ISSN-e: 2683-3360

Artículo Científico

Prevalence and factors associated with anxiety and

depression symptoms in adults from Chihuahua

City, Mexico during COVID-19 pandemic and

lockdown measures

Prevalencia y factores asociados a síntomas de ansiedad y depresión

en adultos de la ciudad de Chihuahua, México durante la pandemia

COVID-19 y las medidas de aislamiento

*Correspondencia: afavila@uach.mx (María Alejandra Favila Pérez)

DOI: https://doi.org/10.54167/tecnociencia.v16i1.889

Recibido: 28 de noviembre de 2021; Aceptado: 29 de marzo de 2022

Publicado por la Universidad Autónoma de Chihuahua, a través de la Dirección de Investigación y Posgrado.

Abstract

Introduction: Worldwide, during the coronavirus disease (COVID-19) pandemic, cases of anxiety and

depression increased among the population. Objective: To determine the prevalence of anxiety and

depression symptoms and identify their associated factors, including lockdown measures in the

population over 18 years from Chihuahua, Chihuahua, Mexico, during the COVID-19 pandemic.

Method: Cross-sectional study, with an online survey and snowball sampling. The GAD-7 (anxiety),

PHQ-9 (depression) and Social Distancing Likert-type scales were used. Frequencies, measures of

central tendency, and dispersion were calculated; bivariate analyses were performed with

prevalence odds ratio as a measure of association between those with the presence and absence of

anxiety and depression symptoms; for the total of the sample and stratifying by sex, calculating the

María Fernanda Guerrero-Lara1, Sandra Alicia Reza-López2, Luis Eduardo Juárez-Nogueira3,

Alva Rocío Castillo-González4, Carlos Arzate-Quintana4, Geovanni Alexis Gómez-Ortega1,

María Isabel Saad-Manzanera1 & María Alejandra Favila-Pérez4*

1 Investigation Department, Autonomous University of Chihuahua. Faculty of Medicine and Biomedical

Sciences. Circuito Universitario Campus II. Chihuahua, Chih., México. C. P. 31109.

2 Embryology Laboratory, Autonomous University of Chihuahua. Faculty of Medicine and Biomedical

Sciences. Circuito Universitario Campus II. Chihuahua, Chih., México. C. P. 31109.

3 Psychiatric Hospital Doctor Ignacio González Estavillo. Av. Zootecnia No. 13201, Col. Zootecnia,

Chihuahua, Chih., México. C.P. 31253.

4 Microbiology and Parasitology Department, Autonomous University of Chihuahua. Faculty of Medicine

and Biomedical Sciences. Circuito Universitario Campus II. Chihuahua, Chih., México. C. P. 31109.

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degree of association between the categorical variables using Fisher's exact test and Chi2, considering

a p<.05. Results: From 377 participants, 46 % had anxiety symptoms and 43 % had depressive

symptoms. Being a woman, single, young (<50 years), student, not exercising, smoking, consuming

alcohol, practicing social distancing measures, a history of a previous mental disorder or mental

health care, were associated with symptoms of anxiety and depression. Discussion and conclusion:

High prevalence of anxiety and depression symptoms were found, justifying a follow-up of the

population's mental health.

Keywords: COVID-19, SARS-CoV-2, mental health, quarantine, social distancing.

Resumen

Introducción: A nivel mundial, durante la pandemia por la enfermedad por coronavirus (COVID-19)

aumentaron los casos de ansiedad y depresión entre la población. Objetivo: Determinar la prevalencia

de síntomas de ansiedad y depresión e identificar sus factores asociados incluyendo las medidas de

aislamiento en población adulta de Chihuahua, Chihuahua, México durante la pandemia COVID-

19. Método: Estudio transversal con encuesta en línea y muestreo en bola de nieve. Se emplearon las

escalas GAD-7 (ansiedad), PHQ-9 (depresión) y de distanciamiento social tipo Likert. Se calcularon

frecuencias, medidas de tendencia central y dispersión; se realizaron análisis bivariados con razón

de momios de prevalencias como medida de asociación entre aquellos con presencia y ausencia de

síntomas de ansiedad y depresión para el total de la muestra y estratificado por sexo, calculando el

grado de asociación entre las variables categóricas mediante la prueba exacta de Fisher y Chi2,

considerando una p<.05. Resultados: De 377 participantes, 46 % presentaron síntomas de ansiedad y

43 % síntomas depresivos. Ser mujer, soltero(a), joven (<50 años), estudiante, no realizar ejercicio, el

tabaquismo, consumo de alcohol, practicar las medidas de distanciamiento social, el antecedente de

un trastorno mental previo y de atención de salud mental, estuvieron asociados con la presencia de

síntomas de ansiedad y/o depresión. Discusión y conclusión: Se encontraron prevalencias elevadas de

síntomas de ansiedad y depresión, justificando un seguimiento de la salud mental de la población.

Palabras clave: COVID-19, SARS-CoV-2, salud mental, cuarentena, distanciamiento social.

