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Citation: Martínez-Vélez, N.A.;
Arroyo-Belmonte, M.; Tiburcio, M.;
Natera-Rey, G.; Fernández-Torres, M.;
Sánchez-Hernández, G.Y. Psycho-
Emotional Factors Associated with
Depressive Symptoms during
Lockdown Due to the COVID-19
Pandemic in the Mexican Population.
Int. J. Environ. Res. Public Health 2023,
20, 4331. https://doi.org/10.3390/
ijerph20054331
Academic Editor: Jie Zhang
Received: 1 February 2023
Revised: 23 February 2023
Accepted: 24 February 2023
Published: 28 February 2023
Copyright: © 2023 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/).
International Journal of
Environmental Research
and Public Health
Article
Psycho-Emotional Factors Associated with Depressive
Symptoms during Lockdown Due to the COVID-19
Pandemic in the Mexican Population
Nora A. Martínez-Vélez, Miriam Arroyo-Belmonte, Marcela Tiburcio *, Guillermina Natera-Rey, Morise Fernández-Torres
and Graciela Y. Sánchez-Hernández
Department of Social Sciences in Health, Direction of Epidemiological and Psychosocial Research,
Ramón de la Fuente Muñiz National Institute of Psychiatry, Calzada Mexico-Xochimilco 101,
San Lorenzo Huipulco, Tlalpan, Mexico City 14370, Mexico
*Correspondence: tibsam@imp.edu.mx; Tel.: +52-55-4160-5162
Abstract:
The COVID-19 pandemic has had a significant impact on mental health, leading to the
increase of depressive symptoms. Identifying these symptoms and the factors associated with them
in women and men will allow us to understand possible mechanisms of action and develop more
specific interventions. An online survey was conducted from 1 May to 30 June 2020 using snowball
sampling; the final sample comprised 4122 adult inhabitants of Mexico; 35% of the total sample
displayed moderate-to-severe depressive symptoms, with a greater proportion of depression being
among female respondents. A logistic regression analysis revealed that individuals under 30 years of
age, those with high levels of stress due to social distancing, those with negative emotions, and those
who reported a significant impact of the pandemic on their lives have a higher risk of depression.
Women with a history of mental health treatment and men with a history of chronic disease were
also more likely to experience depressive symptoms. Social environment and sex are factors that
intervene in the development of depressive symptoms, meaning that appropriate early identification
and intervention models should be designed for the care of men and women in highly disruptive
situations such as the recent pandemic.
Keywords: mental health; depressive symptomatology; COVID-19
1. Introduction
The public health emergency caused by COVID-19 began in December 2019, with the
first cases in Mexico being identified in February 2020 and the declaration of a national
emergency in the country at the end of March 2020 [
1
]. This emergency posed complex
challenges for the general population as, in addition to the obvious consequences for
physical health, it affected the mental health of men and women [
2
]. Much of the literature
published to date has identified an increase in moderate or severe symptoms of acute
stress, anxiety, and depression [
3
–
9
]. Since the start of the pandemic, there has been a
worldwide increase of 27.6% in depressive disorders, with women and young people being
the most affected [
10
]. Mexico has been no exception: an online survey of medical students
conducted from April to December 2020 found that the prevalence of depressive symptoms
increased during that period from 19.84% to 40.8% [11].
Few studies, however, have analyzed the factors behind this increase. Stress is well-
known as a trigger of depressive reactions, fear, and anxiety [
12
–
16
]. Stressors related to
previous natural disasters and accidents have been linked to declines in mental health not
just during these events, but for many months or years after the events [17,18].
The stress generation model of depression (SGMD) [
19
,
20
] has substantially con-
tributed to an advanced understanding of the relationship between stress and depression
and of the factors and mechanisms involved in its persistence and recurrence; it allows us
Int. J. Environ. Res. Public Health 2023,20, 4331. https://doi.org/10.3390/ijerph20054331 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2023,20, 4331 2 of 10
to understand that not all domains of stressful life events have an equal effect on people’s
health. This model differentiates the impact of factors associated with the discord in peo-
ple’s interpersonal relationships and the factors of their context (such as financial stress,
academic or work difficulties, and poor health) in the shaping of depression [
12
,
19
,
20
].
