs 57.6%; p = 0.007), as was fear of cancer (61.5% vs 85.6%; p < 0.001) and other diseases. The perceived risk of getting COVID-19 was lower among patients (25.2% vs 52.7%; p < 0.001), as was the belief of having been exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (18.1% vs 40.8%; p < 0.001). The physical component of QoL was better among the population (54.5 vs 43.8; p < 0.001); the reverse was true for patients' psychological well-being (44.6 vs 39.6; p < 0.001). The qualitative data supported such results, showing a reduced psychological effect on the patients with cancer compared to the controls. Various reasons explain this result, including the awareness of being treated for cancer and nevertheless protected against getting infected in a cancer center of public health reorganized to continue treating patients by protecting them and personnel from the risk of infection. CONCLUSIONS: The experience of a cancer diagnosis, together with proper hospital reorganization, may act as protective factors from fears and psychological consequences of the COVID-19 outbreak.

Maladaptive Daydreaming in an Adult Italian Population During the COVID-19 Lockdown.

During the COVID-19 outbreak, individuals with or without mental disorders may resort to dysfunctional psychological strategies that could trigger or heighten their emotional distress. The current study aims to explore the links between maladaptive daydreaming (MD, i.e., a compulsive fantasy activity associated with distress and psychological impairment), psychological symptoms of depression, anxiety, and negative stress, and COVID-19-related variables, such as changes in face-to-face and online relationships, during the COVID-19 lockdown in Italy. A total of 6,277 Italian adults completed an online survey, including socio-demographic variables, COVID-19 related information, the 16-item Maladaptive Daydreaming Scale (MDS-16), and Depression, Anxiety, and Stress Scales-21 Items (DASS-21). Based on an empirically derived cut-off score, 1,082 participants (17.2%) were identified as probable maladaptive daydreamers (MDers). A binary logistic regression revealed that compared to controls, probable MDers reported that during the COVID-19 lockdown they experienced higher levels of anxiety and depression, decreased online social relationships, and, surprisingly, stable or increased face-to-face social relationships. Given the peculiar characteristics of the pandemic context, these findings suggest that the exposure to the risk of contagion had probably exacerbated the tendency of probable MDers to lock themselves inside their mental fantasy worlds, which in turn may have contributed to further estrangement from online social relationships and support, thus worsening their emotional distress.

In the Eye of the Covid-19 Storm: A Web-Based Survey of Psychological Distress Among People Living in Lombardy.

In March 2020, the World Health Organization announced the Covid-19 outbreak a pandemic and restrictive measures were enacted by the Governments to fight the spread of the virus. In Italy, these measures included a nationwide lockdown, with limited exceptions including grocery shopping, certain work activities, and healthcare. Consistently with findings from previous studies investigating the psychological impact of similar pandemics [e.g., Severe Acute Respiratory Syndrome (SARS)], there is evidence that Covid-19 is associated with negative mental health outcomes. Given this background, we conducted a cross-sectional study aimed at investigating the impact of the Covid-19 pandemic and the subsequent restrictive measures imposed by the Government on the psychological health of Italian men and women aged = 18 years and living in Lombardy, one of the worst-hit regions. The study also aimed at identifying what factors are associated with specific psychological outcomes. Thus, we developed an online survey that included a researcher-made questionnaire to collect sociodemographic, household, general health, and pandemic-related information. The Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9 and the Perceived Stress Scale were used to assess anxiety, depression, and perceived stress, respectively. We found that younger age, greater concerns about the pandemic, female gender, being unmarried, not having children, and being a student were associated with worse psychological health. These findings may provide further insight into the risk factors associated with negative psychological outcomes during the current pandemic, with identification of vulnerable groups. This body of evidence may help professionals implement targeted psychosocial treatment and prevention programs.

Pandemic nightmares: Effects on dream activity of the COVID-19 lockdown in Italy.