1. Introduction

Since SARS-CoV-2 is a highly contagious virus, social distancing and quarantine measures were

adopted; although they have been essential strategies to reduce the infection rate, the World Health

Organization (WHO) recognizes that they may be linked to negative effects on mental health (WHO,

2020).

During the first two weeks of quarantine in Wuhan, China, depression, and anxiety in adults were

reported in 26.47 % and 70.78 % respectively; the prevalence was significantly higher among

quarantined subjects (Tang et al., 2020). Similar results were obtained in adults in Italy (Rossi et al.,

2020), the United States (Marroquín et al., 2020) and Mexico (Galindo-Vázquez et al., 2020):

quarantine and social distancing were independently associated with more severe symptoms of

depression and anxiety, and the prevalence of these symptoms were even higher than in other

pandemics. Contrary to the results in a Mexico City study, where the presence of depressive

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symptoms and general anxiety were associated with non-adherence to public health directives. In

addition, economic difficulties were associated with poor mental health (Flores-Torres et al., 2021).

An interesting scenario that has been described in a Mexican population sample is where those who

had symptoms of depression before social isolation reported the disappearance of depressive

symptoms due to the effect of social isolation. It is worth mentioning that during the lockdown

measures, in this same study, 4.29 % increased their tobacco consumption, and the highest

percentage (18.18 %) of increase in alcohol level consumption was in individuals who drank alcoholic

beverages to the point of losing consciousness before social isolation (Genis-Mendoza et al., 2021).

Furthermore, in other Mexican sample during the period from May to June 2020, reported that,

throughout their lives, 58.8 % of the population had received some type of mental health care, and

the most prevalent pathologies found were depression and anxiety (Rodríguez-Hernández et al.,

2021).

Chihuahua was the first state in Mexico to return to red traffic light (monitoring system for

epidemiological risk of COVID-19) in October 2020, causing stricter implementation of measures to

prevent the transmission of the virus (Gobierno del Estado de Chihuahua, 2020). In addition,

Chihuahua is third place nationwide in depression (Dirección General de Epidemiología de la

Secretaría de Salud [DGE], 2021), and has the highest suicide rate by state (Instituto Nacional de

Estadística y Geografía [INEGI], 2019). Therefore, these COVID-19 preventive measures, in addition

to causing a possible increase in the prevalence of psychiatric disorders such as depression, it could

raise suicide rates in the same way.

This highlights the need to assess mental health in the population. However, to date, there are no

studies (to our knowledge) where the mental health of the general population of Chihuahua has

been investigated, associated with the pandemic, social distancing measures and quarantine.

Therefore, the objective of this study was to determine the prevalence of symptoms of anxiety,

depression and their associated factors in the population over 18 years from Chihuahua, Chihuahua,

Mexico, one year after the implementation of social distancing measures and quarantine for the

COVID-19; which were applied by the federal government of Mexico on March 23, 2020 (Suárez et

al., 2020).

2. Materials and Methods

2.1. Design of the study

An observational study was conducted with a cross-sectional design using an online survey.

2.2. Subjects

People over 18 who could read and write, and those who were residents of the city of Chihuahua

during the COVID-19 pandemic, were included. Those who did not wish to participate were

excluded; and the surveys of those who during or after filling it out decided not to continue

participating or had missing data were eliminated. We had a total of n = 377 participants, however

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because of the web-based design, no response rate could be estimated, as it was not possible to

estimate how many persons were reached. The sampling method used was non probabilistic.

2.3. Procedures

The data was collected with a Google Forms online survey, with snowball sampling from

February 11 to March 11, 2021. The survey was first distributed to college students from the

Autonomous University of Chihuahua via social networks (WhatsApp, Email, Facebook, and

Telegram) and they were encouraged to share it. When accessing the link, informed consent was

included prior to the questionnaire, it indicated the purpose of the research, and assured that the

information to be provided as confidential, anonymous and that the participant could withdraw at

any time. In addition, an email was provided for those who had questions before or after filling in

the survey.

The questionnaire consisted of 39 items divided into six sections: 1. Sociodemographic and general

data (age, sex, marital status, household, employment status, chronic diseases, smoking and alcohol

consumption [these last two factors were also asked to determine whether there was any increase in

the consumption of such substances since the implementation of the COVID-19 restrictive

measures]); 2. Quarantine and social distancing (with quarantine / without quarantine, social

distancing Likert-type scale, isolation time); 3. Mental health (previous mental disorder, previous

mental health care); 4. Scale for symptoms of depressive disorders (PHQ-9); 5. Scale for general

anxiety disorder (GAD-7); and 6. Other factors (social support, use of telecommunications, financial

concerns, frequency of exposure to information about COVID-19, home office and online classes,

physical exercise, loss of a loved one [Appendix 1]). The questionnaire had an average duration of

10 minutes and could be done at any time within the established days. The data was collected

automatically by the same Google Forms online survey collector via Excel Microsoft Office.