The COVID-19 pandemic affected interpersonal relationships through restrictions on so-
cial interactions [
21
], and it has also generated contextual changes such as disruptions in
employment, personal finances, and work–life balance [22,23].
However, we do not know if these factors have affected women and men equally or if
they have had a differentiated impact on this increase in depression. Studies carried out
at the start of the pandemic have found that being female, younger (particularly under
35 years of age), and having less education or financial resources were variables that were
associated with the presence of depressive symptoms [
9
,
16
,
24
]. Other studies, however,
suggest that various factors have been associated with a higher risk of depression during
the COVID-19 pandemic. Early in the pandemic, pre-existing mental health conditions,
living alone, and marital status were associated with elevated levels of anxiety and/or de-
pression [
25
]. Physical health conditions, being in close contact with people with
COVID-19
,
mental comorbidity, coping styles, stigmas, psychosocial support, personal protection mea-
sures, risk of contracting COVID-19, and concerns that a family member would be infected
were also associated with depression [2,26].
In addition to these contextual stress factors, psycho-emotional factors also play a
fundamental role in the configuration of depressive symptomatology. A pandemic triggers
an emotional response [
27
] that can range from risk denial to high levels of fear and
anxiety [
28
]. Some studies have suggested that women tend to be more worried, anxious,
scared, sad, and angry than men [
29
,
30
]. The SGMD has also recognized the important
role of emotion as an associated factor, which is usually conceptualized in broad categories
such as negative versus positive emotions [
31
]. For example, it has been observed that
positive affect may facilitate resilience in the presence of stressors and reduce vulnerability
to mental health disorders [32].
Although there is evidence of differences between women and men in the stress and
worry experienced during the pandemic, the contextual and psycho-emotional correlates
that imply a greater risk of developing depressive symptoms have not been accurately
identified. The purpose of this article, therefore, is to estimate the prevalence of depressive
symptoms and to identify the influence of psycho-emotional and contextual stress factors
associated with the COVID-19 pandemic on depressive symptoms in men and women in
the early months of the pandemic lockdown. We expected to find similar results to those
reported in previous research conducted, where the impact on women’s mental health is
more severe than on men.
2. Materials and Methods
This was an exploratory descriptive study, and data was collected using an online
survey; the main objective of the study was to explore substance use and the presence of
mental health problems during the lockdown due to the COVID-19 pandemic.
The online survey was conducted using Google Forms in May and June of 2020, the pe-
riod in which Mexico experienced the strictest lockdown. The link to the questionnaire was
published on the official social media accounts (Facebook, (Zuckerberg, Saverin, McCollum,
Moskovitz & Hughes, 2004, Cambridge, MA, USA), Twitter, (Dorsey, Williams, Glass &
Stone, 2006, San Francisco, CA, USA) and WhatsApp (Acton, Koum, WhatsApp LLC, Menlo
Park, CA, USA; Meta Platforms, Inc. version 2.21.15.20, 2009, Cambridge, MA, USA)) of the
Ramón de la Fuente Muñiz National Institute of Psychiatry. A total of 4122 individuals were
surveyed. All of them were aged 18 years or over, were residents of Mexico, and provided
consent for their voluntary participation [
33
]. The questionnaire comprised 13 sections;
however, we have only reported on the following:
Ten questions about sex, age, educational attainment, marital status, occupation, state
of origin, income, and family characteristics.
Int. J. Environ. Res. Public Health 2023,20, 4331 3 of 10
Adversity and Stress Scale: Eleven questions formulated for this study were used to
measure the stress level caused by the pandemic in different aspects of life during the
previous month. The questions were divided into two groups: (a) relational stress, derived
from the effects on social interactions at school or work or on the management of free
time (six items); and (b) contextual stress, associated with changes in a person’s social and
economic status (five items). There were five response options on a Likert scale ranging
from 0 (“not at all or only slightly stressful”) to 4 (“very stressful”). The evaluation of
the scale’s psychometric characteristics yielded a reliability coefficient of 0.86 for this
sample [34].
