Anxiety, depression, attitudes, and internet addiction during the initial phase of the 2019 coronavirus disease (COVID-19) epidemic: A cross-sectional study in México

  1. Bryan Adrián Priego-Parra
  2. Arturo Triana-Romero
  3. Samanta Mayanin Pinto-Gálvez
  4. Cristina Durán Ramos
  5. Omar Salas-Nolasco
  6. Marisol Manriquez Reyes
  7. Antonio Ramos-de-la-Medina
  8. Jose María Remes-Troche

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Abstract

Objectives

To describe the prevalence and distribution of anxiety and depression among Mexican population, and to examine its association with internet addiction during the COVID-19 outbreak.

Design

A web-based cross-sectional study.

Setting

General population in México.

Participants

561 subjects were recruited (71% female, mean age 30.7 ± 10.6 years).

Interventions

An online survey to assess personal attitudes and perceptions towards COVID-19, sleep-disorders related, the Mexican version of the Hospital Anxiety and Depression Scale (HADS) and the Internet Addiction Test (IAT) was applied.

Primary and secondary outcome measures

Prevalence of anxiety, depression, internet addiction and sleep disorders and associated factors. Also, prevalence for anxiety and depression were compared to an historic control group.

Results

During the initial phase of the COVID-19 pandemic the prevalence for anxiety and depression was 50% (95% CI, 45.6% to 54.1%) and 27.6%, (95% CI 23.8% to 31.4%), respectively. We found a 51% (33% to 50%) increase in anxiety and up to 86% increase in depression during the initial weeks of the lock-down compared to the control group. According to the IAT questionnaire, 62.7% (95% CI 58.6% to 68.8%) of our population had some degree of internet addiction. Odds ratio for development of anxiety symptoms was 2.02 (95% CI1.56-2.1, p=0.0001) and for depression was 2.15 (95% CI 1.59-2.9, p=0.0001). In the multivariate analysis, younger age (p=0.006), sleep problems (p=0.000), and internet addiction (p=0.000) were associated with anxiety and depression.

Conclusions

Our study provides valuable information on the psychological impact that the COVID-19 pandemic has had on the Mexican population. As in other parts of the globe, in Mexico, fear of SARS-CoV-2 infection has had devastating consequences on mental health, such as anxiety, depression and sleeping disturbances. Internet abuse and the consequent overexposure to rapidly spreading misinformation (infodemia) are associated to anxiety and depression.

Strengths and limitations of this study

  • Our study have addressed the immediate psychological effect of the pandemic in the general population in a Latin American country, specifically in Mexico, a nation with high population density.

  • Using the IAT (a specific tool to assess internet dependency), we found internet addiction was highly prevalent and correlated to anxiety and depression.

  • We used the snowball sampling strategy; thus, our population is biased and may not reflect the actual pattern of general population.

  • We decided to compare anxiety and depression with an historic cohort, and although this control group is not exactly matched to our studied population, the prevalence of anxiety and mood disorders are like those reported previously in Mexico.

  • Other limitations include response bias due to fewer older subjects participating, the fact that sleep problems were not rigorously evaluated with a specific tool, and some states in our country were not represented in this work.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.05.10.20095844: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Upon receiving and clicking the link, participants got auto directed to information on the study and informed consent.
    IRB: This study was approved by the Internal Institutional Review Board of the Medical Biological Research Institute (IIIMB-UV#2020-01-005).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableAs a control group, to compare anxiety and depression symptoms, we used data from 458 subjects (62% female, mean age 29.8 ± 8.6 years) to whom the same questionnaires for anxiety and depression were applied between September 2019 and January 2020.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Mexican citizens aged >18 years old were invited to participate in an online survey using the Google Forms software.
    Google Forms
    suggested: None
    This study was approved by the Internal Institutional Review Board of the Medical Biological Research Institute (IIIMB-UV#2020-01-005).
    Medical Biological
    suggested: None
    The IBM SPSS version 24 (IBM, Chicago, Illinois, US) was used to carry out all analyses.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    It is important to acknowledge that our study has several limitations. As in other studies performed during this period, we adopted the snowball sampling strategy, thus our population is biased and may not reflect the actual pattern of general population. In an ideal scenario we should conduct a prospective evaluation of the same group of participants a period after the pandemic. We acknowledge that additional longitudinal studies, such as cohort studies or nested case-control studies are essential in the future. However, we decided to compare anxiety and depression with an historic cohort, and although this control group is not exactly matched to our studied population, the prevalence of anxiety and mood disorders are like those reported previously in Mexico. Other limitations include response bias due to fewer older subjects participating, the fact that sleep problems were not rigorously evaluated with a specific tool, and some states in our country were not represented in this work. In conclusion, our study provides valuable information on the psychological impact that the COVID-19 pandemic has had on the Mexican population. COVID-19 has brought major changes in our lives and interpersonal relationships, creating uncertainty, fear, confusion, panic. In Mexicans, it has specifically had devastating consequences on mental health, such as anxiety, depression and sleeping disturbances. Federal agencies and some academic institutions (such as Universidad Veracruzana) have imple...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.10.20095844 on medRxiv