COVID-19 has critically impacted the world. Recent works have found substantial changes in sleep and mental health during the COVID-19 pandemic. Dreams could give us crucial information about people's well-being, so here we have directly investigated the consequences of lockdown on the oneiric activity in a large Italian sample: 5,988 adults completed a web-survey during lockdown. We investigated sociodemographic and COVID-19-related information, sleep quality (by the Medical Outcomes Study-Sleep Scale), mental health (by the Depression, Anxiety, and Stress Scales), dream and nightmare frequency, and related emotional aspects (by the Mannheim Dream Questionnaire). Comparisons between our sample and a population-based sample revealed that Italians are having more frequent nightmares and dreams during the pandemic. A multiple logistic regression model showed the predictors of high dream recall (young age, female gender, not having children, sleep duration) and high nightmare frequency (young age, female gender, modification of napping, sleep duration, intrasleep wakefulness, sleep problem index, anxiety, depression). Moreover, we found higher emotional features of dream activity in workers who have stopped working, in people who have relatives/friends infected by or who have died from COVID-19 and in subjects who have changed their sleep habits. Our findings point to the fact that the predictors of high dream recall and nightmares are consistent with the continuity between sleep mentation and daily experiences. According to the arousal-retrieval model, we found that poor sleep predicts a high nightmare frequency. We suggest monitoring dream changes during the epidemic, and also considering the implications for clinical treatment and prevention of mental and sleep disorders.

Resilience Contributes to Low Emotional Impact of the COVID-19 Outbreak Among the General Population in Italy.

BACKGROUND: The COVID-19 outbreak is severely affecting the overall mental health with unknown psychological consequences. Although a strong psychological impact is possible, scant evidence is available to date. Past studies have shown that resilience decreases the negative effects of stress. This study aimed to examine depression, anxiety, and stress among the Italian general population during the phase characterized by lockdown, and to investigate the role of resilience as a potential predictor. METHODS: A total sample of 6,314 Italian people participated in this study. Participants were recruited between March 29 and May 04 2020 through an online survey. The Depression Anxiety Stress Scales-21 (DASS-21) and the Resilience Scale (RS) were administered. Demographic data and lockdown related information were also collected. A correlational analysis was carried out to examine relationships between psychopathological domains and resilience. Three hierarchical regression analyses were conducted using the depression, anxiety, and stress as dependent variables and the resilience as independent variable controlling for age, gender, and education. COVID-19 specific variables were also included in the three regression analyses. A further exploratory analysis was carried out to examine which aspects of resilience predict depression, anxiety, and stress. RESULTS: The prevalence of moderate to extremely severe symptoms among participants was 32% for depression, 24.4% for anxiety, and 31.7% for stress. The sample mean scores on depression, anxiety, and stress were higher than the normal scores reported in the literature. Results of correlational analysis showed that resilience factors, such as meaningfulness, self-reliance, existential aloneness, and equanimity, are inversely associated with depression, anxiety, and stress. Results of regression analyses indicated that resilience was statically significant in predicting depression, anxiety, and stress. Geographic area of residence and infected acquaintances were also significant predictors. Regarding the resilience factors, results revealed that meaningfulness, perseverance, and equanimity were statistically significant in predicting all the DASS-21 scales. CONCLUSION: About a third of respondents reported moderate to extremely severe depression, anxiety, and stress. The present study suggests that psychological resilience may independently contribute to low emotional distress and psychological ill-being. These findings can help explain the variability of individual responses during the COVID-19 outbreak.

Poor Sleep Quality and Its Consequences on Mental Health During the COVID-19 Lockdown in Italy.

BACKGROUND: Coronavirus disease 2019 (COVID-19) seriously affected the whole of Italy. The extreme virulence and the speed of propagation resulted in restrictions and home confinement. This change was immediately perceived by people who found themselves exposed to feelings of uncertainty, fear, anger, stress, and a drastic change in the diurnal but above all nocturnal lifestyle. For these reasons, we aimed to study the quality of sleep and its connection to distress levels and to evaluate how lifestyle changed in the Italian population during the lockdown. METHODS: By means of an Internet survey we recruited 6,519 adults during the whole of the COVID-19 lockdown (from March 10-1st phase to May 4-2nd phase). We investigated the sociodemographic and COVID-19-related information and assessed sleep quality using the Medical Outcomes Study-sleep scale (MOS-SS) and mental health with the short form of Depression, Anxiety, and Stress Scales-21 Items (DASS-21). Multiple logistic regression model was used to evaluate the multivariate association between the dependent variable (good sleeper vs. poor sleeper) and all the variables that were significant in the univariate analysis. RESULTS: A total of 3,562 (55.32%) participants reported poor sleep quality according to the MOS-Sleep Index II score. The multiple binary logistic regression results of poor sleepers revealed several risk factors during the outbreak restrictions: female gender, living in Central Italy, having someone close who died because of COVID-19, markedly changed sleep-wake rhythms characterized by earlier or postponed habitual bedtime, earlier habitual awakening time and reduced number of afternoon naps, and extremely severe levels of stress, anxiety, and depression. CONCLUSION: This is the first study designed to understand sleep quality and sleep habits during the whole of the lockdown period in the Italian population that provides more than 6,000 participants in a survey developed specifically for the health emergency related to COVID-19. Our study found that more than half of the Italian population had impaired sleep quality and sleep habits due to elevated psychological distress during the COVID-19 lockdown containment measures. A multidisciplinary action should be undertaken in order to plan appropriate responses to the current crisis caused by the lockdown for the COVID-19 outbreak.