Patient Health Questionnaire-2 (PHQ-2): This questionnaire included the first two
questions from the PHQ-9, which identified depressive symptomatology in the previous
two weeks. There were four response options ranging from 0 (“never”) to 3 (“almost
every day”) with a maximum possible score of 6 [
35
]. In Mexico, the discriminating power
of this questionnaire has been evaluated with indigenous women, and the best cutoff
point found was 3, with a sensitivity of 80% and a specificity of 86.8% [
36
]. The reliability
coefficient for this sample was 0.78. In the meta-analysis by Levis et al. [
37
], the cut-off
point of
≥
3 has a 72% sensitivity and 85% specificity independent of the respondent’s sex.
Perceived threat and experiences with coronavirus: This was a short version of three scales
developed by Conway, Woodard, and Zubrod [
38
] that explore the perceived threat of the
coronavirus (three items,
α
= 0.89: “Thinking about the coronavirus [COVID-19] makes me
feel threatened”, “I am afraid of the coronavirus [COVID-19]”, and “I am stressed around
other people because I worry I’ll catch the coronavirus [COVID-19]”), the impact of the
coronavirus (six items,
α
= 0.84: “The coronavirus [COVID-19] has impacted me negatively
from a financial point of view”, “I have lost job-related income due to the coronavirus
[COVID-19]”, “I have had a hard time getting needed resources (food, toilet paper) due
to the coronavirus [COVID-19]”, “It has been difficult for me to get the things I need due
to the coronavirus [COVID-19]”, “I have become depressed because of the coronavirus
[COVID-19]”, and “the coronavirus (COVID-19) outbreak has impacted my psychological
health negatively”), and experiences with coronavirus (seven items,
α
= 0.71: “I have been
diagnosed with the coronavirus [COVID-19]”, “I have had coronavirus-like symptoms
at some point in the past two months”, “I have been sick from something other than the
coronavirus in the past two months”, “I have been in close proximity with someone who
has been diagnosed with coronavirus [COVID-19]”, “I have been in close proximity with
someone who has had coronavirus-like symptoms in the last two months”, “I watch a lot of
news about the coronavirus [COVID-19]”, and “I spend a huge percentage of my time trying
to find updates online or on TV about coronavirus [COVID-19]”). The scales, translated
into Spanish for this study, contain seven Likert responses ranging from 1 (“not true of me
at all”) to 7 (“very true of me”) [33].
Emotional state: This questionnaire was created for the study; it is a list of 12 feelings,
consisting of six positive (happiness, hope, pleasantness, joy, relaxation, tranquility) and
six negative (boredom, stress, fear, vulnerability, worry, despair) emotions that could be
experienced during the lockdown.
Descriptive statistics were used to determine the sociodemographic characteristics
of the respondents. The mean score and dimensions of the scales and the prevalence of
depressive symptomatology (PHQ-2 score
≥
3) were obtained. X
2
and Student’s t-tests
were performed to evaluate the differences by sex. The effect size was measured with
Cramer’s V coefficient for X
2
tests and Cohen’s d for t-tests. Binomial logistic regression
models were used to identify the factors associated with depressive symptomatology in
men and women. Th adjusted odds ratios (OR) are reported with 95% confidence intervals
(CI). The Hosmer–Lemeshow test was used to assess the fit of the models. All statistical
analyses were performed using the Statistical Package for the Social Sciences (SPSS) for
Windows (version 25.0, IBM Corp., Armonk, NY, USA).
Int. J. Environ. Res. Public Health 2023,20, 4331 4 of 10
3. Results
3.1. Respondent Characteristics
A total of 4122 responses were obtained. Only 28.2% of the respondents were men;
the majority of respondents were aged 21–40 years (55.9%), were unpartnered (57.1%), had
completed undergraduate and postgraduate studies (77.2%), and were employed (69.1%)
(for more details about the survey, see Martínez-Vélez et al. [33]).
