Our findings suggest that during the period of social isolation (April-May), respondents experienced psychosomatic symptoms, anxiety, social dysfunction and severe depression as assessed by GHQ-28. Gender, age, education level, and having moderate concerns about purchasing protective products influenced the mental health of respondents; other variables, including nationality, employment and marital status, and being afraid of the coronavirus disease were not significantly associated with the presence of psychological symptoms. In our sample, educational status is a protective factor against mental health disturbances. In similar research, studies in China at the beginning of the pandemic found that education, employment and marital status are protective factors of mental health (12) (40).
Our data suggests that women experience higher levels of somatic symptoms and anxiety/insomnia. These findings are consistent with previous studies reporting greater levels of anxiety (12), fear within women (13), and older adults exposed to public health messages in the context of European quarantined countries, such as Italy (41). Being female and a young adult (29–38) increases risk of anxiety; while older are more likely to report depression, these findings are similar to Newby's (14) who found that students were at greater risk for depression than older adults.
Regarding sources of concern, we found that participants reported little concern respect to some changes in circumstances, such a working without family (3.69%), doing domestic work (4.15%) and maintaining children and family care (10.14%). A higher percentage was worried because of social isolation (38.94%), and not being able to work (27.88%). Drawing from another studies we notice that people report higher rates of anxiety due to concern for themselves and their family (42). The distinctive distribution of work and responsibilities across Peruvian families seems to be driving varied behavioral responses (somatic symptoms, anxiety/insomnia, social dysfunction and severe depression) supported by the last national report. In here, a great number of families were classified as nuclear households (53.9%) made up of a couple with or without children or at least one, followed by extended families (20.6%) and single person households (16.8%) (43). The changes of working circumstances due to the current social distancing are perceived differently among single respondents (71.2%) who are less likely to report concern for others or to work without being with the family. Nearly half of respondent (47.70%) also reported significant higher somatic symptoms due to shortage of protective products (personal toiletries). The use of tonics and medicines to not get sick or prevent physical discomfort are also reported in similar studies regarding massive purchases of cleaning supplies and food upon higher alarm among the population (7).
Interestingly, sociodemographic such as gender, age, educational status and the likelihood of being married influence a person’s likelihood of using active coping style. In our study self-distraction and self-blame, both passive strategies, were significantly informed. Self-distraction was used by individuals of all ages except among those 18 to 28 years old. Analyzing religion -related coping beliefs, we found that university students and groups from 39 to 48 years old increases in praying as a strategy, which corresponds with the country culture according to national records (76.0% of Peruvians profess being Catholic) (43). A great deal of women respondent (61.3%) reported using religion-based strategies probably to mitigate stress, those results are also supported by previous recent Chinese studies during the pandemic (74.77%)(9).
Psychological problems and use of coping strategies
Coping strategies are mediated by cultural factors and gender differences. This study confirms that women tend to use more passive strategies, except for positive re-evaluation as an active strategy. Contrastingly, Asian- based studies reported the deployment of active styles focusing on problem solving (active, social support and planning) are analyzed and can significantly predict responses of anxiety (3.4%), anger (2.2.%) and sadness (0.9%). With that said, women may be more likely to use proactive, problem-centered coping in the face of the pandemic and less likely to use passive strategies than men. (13). This has some minor fluctuations in North America, where women are more likely to report strategies that focus on passive behaviors such as distraction, religion, and less humor (44). We found that women with psychological problems use religion, self-distraction and venting possibly to alleviate the distress they feel about the pandemic, has not been reported in other studies.
People with psychological problems use adaptive strategies based on acceptance and the support-seeking behaviors to face the crisis. In contrast, the sample of participants without psychological problems had a predominance of cognitive coping with planning and disconnecting from activities, followed by less seeking social support, most likely due to the higher educational status of the respondents; self-distraction was the only passive or blocking coping strategy that ranked high in this group. Interestingly, in Singapore, in late 2002, in the face of severe acute respiratory syndrome (SARS) two coping strategies, denial and planning, were associated with post-traumatic morbidity. Both, lack of planning and denial are ways of reducing powerlessness in the face of stress but at the same time they are maladaptive strategies leading to psychological problems (5). We found that the use of passive responses (denial, self-distraction, self-blame, venting, and religion) may respond to the unprecedented impact of the COVID-19 pandemic on a country and global scale; metaphorically, it is understood as a chain of misadjusted responses that begins with rejecting the deadly consequences of the disease, not accepting reality, resorting to various activities to avoid thinking about the crisis, and avoiding confronting the problem.
Among the strengths, this study was one of the first to investigate the impact of COVID-19 on mental health and coping strategies in the face of the crisis. It was conducted two weeks after the declaration of the state of emergency by the Peruvian government
Future research could follow participants in the aftermath of the pandemic and examine the evolution of psychological problems after the state of emergency. Other studies on low-income populations with educational and health needs and restricted access to the Internet provided insight into their coping strategies and the effects on their mental health.