2.4. Measurements

The following evaluation tools were used:

a) Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001): an instrument with nine items,

where the response is evaluated on a scale from 0 to 3, being 0 "not at all”, 1 “several days”, 2 “more

than half the days” and 3 “nearly every day”. It evaluates the possible presence of major depressive

disorder and the severity of depression symptoms. They were validated in the Mexican population

(Familiar et al., 2015). Symptom severity classification was used with the values established by the

scale authors, where 0-4 points are minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe and

20-27 severe. In addition, the cut-off point ≥10 was used to consider the presence of depressive

symptoms (Kroenke et al., 2001). In our sample, the Cronbach's alpha was α = 0.89

b) Generalized Anxiety Disorder (GAD-7) (Spitzer et al., 2006): a seven items questionnaire, where

the response is evaluated with the same 0 - 3 scale mentioned above. It assesses the presence of

possible generalized anxiety disorder. Validated in Mexican population (Castro Silva et al., 2016).

Symptom severity classification was used with the values established by the scale authors, where 0-

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4 points are minimal, 5-9 mild, 10-14 moderate and 15-21 severe. In addition, the cut-off point ≥10

was used to consider the presence of anxiety symptoms (Spitzer et al., 2006). In our sample, the

internal consistency was α = 0.91

c) Social Distancing Likert-type scale: the actions evaluated were: 1. Staying at least 1.5 meters away

from other people. 2. Work from home (online classes or home office). 3. Avoid greeting someone by

shaking hands, hugging or kissing. 4. Not attending social gatherings or conglomerate sites. These

measures were assessed on a five point scale, in which 0 means "I do not follow the recommendation

at all", 1 “I follow the recommendation some of the time”, 2 “less than half the time”, 3 “more than

half the time”, 4 “most of the time” and 5, "I follow the recommendation all the time"; to gather

information about how individuals practiced social distancing measures until the moment of the

survey. A cut-off point of ≥14 was used to consider participants who fully complied with the

measures (Galindo-Vázquez et al., 2020), reaching an internal consistency of α = 0.77

d) The participants who were considered in quarantine were those who claimed to remain at

home and avoided social contact, only going out for what was strictly necessary during the pandemic

(for the acquisition of essential supplies, in case of the need for medical care or emergencies); this,

according to the regulations of agreement No. 049/2020 of the official newspaper of the Government

of the State of Chihuahua, March 25, 2020 (Gobierno del Estado de Chihuahua, 2020).

2.5. Statistical analyses

A minimum sample size of 306 participants was calculated, with an expected baseline frequency

of 27.5 % based on the prevalence obtained in previous studies (Galindo-Vázquez et al., 2020), and a

95 % confidence level, using the CDC's STATCALC application, EPI-INFO.

An exploratory analysis was performed; the Kolmogorov-Smirnov goodness-of-fit test was applied

to verify the normal distribution of the variables measured on a ratio scale. Measures of central

tendency and dispersion were obtained for the age. The prevalence of anxiety and depression

symptoms was calculated. Pearson's Chi-square and Fisher's exact test were used to identify the

association between the independent (IV) and dependent variables (DV). The DV was the presence

or absence of symptoms of anxiety and depression; the IV were those in which statistically significant

differences (p < .05) were found: age, sex, marital status, employment status, comorbidities, use of

telecommunications, financial concerns, home office, online classes, physical exercise, social

distancing measures and quarantine. Prevalence Odds Ratio (POR) was calculated for each variable

with a 95 % confidence interval (95 % CI). Additionally, a bivariate analysis stratified by sex was

performed with the same procedure. Finally, Spearman's correlation was used to determine the

linear relationship between anxiety and depression scores. Data was analyzed in SPSS V25.0, with

statistical significance established at p < .05.

2.6 Ethical considerations

The present study was reviewed and approved by the Research Ethics Committee of the Faculty

of Medicine and Biomedical Sciences of the Autonomous University of Chihuahua in February 2021

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(CI-040-20). Informed consent was obtained prior to data collection, where the confidentiality and

anonymity of the information was ensured. The ethical principles for medical research involving

human subjects established in the Declaration of Helsinki were followed (World Medical

Association, 2013).

3. Results and Discussion

A total of 416 individuals participated, of which 39 were excluded. The final sample consisted of

377 participants, of whom 262 were women and 115 men, with an age range of 18 to 83 years (Median

[Me] = 25, Interquartile Range [IQR] = 14). The sociodemographic characteristics are shown in Table

Table 1. Sociodemographic characteristics

from the study population (n = 377)

Tabla 1. Características sociodemográficas de

la población de estudio (n = 377)

Characteristic

n (%)

Age

≤ 22 years

66 (18)

23-25 years

156 (41)

26-30 years

39 (10)

31-49 years

51 (14)

≥ 50 years

65 (17)

Sex

Woman

262 (69)

Men

115 (31)

Marital status

Single

262 (69)

Divorced or separated

16 (4)

Widow

7 (2)

Consensual union

6 (2)

Married

86 (23)

Household

Living alone

21 (6)

Living with someone

356 (94)

Employment status

Student

105 (28)

Health professional

85 (23)

Employee from other areas

139 (37)

Unemployed

17 (5)

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Retired

10 (3)

Pensioner

4 (1)

Housekeeper

17 (5)

Comorbidities

Presence of chronic

diseases

75 (120)

Absence of chronic

diseases

302 (80)

Smokers

52 (14)

Non-smokers

325 (86)

Alcohol consumption

242 (64)

No alcohol consumption

135 (36)

Presence of previous

mental disorder

143 (38)

Absence of previous

mental disorder

234 (62)

Prior mental health care

174 (46)

Absence of prior mental

health care

203 (54)

Depressive and anxiety symptoms prevalence are shown in Figures 1 and 2, respectively.