As can be seen in Table 1, significant differences were found between men and women
in the psychosocial factors associated with the pandemic. More women than men reported
having previously been in treatment for mental health (29.9% vs. 21.9%) together with
a higher percentage of depressive symptoms (38.2% vs. 28.1%) and higher stress scores
in interpersonal interactions. Likewise, women reported experiencing negative feelings
more often than men and felt more threatened from the coronavirus. Conversely, men
reported a greater number of previous chronic diseases than women (34.7% vs. 22.1%) and
higher scores on the context-related stress (family economy, family health, socio-economic
status); men also reported experiencing more positive feelings with statistically significant
differences in relation to women.
Table 1. Percentage distribution of the psychosocial factors associated with the pandemic by sex.
Men Women Total
(n = 1160) (n = 2962) (n = 4122)
f%f%f%X2/df p V *
Previous chronic illness
No 757 65.3 2051 69.2 2808 68.1 6.096/1 0.014 0.038
Yes 403 34.7 911 30.8 1314 31.9
Tx mental health in the past 12 months
No 906 78.1 2076 70.1 2982 72.3 26.768/1 0.000 0.081
Yes 254 21.9 886 29.9 1140 27.7
Depressive symptomatology
PHQ2 ≤2 834 71.9 1831 61.8 2665 64.7 37.062/1 0.000 0.095
PHQ2 ≥3 326 28.1 1131 38.2 1457 35.3
Mean SD Mean SD Mean SD t/df p d **
Relational stress 1.08 0.90 1.30 0.92 1.24 0.92 −6.95/4120 0.000 0.245
Contextual stress 1.44 1.02 1.73 1.04 1.63 1.05 −8.16/4120 0.000 0.285
Positive emotions during lockdown 17.52 5.58 16.92 5.27 17.08 5.36 3.15/4120 0.001 −0.107
Negative emotions during lockdown 16.77 6.46 19.58 6.30 18.79 6.47 −12.79/4120 0.000 0.435
Impact of coronavirus 15.97 8.68 16.22 8.65 16.15 8.66 −0.84/4120 0.401 0.029
Experiences of coronavirus 14.97 7.35 14.75 7.22 14.81 7.25 0.87/4120 0.386 −0.029
Threat of coronavirus 8.63 5.11 9.97 5.61 9.59 5.50 −7.32/4120 0.000 0.261
* Cramer’s V; ** Cohen’s d.
3.2. Depressive Symptoms
The respondents with depressive symptoms were mostly women, aged 21–30 years,
single, and with bachelor’s degrees. People who reported having been in treatment for
a mental health problem in the previous 12 months showed the highest percentages of
depressive symptoms, and this difference was statically significant; however, the effect size
of this difference was low. On the other hand, the lowest scores of depressive symptoms
were reported among the group of respondents aged 31–40 years. The highest levels of
stress, negative emotions or feelings, impact of coronavirus, experiences with the virus, and
feeling threatened by COVID-19 were reported by people with three or more symptoms of
depression (Table 2).
Int. J. Environ. Res. Public Health 2023,20, 4331 5 of 10
Table 2.
Percentage distribution of the demographic data and psychosocial factors associated with
the pandemic due to depressive symptomatology.