Knowledge, Concerns, and Behaviors of Individuals During the First Week of the Coronavirus Disease 2019 Pandemic in Italy.

Importance: At the beginning of a public health crisis, such as the coronavirus disease 2019 (COVID-19) pandemic, it is important to collect information about people's knowledge, worries, and behaviors to examine their influence on quality of life and to understand individual characteristics associated with these reactions. Such information could help to guide health authorities in providing informed interventions and clear communications. Objectives: To document the initial knowledge about COVID-19 and recommended health behaviors; to assess worries (ie, one's perception of the influence of the worries of others on oneself), social appraisal, and preventive behaviors, comparing respondents from areas under different movement restrictions during the first week after the outbreak; and to understand how worries, perceived risk, and preventive behaviors were associated with quality of life and individual characteristics among Italian adults. Design, Setting, and Participants: This convenience sample, nonprobablistic survey study recruited adult participants with a snowballing sampling method in any Italian region during the first week of the COVID-19 outbreak in Italy from February 26, 2020, to March 4, 2020. Data were analyzed from March 5 to 12, 2020. Exposures: Information was collected from citizens living in the quarantine zone (ie, red zone), area with restricted movements (ie, yellow zone), and COVID-19-free regions (ie, green zone). Main Outcomes and Measures: Levels of knowledge on the virus, contagion-related worries, social appraisal, and preventive behaviors were assessed with ratings of quality of life (measured using the Short Form Health Survey). Additionally, some individual characteristics that may be associated with worries and behaviors were assessed, including demographic characteristics, personality traits (measured using Big Five Inventory-10), perceived health control (measured using the internal control measure in the Health Locus of Control scale), optimism (measured using the Revised Life Orientation Test), and the need for cognitive closure (measured using the Need for Closure Scale). Results: A total of 3109 individuals accessed the online questionnaire, and 2886 individuals responded to the questionnaire at least partially (mean [SD] age, 30.7 [13.2] years; 2203 [76.3%] women). Most participants were well informed about the virus characteristics and suggested behaviors, with a mean (SD) score of 77.4% (17.3%) correct answers. Quality of life was similar across the 3 zones (effect size = 0.02), but mental health was negatively associated with contagion-related worries (ß = -0.066), social appraisal (ß = -0.221), and preventive behaviors (ß = -0.066) in the yellow zone (R2 = 0.108). Social appraisal was also associated with reduced psychological well-being in the green zone (ß = -0.205; R2 = 0.121). In the yellow zone, higher worries were negatively correlated with emotional stability (ß = -0.165; R2 = 0.047). Emotional stability was also negatively associated with perceived susceptibility in the yellow (ß = -0.108; R2 = 0.040) and green (ß = -0.170; R2 = 0.087) zones. Preventative behaviors and social appraisal were also associated with the need for cognitive closure in both yellow (preventive behavior: ß = 0.110; R2 = 0.023; social appraisal ß = 0.115; R2 = 0.104) and green (preventive behavior: ß = 0.174; R2 = 0.022; social appraisal: 0.261; R2 = 0.137) zones. Conclusions and Relevance: These findings suggest that during the first week of the COVID-19 outbreak in Italy, people were well informed and had a relatively stable level of worries. Quality of life did not vary across the areas, although mental well-being was challenged by the social appraisal and worries related to the contagion. Increased scores for worries and concerns were associated with more cognitive rigidity and emotional instability.