A prevalence of 12 % (n = 44) of participants with only anxiety symptoms was found, followed by 9

% (n = 35) for those with depressive symptoms only, and a 34 % (n = 128) prevalence for those with

symptoms of anxiety and depression altogether. A strong positive correlation (Spearman’s rho = .77,

p < .001) was identified between the scores of the depression and anxiety scales.

For the female sex (n = 262), a prevalence of 53 % (n = 138) and 48 % (n = 127) was identified for

anxiety (p < .001) and depression symptoms (p .001), respectively; while in men (n = 115) these

prevalences were 30 % (n = 34) and 31 % (n = 36). Furthermore, being a woman was identified as a

factor associated with a higher frequency of both anxiety (POR 2.65 [95 % CI 1.66-4.23] p < .001) and

depression symptoms (POR 2.06 [95 % CI 1.3-3.27] p .001).

Among the 64 % (n = 241) quarantined subjects from the sample, 43 % (n = 104) had anxiety

symptoms and 41 % (n = 98) of depression. On the other hand, of the individuals who frequently

practiced the social distancing measures (73 %, n = 274), 45 % (n = 124) exhibited depressive and

49 % (n = 134) anxiety symptoms. No association was found between the quarantine group and the

presence of symptoms; while those who frequently practiced the social distancing measures were

associated with a higher frequency of anxiety symptoms (POR 1.63 [95 % CI 1.02-2.60] p .03),

compared to those who partially complied them.

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The results of the bivariate analyses illustrating the factors associated with a higher frequency of

anxiety and depression symptoms in our population sample are shown in Table 2. The bivariate

analyses stratified by sex are presented in Table 3.

Absence of

anxiety

symptoms

n= 205 (54 %)

Moderate

n= 106

(28 %)

Severe

n = 66

(18 %)

Figure 2. Prevalence of anxiety symptoms in the ≥18-year-old population of Chihuahua, Chihuahua

during the COVID-19 pandemic.

Figura 2. Prevalencia de síntomas de ansiedad en personas ≥18 años de edad en la ciudad de Chihuahua,

Chihuahua durante la pandemia de COVID-19.

Absence of

depression

symptoms

n= 214 (57 %)

Moderate

n= 64

(17 %)

Moderately

severe

n= 53 (14 %)

Severe

n= 46

(12 %)

Figure 1. Prevalence of depressive symptoms in the ≥ 18-year-old population of Chihuahua, Chihuahua

during the COVID-19 pandemic.

Figura 1. Prevalencia de síntomas depresivos en personas ≥ 18 años de edad en la ciudad de Chihuahua,

Chihuahua durante la pandemia de COVID-19.

ISSN-e: 2683-3360

Table 2. Bivariate analyses of factors associated with symptoms of anxiety and depression in the ≥ 18-year-old population of Chihuahua, Chihuahua

(n = 377).

Tabla 2. Análisis bivariados de factores asociados a síntomas de ansiedad y depresión en la población ≥ 18 años de Chihuahua, Chihuahua (n = 377).

Presence of

anxiety

symptoms

Absence of

anxiety

symptoms

POR (95 % CI)

Presence of

depression

symptoms

Absence

depression

symptoms

POR (95 % CI )

n = 172

(46 %)

n = 205

(54 %)

n = 163

(43 %)

n = 214

(57 %)

Age

≤ 22 years

41 (62 %)

25 (38 %)

7.24 (3.25-16.12)

< .001

43 (65 %)

23 (35 %)

9.17 (4.03-20.89)

< .001

23-25 years

73 (47 %)

83 (53 %)

3.88 (1.92-7.83)

< .001

70 (45 %)

86 (55 %)

3.99 (1.94-8.21)

< .001

26-30 years

18 (46 %)

21 (54 %)

3.78 (1.55-9.20)

0.002

19 (49 %)

20 (51 %)

4.66 (1.89-11.50)

< .001

31-49 years

28 (55 %)

23 (45 %)

5.37 (2.33-12.39)

< .001

20 (39 %)

31 (61 %)

3.16 (1.34-7.47)

0.007

≥ 50 years

12 (18 %)

53 (82 %)

(Ref.)

11 (17 %)

54 (83 %)

(Ref.)