Without Depressive
Symptomatology
(PHQ2 ≤2)
With Depressive
Symptomatology
(PHQ2 ≥3)
(n = 2665) (n = 1457)
f%f%X2/df p V *
Sex
Male 834 31.3 326 22.4 37.062/1 0.000 0.095
Female 1831 68.7 1131 77.6
Age
18–20 years 143 5.4 180 12.4 239.444/4 0.000 0.241
21–30 years 609 22.9 549 37.7
31–40 years 765 28.7 380 26.1
41–50 years 600 22.5 218 15.0
51 years or over 548 20.6 130 8.9
Marital Status
Single 1102 41.4 828 56.8 92.644/3 0.000 0.150
Married/partnered 1274 47.8 496 34.0
Divorced/separated 252 9.5 118 8.1
Widowed 37 1.4 15 1.0
Education
Elementary/Jr. High 75 2.8 49 3.4 26.799/3 0.000 0.117
High School 450 16.9 367 25.2
Bachelor’s Degree 1413 53.0 756 51.9
Graduate Degree 727 27.3 285 19.6
Occupation
Homemaker 129 4.8 75 5.1 175.391/5 0.000 0.206
Unemployed b/l 81 3.0 89 6.1
Unemployed s/l 105 3.9 97 6.7
Employed 1608 60.3 639 43.9
Student 332 12.5 366 25.1
Self-employed 410 15.4 191 13.1
Previous chronic illness
No 1819 68.3 989 67.9 0.061/1 0.807 0.004
Yes 846 31.7 468 32.1
Mental health Tx in the past 12 months
No 2103 78.9 879 60.3 162.575/1 0.000 0.199
Yes 562 21.1 578 39.7
Mean SD Mean SD t/df p d **
Pandemic-related stress
Relational stress 0.89 0.74 1.87 0.88 −37.826/4120 0.000 1.323
Contextual stress 1.32 0.92 2.24 1.00 −29.534/4120 0.000 0.990
Positive emotions during lockdown 18.38 5.23 14.72 4.76 22.143/4120 0.000 −0.699
Negative emotions during lockdown 16.38 5.78 23.21 5.24 −37.462/4120 0.000 1.181
Impact of coronavirus 13.73 7.45 20.57 8.97 −26.149/4120 0.000 0.980
Experiences of coronavirus 13.54 6.54 17.13 7.90 −15.590/4120 0.000 0.547
Threat of coronavirus 8.47 4.99 11.65 5.80 −18.434/4120 0.000 0.636
* Cramer´sV; ** Cohen’s d.
3.3. Identification of Factors Associated with Depressive Symptoms in Women and Men
The factors associated with depressive symptoms during the COVID-19 lockdown are
shown in Table 3. The logistic regression model for men showed that those aged 18–20 years
(OR = 2.74, 95% CI [1.33, 5.64]), and those aged 21–30 years (OR = 1.7, 95% CI [1.03, 9.96])
were more likely to present with depressive symptoms than those aged 51 years or over.
Those who had a previous history of chronic disease were more likely to have symptoms
(OR = 0.69, 95% CI [0.47, 1.48]) than those who did not. Furthermore, those who reported
more stress associated with interpersonal relationships (OR = 1.8, 95% CI [1.44, 2.42]), more
negative emotions (OR = 1.1, 95% CI [1.13, 1.22]), those experiencing a greater impact of
COVID-19 (OR = 1.0, 95% CI [1.01, 1.05]), those with a greater degree of experience of
the pandemic (OR = 1.0, 95% CI [1.01, 1.05]), and those with a greater perceived threat
from COVID-19 (OR = 0.929, 95% CI [0.981–0.969]) were more likely to present depressive
symptoms than those who reported lower levels of these factors.
Int. J. Environ. Res. Public Health 2023,20, 4331 6 of 10
Table 3. Factors associated with the depressive symptomatology during lockdown by sex.
Risk of Depressive Symptomatology
Men * Women **
(n = 1160) (n = 2962)
OR pOR p
Social vulnerability
Age
51 years or over 1 - 1
18–20 years 2.74 0.01 4.62 0.00
21–30 years 1.72 0.05 1.90 0.00
31–40 years 0.96 0.89 1.37 0.07
41–50 years 0.82 0.52 1.12 0.52
Psychobiological vulnerability
Previous chronic illness
No 1 - 1 -
Yes 0.63 0.01 0.91 0.37
Tx mental health disorder in the past 12 months
No 1 - 1 -
Yes 0.69 0.06 0.77 0.01
Impact of COVID pandemic
Pandemic-related stress
Relational stress 1.87 0.00 1.64 0.00
Contextual stress 0.95 0.657 1.10 0.18
Positive emotions during lockdown 0.94 0.00 0.87 0.00
Negative emotions during lockdown 1.17 0.00 1.15 0.00
Impact of coronavirus 1.04 0.00 1.03 0.00
Experiences due to coronavirus 1.03 0.02 1.00 0.68
Threat of coronavirus 0.93 0.00 0.98 0.08
* Logistic regression model in men (
χ2
= 460.26, gl = 13, p< 0.001); Hosmer–Lemeshow test (
χ2
= 9.61, gl = 8,
p= 0.294). The model explained between 33% Cox & Snell and 47% Negelkerke of the variance. The total correct
prediction was 81%, and it included 57% of those who had depressive symptoms and 91% of those who did not.
