To our knowledge, this is the first work providing a description of the psychological response to COVID-19 in terms of emotions, rather than clinical symptoms, using the SPAN scale. In this regard, it is worthy to note that the online survey investigated the emotional reaction to the limitation induced by the pandemic state. Among the emotional sequelae of the pandemic considered as outcomes indicators, the most frequent combination was nervousness and anger (23%). Seen in light of the model proposed by Henry Selye , these may be understood as part of the acute phase of a triphasic physiological stress reaction: the alarm reaction (i.e. sympathetic activation of the nervous system and physiological arousal increase) is followed by a resistance phase and by the possible exhaustion stage, where the body and the mind health may be threatened and where the clinical relevance can be reached . Nervousness and anger may be seen as the physiological strain of the individual to cope with the first national lockdown, as these emotions are coherent with the alarm reaction, with no necessary clinical relevance: this could explain why in several studies the psychological impact of the pandemic has been indicated as moderate [6, 7]. Moreover, alongside with the extension of the lockdown (October—December 2020/February—April 2021) manifestations of exhaustion are expected to be found, together with emotions such as numbness and sadness. This reflects the distribution of emotional reactions that have been found in our sample, the majority of which (92%) was interviewed before the 3rd of May 2020: indeed, the 15,6% of the subjects only experienced numbness, compared to the 48.9% and the 41.3% that experienced respectively nervousness and anger. However, this needs more longitudinal studies to be confirmed . Furthermore, to better characterize the emotional response to COVID-19, the analysis highlighted potential factors associated with the occurrence of negative feelings during the lockdown period, which are going to be discussed in the following section.
The association between female gender and greater level of psychological distress has been reported in several previous studies on the psychological impact of the COVID-19 pandemic . Furthermore, epidemiological studies reported higher prevalence of depression, anxiety and PTSD in women . This may be consistent with the Italian context, where women are burdened by their double role of housekeepers, family caregivers and workers . Higher levels of nervousness, anger and physiological arousal, may reflect the combination of the pandemic stressor together with the one coming from the social platform, which demands women to be even more resilient in different settings, such as the family and the workplace environment.
Our results suggest that older people (> 70 years) tend to be less nervous, angry and numb and to experience less physiological symptoms, compared to younger people (16–29 years). The elderly seems more resilient than younger people, confirming evidence from other studies [21, 22]. In contrast, adolescents and young adults reported higher levels of nervousness, anger and, to a lesser extent, of numbness. This may fit with the evidence that the psychological impact of COVID 19 on the younger people resulted in significant emotional changes .
An updated definition of adolescence has been stretched ahead over time : the new adolescence is considered to go from 10 to 25 years, and this is particularly true in the Italian context, where the transition from school to an independent work is slower . Based on this, it may be possible that adolescents and young adults share similar psychological mechanisms in reaction to the actual pandemic, which are different from those displayed by older people. In particular, a lower risk perception and a greater rules’ aversion, features of the adolescent brain , together with a low mortality rate of COVID-19 in young people , may make them less compliant with the restrictions. Moreover, nervousness and anger may be worsened by the limitation of freedom and social life that those rules entail, including the school closures . This may be because the ability to regulate their own emotions is, in younger people, much more dependent on the developmental environment than that in adulthood . For these reasons, this seems a critical population to support, throughout the unfolding of the COVID-19 pandemic.
Being single or separated
This is a previously reported risk factor in developing psychological distress and depressive symptoms . Nevertheless, it seems possible not to consider singlehood as a risk factor per se, but in the context of an imposed social distancing, where any kind of relationship or human contact is forbidden, excluding those with relatives or partners. In this regard, there is a lack of data about the effect of social distancing on mental health outcomes, even if it may increase fear, anxiety symptoms, loneliness, and depressed mood .
Increasing the intake of alcohol
The consumption of alcohol has been shown to rise during the pandemic , since this may represent one of the possible coping strategies to deal with negative emotions . Indeed, both in clinical and general samples, it has been shown that the implementation of avoidant coping strategies is positively correlated with drinking behaviour and may account for its maladaptive use . Finally, previous studies  showed the association between a variety of psychiatric disorders and the alcohol abuse level, where anger and nervousness could be more implicated.
Reducing the physical activity
The current pandemic greatly limited the possibility to practice physical activity, which has several benefits on mental health outcomes, both at cognitive and emotional level . Indeed, it has been reported that physical activity can improve psychological well-being , even during the COVID-19 pandemic, where exercising softened the virus' impact on anxiety and depression levels . Therefore, it may not be surprising that our results associated a decreased physical activity with increased negative emotions, such as anger, nervousness and increased physiological arousal.
Experiencing sleep disturbances
Sleep patterns have been disrupted by the pandemic, given that this issue globally affected the 40% of people from the general and the healthcare population . To preserve a good sleep quality during COVID-19 pandemic is relevant, given the multiple levels that its deprivation can affect: indeed, it has been reported that the lack of sleep can impact the cognitive performances, the circadian rhythms, the immune activity, the emotional regulation and the sympathetic nervous system activity, leading to an increased stress responsivity . Interestingly, in our study restless sleep was the variable most strongly associated with all emotional domains, suggesting the same pivotal role of sleep in regulating affective expression and well-being.
Among housing conditions, the presence of an external space is slightly associated with less numbness. This is consistent with previous reported data from the Italian context , where a strong association between depressive symptoms and poor housing has been shown. In particular, it seems that safe, open and natural housing spaces can strongly impact the quarantined quality and mental health, reducing the sensation of being trapped , even if further studies are needed to draw firmer conclusions.
Limitations and strengths
This study has few limitations. Firstly, as a snowball sampling was used, the sample should not be considered representative of the Italian general population.
A selection bias might have occurred, especially in the older population, composed of highly educated individuals. This potential bias could have influenced one of the findings of the survey, namely a better condition of older people compared to younger ones.
Due to the cross-sectional design of the study, it was not possible to measure a change over time of lifestyle habits. Only self-reported information about a general increase or decrease in habits, as perceived by the respondents, was available.
Questions concerning mental well-being and sleeping disorders refer to what happened in the 14 days before the interview. Therefore, we can only explore the recent mental health status without knowing whether it has improved or worsened compared to a baseline.
Lastly, the four domains of the SPAN questionnaire were used at individual level to evaluate single emotions, although the questionnaire was built to screen for PTSD symptoms using its total score. Future studies should also consider evaluating the difficulties in emotional regulation.
The major strength of this work is its rapid implementation and the involvement of a large sample of citizens, allowing to gain, in a period of emergency, valuable information for identifying vulnerable population subgroups.