Marital status

Single

130 (50 %)

132 (50 %)

2.04 (1.22-3.40)

0.005

131 (50 %)

3.09 (1.78-5.35)

< .001

Divorced or separated

8 (50 %)

2.07 (0.70-6.09)

0.18

6 (37 %)

10 (63 %)

1.85 (0.60-5.72)

0.27

Widow

2 (29 %)

5 (71 %)

0.82 (0.15-4.53)

2 (29 %)

5 (71 %)

1.23 (0.22-6.85)

Consensual union

4 (67 %)

2 (33 %)

4.14 (0.71-23.99)

0.17

3 (50 %)

3.09 (0.58-16.51)

0.18

Married

28 (33 %)

58 (67 %)

(Ref.)

21 (24 %)

65 (76 %)

(Ref.)

Employment status

Student

55 (52 %)

50 (48 %)

1.67 (0.83 - 3.36)

0.14

59 (56 %)

46 (44 %)

3.84 (1.80 - 8.21)

< .001

Health professional

35 (41 %)

50 (59 %)

1.06 (0.51 - 2.19)

0.85

39 (46 %)

46 (54 %)

2.54 (1.16 - 5.55)

0.017

Employee from other areas

63 (45 %)

76 (55 %)

1.26 (0.64 - 2.46)

0.48

53 (38 %)

86 (62 %)

1.84 (0.88 - 3.86)

0.01

Currently not working*

19 (40 %)

29 (60 %)

(Ref.)

12 (25 %)

36 (75 %)

(Ref.)

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Comorbidities

Presence of chronic diseases

27 (36 %)

48 (64 %)

0.60 (0.36 – 1.02)

0.06

27 (36 %)

48 (64 %)

0.68 (0.40 – 1.15)

0.15

Absence of chronic diseases

145 (48 %)

157 (52 %)

(Ref.)

136 (45 %)

166 (55 %)

(Ref.)

Smokers

29 (56 %)

23 (44 %)

1.60 (0.89-2.89)

0.11

36 (69 %)

16 (31 %)

3.50 (1.86-6.58)

< .001

Non-smokers

143 (44 %)

182 (56 %)

(Ref.)

127 (39 %)

198 (61 %)

(Ref.)

Alcohol consumption

119 (49 %)

123 (51 %)

1.49 (0.97-2.29)

0.06

120 (50 %)

122 (50 %)

2.10 (1.35-3.27)

0.001

No alcohol consumption

53 (39 %)

82 (61 %)

(Ref.)

43 (32 %)

92 (68 %)

(Ref.)

Presence of previous mental

disorder

90 (63 %)

53 (37 %)

3.14 (2.04-4.85)

< .001

88 (62 %)

55 (38 %)

3.39 (2.19-5.23)

< .001

Absence of previous mental

disorder

82 (35 %)

152 (65 %)

(Ref.)

75 (32 %)

159 (68 %)

(Ref.)

Prior mental health care

96 (55 %)

78 (45 %)

2.05 (1.36-3.10)

< .001

99 (57 %)

75 (43 %)

2.86 (1.88-4.37)

< .001

Absence of prior mental

health care

76 (37 %)

127 (63 %)

(Ref.)

64 (32 %)

139 (68 %)

(Ref.)

Use of telecommunications

Always

70 (48 %)

77 (52 %)

0.57 (0.28-1.13)

0.1

63 (43 %)

84 (57 %)

0.57 (0.28-1.12)

0.1

Occasionally

75 (40 %)

111 (60 %)

0.42 (0.21-0.83)

0.01

75 (40 %)

111 (60 %)

0.51 (0.26-0.99)

0.04

Rarely

27 (61 %)

17 (39 %)

(Ref.)

25 (57 %)

19 (43 %)

(Ref.)

Financial concerns

Always

24 (49 %)

25 (51 %)

0.90 (0.47-1.73)

0.76

22 (45 %)

27 (55 %)

0.94 (0.48-1.81)

0.85

Occasionally

77 (40 %)

113 (60 %)

0.64 (0.41-1.00)

0.04

77 (40 %)

113 (60 %)

0.78 (0.50-1.22)

0.29

Rarely

71 (51 %)

67 (49 %)

(Ref.)

64 (46 %)

74 (54 %)

(Ref.)

Home office and online classes

Rarely

27 (31 %)

61 (69 %)

0.44 (0.26-0.75)

0.003

31 (36 %)

56 (64 %)

0.66 (0.40-1.12)

0.12

Occasionally

42 (54 %)

36 (46 %)

1.21 (0.72-2.03)

0.44

36 (46 %)

42 (54 %)

1.03 (0.61-1.74)

0.89

Frequently

103 (27 %)

108 (29 %)

(Ref.)

96 (25 %)

116 (31 %)

(Ref.)

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Physical exercise

Never

62 (54 %)

52 (46 %)

1.90 (1.06-3.37)

0.02

55 (48 %)

59 (52 %)

1.70 (0.77-3.77)

0.18

1 day per week

20 (38 %)

32 (62 %)

0.99 (0.48-2.03)

0.99

21 (40 %)

31 (60 %)

1.24 (0.50-3.04)

0.63

2 - 3 days per week

42 (45 %)

52 (55 %)

1.28 (0.70-2.34)

0.4

43 (46 %)

51 (54 %)

1.54 (0.68-3.48)

0.29

4 - 5 days per week

32 (39 %)

51 (61 %)

(Ref.)