** Logistic regression model in women (
χ2
= 1296.24, gl = 13, p< 0.001); Hosmer–Lemeshow test (
χ2
= 21.53, gl = 8,
p= 0.06). The model explained between 35% Cox & Snell and 48% Negelkerke of the variance. The total correct
prediction was 80%, and it included 70% of those who had depressive symptoms and 86% of those who did not.
Younger women were also more likely to present depressive symptoms than women
over 51 years old. Having been in mental health treatment in the past 12 months increased
the risk of presenting depressive symptoms (OR = 0.77, 95% CI [0.63, 0.95]). Those who
reported more stress associated with interpersonal relationships (OR = 1.6, 95% CI [1.40, 1.89]),
more negative emotions (OR = 1.1, 95% CI [1.12, 1.17]), and those with a greater impact
of the coronavirus (OR = 1.0, 95% CI [1.02, 1.05]) were more likely to present depressive
symptoms than those who reported lower levels of these factors.
4. Discussion
This study estimated the prevalence of depressive symptoms and their contextual and
psycho-emotional correlates among Mexican women and men during the early months
of the COVID-19 pandemic lockdown. It was found that 38% of women and 28% of men
presented depressive symptoms. The prevalence of these symptoms was much higher
than that reported in previous studies in Mexico, which has ranged between 12% and
25% depending on the study population [
36
,
39
]; furthermore, it was much higher than the
prevalence of major depressive disorder in Mexico, which is estimated to be present in
7.2% of the general population [
40
]. A similar prevalence of depressive symptoms has been
identified as a result of the pandemic in countries such as China and Spain with a greater
proportion being found in women than in men [7,8].
Our results suggest that the COVID-19 pandemic has substantially affected the mental
health of men and women in Mexico, and these findings are consistent with previous
Int. J. Environ. Res. Public Health 2023,20, 4331 7 of 10
studies that reported that exposure to public health emergencies, such as in the case of
the Ebola and SARS outbreaks, can cause mental health problems [
41
,
42
]. Global evidence
supports the observation of this upward trend in depression symptoms due to emotional
distress and stressors related to COVID-19, including the disruption of social relationships,
isolation, fears of illness and economic loss, and concern for one’s own health and that
of loved ones, all of which can trigger depression or exacerbate existing symptoms [
21
].
The survey showed high percentages of people who reported that they feared that their
mental health would be affected by COVID-19 (between 87% and 92%). There was also a
high level of negative emotions experienced during lockdown together with significant
stress levels associated with the pandemic.
This high prevalence of stress and negative emotions, especially regarding relation-
ships, was significantly linked to the presence of depressive symptoms for both sexes.
These findings coincide with the stress generation model of depression (SGMD), which
has documented that both interpersonal and non-interpersonal stress are well-established
risk factors for major depressive disorder, with interpersonal stress having the greatest
impact [
12
,
19
,
20
]. It has also been observed that positive emotions significantly reduce
the effects of interpersonal stress on the severity of depressive symptoms, while negative
emotions increase the effects of non-interpersonal stress on their severity [32].
For both men and women, the stressful effect of the COVID-19 pandemic lockdown on
areas of life such as personal relationships and the changes in context or life situations led to
a situation of continuous tension from different sources, including the economic status and
health of the family, which resulted in an increased risk for depressive symptoms [43–45].
