Social Inequalities in Mental Health and Self-Perceived Health in the First Wave of COVID-19 Lockdown in Latin America and Spain: Results of an Online Observational Study.

COVID-19 lockdowns greatly affected the mental health of populations and collectives. This study compares the mental health and self-perceived health in five countries of Latin America and Spain, during the first wave of COVID 19 lockdown, according to social axes of inequality. This was a cross-sectional study using an online, self-managed survey in Brazil, Chile, Ecuador, Mexico, Peru, and Spain. Self-perceived health (SPH), anxiety (measured through GAD-7) and depression (measured through PHQ-9) were measured along with lockdown, COVID-19, and social variables. The prevalence of poor SPH, anxiety, and depression was calculated. The analyses were stratified by gender (men = M; women = W) and country. The data from 39,006 people were analyzed (W = 71.9%). There was a higher prevalence of poor SPH and bad mental health in women in all countries studied. Peru had the worst SPH results, while Chile and Ecuador had the worst mental health indicators. Spain had the lowest prevalence of poor SPH and mental health. The prevalence of anxiety and depression decreased as age increased. Unemployment, poor working conditions, inadequate housing, and the highest unpaid workload were associated with worse mental health and poor SPH, especially in women. In future policies, worldwide public measures should consider the great social inequalities in health present between and within countries in order to tackle health emergencies while reducing the health breach between populations.

Self-Reported Anxiety in Spain: A Gendered Approach One Year After the Start of COVID-19 Pandemic.

The COVID-19 pandemic has an impact on mental health. However, there is little evidence on how different axes of social inequity influence mental health from a gender perspective and over time. Our aim is to analyze anxiety according to gender identity and other axes of social inequities (migration status, sexual orientation, age, and employment conditions) one year after the start of the COVID-19 pandemic in Spain. We conducted a cross-sectional study among adults living in Spain with an online survey from April 8 to May 28, 2021. The main variable was anxiety measured by Generalized Anxiety Disorder Scale (GAD-7). Sex-stratified multivariate logistic regression models were constructed to assess the association between axes of inequities and anxiety. Our findings (N = 2,053) suggest that women have greater anxiety risk than men (35.2 vs. 28.2%, respectively). We observe in both genders that there is a clear age gradient, with anxiety decreasing as age increases; and that there is an association between worsening employment status and anxiety risk, although there is a difference between women by education level. Additionally, not having Spanish nationality is also associated with greater anxiety risk in women. In men, identifying as non-heterosexual is associated with a higher risk of anxiety. The axes of inequities have different effects according to gender identity. These differences in anxiety risk by population subgroup must be taken into account in order to sensibly and equitably treat the surge in mental health disorders brought on by the COVID-19 pandemic.

Inequities in the distribution of COVID-19: an adaptation of WHO's conceptual framework.

The COVID-19 pandemic currently affects populations worldwide. Although everyone is susceptible to the virus, there are numerous accounts of the pandemic having a greater impact on lower socioeconomic groups and minorities, which is a ubiquitous phenomenon. It is essential for public health administrations and governments to uncover and understanding these inequities to develop proper intersectoral policies to tackle this crisis. Therefore, developing a conceptual framework on this topic, describing the social mechanisms that explain the unjust distribution of the incidence and mortality of COVID-19, is a key task. The aim of this paper is to adapt the framework on social determinants of health from the World Health Organization to the specifics of COVID-19 pandemic. Thus, it identifies and explains the structural and intermediate determinants involved in this pandemic, and adds some new elements (such as the role of the oppression systems and communication) which may help to understand, and ultimately tackle, social inequities in COVID-19 distribution.

Desigualdades en la distribución de la COVID-19: una adaptación del marco conceptual de la OMS Inequities in the distribution of COVID-19: an adaptation of WHO’s conceptual framework

La pandemia de COVID-19 afecta actualmente a poblaciones de todo el mundo. Aunque todas las personas son susceptibles de contraer la enfermedad, hay numerosos argumentos de que la pandemia tiene un mayor impacto en los grupos socioeconómicos más desfavorecidos y en las minorías, lo que es un fenómeno omnipresente. Es esencial que las Administraciones de salud pública y los gobiernos comprendan las desigualdades para desarrollar políticas intersectoriales adecuadas para hacer frente a esta crisis. Por lo tanto, es clave desarrollar un marco conceptual sobre este tema, que describa los mecanismos sociales que explican la injusta distribución de la incidencia y la mortalidad de la COVID-19. El objetivo de este trabajo es adaptar el marco sobre determinantes sociales de la salud de la Organización Mundial de la Salud a las particularidades de la pandemia de COVID-19, identificar y explicar los determinantes estructurales e intermedios implicados en esta pandemia, así como añadir algunos elementos nuevos (como el papel de los sistemas de opresión y la comunicación) que pueden ayudar a comprender, y en última instancia a abordar, las desigualdades sociales en la distribución de la COVID-19.