32 (39 %)

51 (61 %)

1.15 (0.50-2.64)

0.74

6 – 7 days per week

16 (47 %)

18 (53 %)

1.41 (0.63-3.17)

0.39

12 (35 %)

22 (65 %)

(Ref.)

Quarantine

Present

104 (43 %)

137 (57 %)

0.75 (0.49-1.15)

0.2

98 (41 %)

143 (59 %)

0.74 (0.49-1.14)

0.18

Absent

68 (50 %)

(Ref.)

65 (48 %)

71 (52 %)

(Ref.)

Social distancing measures

Always complies them

134 (49 %)

140 (51 %)

1.63 (1.02 -2.60)

0.03

124 (45 %)

150 (55 %)

1.35 (0.85-2.15)

0.19

Partially complies them

38 (37 %)

65 (63 %)

(Ref.)

39 (38 %)

64 (62 %)

(Ref.)

POR, prevalence odds ratio; 95 % CI, 95 % confidence interval, * It includes the unemployed, retired, pensioner, and housekeeper categories.

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Table 3. Bivariate analyses of factors associated with depression and anxiety symptoms stratified by sex, in the ≥ 18-year-old population of

Chihuahua, Chihuahua (n = 377).

Tabla 3. Análisis bivariados de factores asociados a síntomas de depresión y ansiedad estratificado por sexo, de la población ≥ 18 años de Chihuahua,

Chihuahua (n = 377).

Women (n = 262)

Men (n = 115)

Depression

symptoms

Anxiety

symptoms POR

(95 % CI )

Depression

symptoms

Anxiety

symptoms POR

(95 % CI )

POR (95 % CI)

POR (95 % CI )

Age

≤ 22 years

14.72 (4.68 - 46.30)

<0.0001

9.08 (3.28 – 25.08)

< 0.0001

4.90 (1.45 – 16.55)

0.008

5.71 (1.34 – 24.33)

0.02

23-25 years

7.32 (2.66 - 20.07)

<0.0001

3.83 (1.66 – 8.80)

0.001

1.01 (0.31 – 3.28)

0.97

2.66 (0.65 – 10.78)

0.21

26-30 years

8.25 (2.46 – 27.63)

0.0003

2.99 (1.03 – 8.65)

0.04

1.75 (0.38 – 7.87)

0.69

5.71 (1.08 – 30.07)

0.07

31-49 years

5.10 (1.64 – 15.84)

0.003

4.16 (1.56 – 11.10)

0.003

1.16 (0.23 – 5.72)

8.0 (1.53 – 41.63)

0.01

≥ 50 years

(Ref.)

Marital status

Single

2.63 (1.40 - 4.94)

0.002

1.92 (1.05 – 3.51)

0.03

5.41 (1.50 – 19.46)

0.004

2.40 (0.82 – 7.01)

0.1

Divorced or separated

1.35 (0.38 – 4.72)

0.63

1.72 (0.51 – 5.79)

0.37

4.33 (0.29 – 63.29)

0.33

2.40 (0.18 – 31.88)

0.47

Widow

0.72 (0.07 – 7.43)

0.49 (0.04 – 5.03)

4.33 (0.29 – 63.29)

0.33

2.40 (0.18 – 31.88)

0.47

Consensual union

2.16 (0.28 – 16.63)

0.59

4.43 (0.43 – 45.31)

0.3

8.66 (0.42 – 177.32)

0.24

4.80 (0.25 – 90.30)

0.35

Married

(Ref.)

Employment status

Student

7.26 (2.89 - 18.22)

<0.0001

3.28 (1.46 – 7.39)

0.003

0.40 (0.06 – 2.49)

0.4

0.24 (0.03 – 1.48)

0.17

Health professional

4.64 (1.87 - 11.51)

0.0006

1.37 (0.62 – 3.04)

0.43

0.14 (0.01 – 1.08)

0.12

0.25 (0.03 – 1.77)

0.19

Employee from other areas

4.06 (1.69 to 9.75)

0.001

2.60 (1.21 – 5.56)

0.01

0.12 (0.01 – 0.76)

0.02

0.13 (0.02 – 0.85)

0.03

Currently not working*

(Ref.)

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Comorbidities

Presence of chronic diseases

0.45 (0.24 - 0.85)

0.01

0.44 (0.24 – 0.83)

0.009

1.86 (0.70 – 4.92)

0.2

1.24 (0.45 – 3.41)

0.67

Absence of chronic diseases

(Ref.)

Smokers

4.32 (1.96 - 9.54)

0.0001

1.52 (0.76 – 3.06)

0.22

2.05 (0.63 – 6.63)

0.22

1.57 (0.47 – 5.20)

0.45

Non-smokers

(Ref.)

Alcohol consumption

2.41 (1.44 – 4.03)

0.0007

1.75 (1.06 – 2.90)

0.02

2.03 (0.78 – 5.25)

0.13

1.45 (0.57 – 3.64)

0.42

No alcohol consumption

(Ref.)