While the predictors of depressive symptomatology were similar between men and
women, there were some differences between the two groups. In general, women tend
to experience negative emotions more intensely than men, which can make them more
susceptible to depression. The review study of Bracke et al. [
46
] points to the association
between gender inequality and depression, showing that gender differences in depression
converge in contexts of greater gender equality and increase in contexts of greater inequality.
These effects compound the consequences for the mental health of taking on work and
family functions at different stages of life. The SGMD also allows us to understand how
gender can shape depression. For example, there is evidence that stress linked to interper-
sonal relationships can be greater for women, in part because of the greater emphasis such
relationships have in women’s lives, especially those characterized by caring for others and
emotional closeness [47].
On the other hand, in the case of men, having a pre-existing physical illness and
experiencing direct encounters with COVID-19 (experiences of coronavirus) were more
associated with depressive symptoms than in women. Rutland-Lawes et al. [
48
] also
identified that a long-standing illness, together with other factors such as alcohol use,
living alone/not alone, and employment status were all significant predictors of change
in depression scores in men. In this sense, we can hypothesize that the loss of health
or functionality and the risk of getting sick could be important predictors of depressive
symptoms in men.
The findings of this study allow for a better, timely understanding of the psychological
consequences of contingencies such as the COVID-19 pandemic, which is essential for
several reasons. First, there is a high prevalence of psychological problems among those
directly or indirectly exposed to potentially stressful situations. Such problems can affect
the daily functioning of a substantial number of people and can cause immediate social and
economic consequences, such as the loss of productivity at work and financial difficulties.
Strategies for protecting the psychological health of men and women through mental health
interventions are crucial for preventing or offsetting interruptions in the delivery of health
services during emergencies.
There is an important need for a greater focus on and understanding of the effect of
the environment on depressive disorders in men and women, which is better understood
through solid frameworks and hypothetical constructs such as the SGMD. Empirical find-
Int. J. Environ. Res. Public Health 2023,20, 4331 8 of 10
ings and new perspectives can greatly contribute to our understanding of these phenomena
and also to the construction of interventions promoting mental health that are sensitive to
differences in gender at times of great stress, such as in the recent pandemic.
Limitations. This study has certain limitations. First, its cross-sectional design means
that causality cannot be inferred from the results. Second, since the population was under
lockdown, the data were collected online through convenience sampling, and the results are
therefore not generalizable to the entire population. Third, the answers were self-reported,
which may have led to information biases. Finally, the lack of evidence about the validity of
the PHQ-2 survey for assessing depressive symptoms among Mexican males is a limitation
of our study, although some studies [
37
] do not make distinctions by gender regarding its
sensibility and specificity. Therefore, the results should be taken with caution.
5. Conclusions
The findings of this study provide information on the structure and correlates of stress
associated with the COVID-19 pandemic and their influence on the presence of depressive
symptoms; they add to the knowledge on how socioenvironmental risk influences mental
health [
49
]. The results also shed light on the nature and degree of psychological responses
to the pandemic and have the potential to serve as a basis for the development of health
promotion and prevention strategies which, together with existing efforts, have the potential to
contain the burden of mental illness. The study shows that strategies that promote the mental
health of the population should be encouraged to prepare for this type of contingency.
Author Contributions:
Conceptualization, M.T., G.N.-R., N.A.M.-V., M.A.-B., G.Y.S.-H. and M.F.-T.
formal analysis, M.A.-B. and N.A.M.-V.; investigation, M.T., G.N.-R., N.A.M.-V., M.A.-B., G.Y.S.-H.
and M.F.-T.; data curation, N.A.M.-V. and M.A.-B.; writing—original draft preparation, N.A.M.-V.
and M.A.-B.; writing—review and editing, M.T., N.A.M.-V. and M.A.-B. All authors have read and
agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement:
The research protocol and data collection for this study were
approved by the Ethics Committee of the Ramón de la Fuente Muñiz National Institute of Psychiatry
(Approval No. CEI/C/011/2020).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: Not available.
Acknowledgments:
The authors are grateful to the Ramón de La Fuente Muñiz National Institute of
Psychiatry for all of the facilities provided.
Conflicts of Interest: The authors declare that they have no conflict of interest.
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