{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T08:52:09Z","timestamp":1781167929217,"version":"3.54.1"},"reference-count":50,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The COVID-19 global pandemic still represents a major threat with detrimental health consequences. Analyzing the psychological outcomes, COVID-19 could be interpreted as a collective traumatic event that can generate symptoms related to post-traumatic stress disorder (PTSD). Considering this, the purpose of this paper is twofold: first, to investigate the relationship between intrusive thoughts and fear related to the COVID-19 pandemic and between intrusive thoughts and mental health; second, to test the mediating role of hyperarousal and avoidance in these two relationships. In order to reach these aims, the present study investigated these relationships and tested a mediation model in two cross-sectional studies in Italy. Altogether, 627 individuals and 495 workers completed an online survey for study 1 and study 2, respectively. Mediation analyses were performed via the SPSS macro PROCESS; the significance of total, direct, and indirect effect was tested via bootstrapping. The results showed that within the PTSD framework, hyperarousal compared with avoidance mediated the relationship between intrusion and the analyzed outcomes. In conclusion, the present study provided empirical evidence for the influence of hyperarousal on individual consequences such as fear of COVID-19 and mental health. Research, as well as theoretical and practical implications, are discussed.<\/jats:p>","DOI":"10.3390\/ijerph18147422","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T21:56:37Z","timestamp":1626126997000},"page":"7422","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":69,"title":["COVID-19 Pandemic as a Traumatic Event and Its Associations with Fear and Mental Health: A Cognitive-Activation Approach"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8663-8889","authenticated-orcid":false,"given":"Martin","family":"Sanchez-Gomez","sequence":"first","affiliation":[{"name":"Department of Evolutionary, Educational, Social Psychology and Methodology, Universitat Jaume I, 12071 Castell\u00f3n de la Plana, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Giorgi","sequence":"additional","affiliation":[{"name":"Department of Human Science, European University of Rome, 00163 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia Libera","family":"Finstad","sequence":"additional","affiliation":[{"name":"Business@Health Laboratory, European University of Rome, 00163 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Urbini","sequence":"additional","affiliation":[{"name":"Department of Human Science, European University of Rome, 00163 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1496-2054","authenticated-orcid":false,"given":"Giulia","family":"Foti","sequence":"additional","affiliation":[{"name":"Business@Health Laboratory, European University of Rome, 00163 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0579-1035","authenticated-orcid":false,"given":"Nicola","family":"Mucci","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, Largo Piero Palagi 1, 50139 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8858-5423","authenticated-orcid":false,"given":"Salvatore","family":"Zaffina","sequence":"additional","affiliation":[{"name":"Occupational Health Unit, Medical Direction, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3928-9799","authenticated-orcid":false,"given":"Jos\u00e9 M.","family":"Le\u00f3n-Perez","sequence":"additional","affiliation":[{"name":"Department of Social Psychology, Universidad de Sevilla, 41004 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1177\/0020764020915212","article-title":"The Outbreak of COVID-19 Coronavirus and Its Impact on Global Mental Health","volume":"66","author":"Torales","year":"2020","journal-title":"Int. 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