Presence of previous mental

disorder

2.79 (1.68 - 4.61)

<0.0001

2.63 (1.59 – 4.35)

0.0001

4.39 (1.71 – 11.27)

0.001

3.13 (1.23 – 7.97)

0.01

Absence of previous mental

disorder

(Ref.)

Prior mental health care

2.95 (1.78 – 4.90)

<0.0001

2.0 (1.22 – 3.28)

0.005

1.78 (0.76 – 4.19)

0.18

1.11 (0.46 – 2.70)

0.8

Absence of prior mental health

care

(Ref.)

Use of telecommunications

Always

0.42 (0.17 – 1.02)

0.05

0.29 (0.11 – 0.79)

0.01

0.87 (0.25 – 3.03)

0.83

1.46 (0.40 – 5.35)

0.75

Occasionally

0.35 (0.14 – 0.83)

0.01

0.22 (0.08 – 0.58)

0.001

0.91 (0.27 – 3.10)

0.89

0.96 (0.26 – 3.51)

Rarely

(Ref.)

Home office and online classes

Rarely

0.85 (0.47 – 1.56)

0.61

0.44 (0.23 – 0.82)

0.009

0.42 (0.14 – 1.20)

0.1

0.57 (0.19 – 1.66)

0.3

Occasionally

1.65 (0.85 – 3.21)

0.13

1.75 (0.88 – 3.50)

0.1

0.53 (0.20 – 1.41)

0.2

1 (0.39 – 2.57)

0.99

Frequently

(Ref.)

POR, prevalence odds ratio; 95 % CI, 95 % confidence interval, * It includes the unemployed, retired, pensioner, and housekeeper categories.

ISSN-e: 2683-3360

In our sample, 14 % (n = 52) reported being smokers. Since the beginning of the pandemic, 5 % (n =

18) showed a decrease in smoking, 4 % (n = 15) remained the same and in another 5 % (n = 19) is

increased. On the other hand, 64 % (n = 241) of the population claimed themselves to consume

alcohol; of which, since the beginning of the pandemic, 26 % (n = 99) reported a decrease in

consumption, in 23 % (n = 88) it remained the same and in 14 % (n = 54) is increased. In this sample,

no association was found between the increase in these habits and being in quarantine or practicing

social distancing.

Compared with previous studies carried out at the beginning of the quarantine in other states of

Mexico, using the same self-assessment scales, the results of this study show a higher prevalence of

symptoms of depression and anxiety. A study conducted in the State of Mexico in April 2020 during

the COVID-19 pandemic (Toledo-Fernández et al., 2020), reported that 6.7 % and 12.5 % of the sample

met the scores for moderate-severe symptoms of depression (PHQ-9) and anxiety (GAD-7),

respectively, values below those observed in the present study. There were minimal differences

compared to national research, with a 20.8 % prevalence of severe anxiety symptoms and 27.5 % of

moderately severe-severe depression symptoms. In addition, this study found a positive correlation

between depression and anxiety scores, as in the present study (Galindo-Vázquez et al., 2020).

According to the 2018-19 National Health and Nutrition Survey (ENSANUT), the prevalence of

moderate to severe depressive symptoms in the adult population of the North of the country

(including the state of Chihuahua) was 12.9 % (Cerecero-García et al., 2020), showing a higher

percentage in the present research; the same situation observed in the case of the presence of anxiety

symptoms reported by the 2003 National Psychiatric Epidemiology Survey, which was 14.3 %

(Medina-Mora et al., 2003). Compared with pre-pandemic data, higher prevalence of depression was

found. Nevertheless, this comparison should be taken with caution, due to the different evaluation

methods used (self-report versus interview) and the sampling strategy. Besides, our research uses

screening tools that suggest the presence of a mental disorder, but do not allow establishing a

diagnosis.

The prevalence of depression and anxiety symptoms among quarantined respondents was lower

than those who were not quarantined; and in our sample no association was found between

quarantine and the presence of symptoms of any disorder, unlike the results found in other research

studies (Marroquín et al., 2020; Ozamiz-Etxebarria, et al., 2020; Rossi et al., 2020; Tang et al., 2020).

This outcome could be due to the fact that following health authorities’ recommendations may have

protective psychological effects by giving individuals confidence and a sense of control in prevention

(Alkhamees et al., 2020), and are consistent with the outcomes found in a study with a Mexican

population sample, in which those who had symptoms of depression before social isolation, reported

the disappearance of symptoms of depression due to the effect of social isolation (Genis-Mendoza et

al., 2021).

Respondents who consistently practiced social distancing measures reported a higher prevalence of

anxiety symptoms than those who did not, and a significant association was observed between social

distancing and anxiety; consistent results with other studies establishing this impact on mental

health as a result of a decrease in social interactions, the perception of loneliness and the fear of being

infected with COVID-19 (Marroquín et al., 2020; Smith et al., 2020; Wang et al., 2020).

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In our population sample of Chihuahua city, being a woman, single, young age (<50 years), not

exercising, having a history of a previous mental disorder or mental health care, were factors

associated with a higher frequency of anxiety symptoms. While the factors associated with the

presence of depressive symptoms were: being a woman, young age (<50 years), single, being a

student (this being the profession with the highest association), health professional or employee in

another area compared to subjects who currently were not working, smoking, alcohol consumption,

having a history of a previous mental disorder and mental health care. Results consistent with

previous studies (Alkhamees et al., 2020; Galindo-Vázquez et al., 2020; Ozamiz-Etxebarria et al., 2020;

Rossi et al., 2020; Schuch et al., 2020).

Factors associated with a lower frequency of anxiety symptoms include not having a home office or

online classes and occasional use of telecommunications to maintain social interaction with loved

ones. The first has been shown in other published works as a factor of anxiety due to unsatisfactory

work environments, such as internet problems or difficulties in following a schedule from home

(Wang et al., 2020). Online classes have also been established as a contributor to stress and anxiety

because of increased academic difficulty due to the abrupt transition to virtual mode, followed by

concerns about delayed graduation and grades (Wang et al., 2020). Finally, the use of

telecommunications has been described as a coping mechanism due to the support received by the

community, family or friends through these media, while at the same time it decreases the perceived

sense of loneliness (Palgi et al., 2020; Smith & Lim, 2020; Wang et al., 2020).

On the other hand, occasional financial concerns were also inversely associated with anxiety

symptoms, unlike the results reported in previous studies where it is established as a risk factor due

to the anxiety generated by the lack of work, being unemployed and the availability of finances in

the future (Smith et al., 2020; Tull et al., 2020). These outcomes may be the consequence of a bias due

confounding variables not assessed, such as resilience. In addition, the survey, being a self-report

instrument, depends on the subject's memory and interpretation, requiring a more objective financial

assessment.

It is worth noting that women with chronic diseases were less likely to present symptoms of both

disorders, contrary to what has been described in the literature, which shows that people with these

diseases suffer higher levels of psychological symptoms due to a higher risk of infection by COVID-

19 along with a worse prognosis (Galindo-Vázquez et al., 2020; Ozamiz-Etxebarria et al., 2020; Özdin

& Bayrak Özdin, 2020). These outcomes may reflect a bias as a result of the sample, since the minority

(n = 75; 19 %) is the one with chronic diseases, requiring a larger sample of patients with this variable

to reach precise conclusions, besides analyzing the impact these have on the quality of life of the

participants.

Lastly, smoking increased in 5 % of the participants and decreased in another 5 %; expected results

are that boredom and social distancing restrictions may have stimulated smoking, but the fear of

contracting COVID-19 might have motivated others to decrease it (Bommelé et al., 2020). The

decrease in alcohol consumption was greater (26 %) than its increase (14 %), which may be due to

the closure of establishments for its consumption. Therefore, the lower consumption may result from

reduced access rather than a voluntary decision (Chodkiewicz et al., 2020).

The present study has some limitations related to the sampling technique. Firstly, being a web-based

survey with voluntary recruitment, it excludes people outside social networks, introducing a

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selection bias, and secondly introducing a self-selection bias, as suggested by the highly unbalanced

gender and age ratio observed (reason why it was decided to divide the sample with these specific

age groups, so that the result could be analyzed with the lowest statistical self-selection bias). Also,

given that the home office does not represent a voluntary decision, and since half of the Mexican

population is working in an informal sector (workers that are not registered, regulated or protected

by legal or regulatory frameworks), it is very likely that a significant proportion of the sample did

not meet this factor because of this. Furthermore, the survey was based on self-report instruments,

depending on the subject's memory or interpretation. For these reasons, the results presented should

be interpreted with caution. However, these tools have been validated in the Mexican population

with good results (Familiar et al., 2015; Castro Silva et al., 2016). It is necessary to mention the fact

that the present study, by using a non-probabilistic sampling method, does not represent the general

population of Chihuahua, which limits the external validity of the results.

4. Conclusions

This study is a first approach to the psychosocial aspect of the pandemic and its social distancing

and quarantine measures in a population sample of Chihuahua, Chihuahua, where high prevalence

of adverse mental health outcomes was found, and highlights the importance of monitoring the

mental state of the population to improve preventive measures for the psychosocial effects of the

pandemic. Those interventions that are already effective can benefit from targeting at-risk groups.

We hope the present study leads to the development of future studies in Chihuahua´s México

population to carry out a statistical surveillance of these psychiatric disorders throughout the

pandemic. Longitudinal studies could be the next step to provide more information by having points

of comparison along time; also, logistic regression analyses can provide more data by knowing

through a predictive and explanatory model, the strength of association between the variables and

the presence of anxiety and depression symptoms.

Funding

None

Conflicts of interest

All authors declare they have no conflicts of interest.

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Appendix 1. Other independent variables analyzed in the present study (n = 377)

Anexo 1. Otras variables independientes analizadas en el presente estudio (n = 377)

Variable