On 14 March 2020, the Spanish Government decreed the first state of alarm due to the covid-19 pandemic. The decree ordered a total lockdown with severe restrictive measures and was in force longer than 2 months. Subsequently there was a progressive de-escalation of the state of alarm and the subsequent introduction of various more or less restrictive measures according to the number of new cases and the pressure on hospitals. This article shows the impact of the pandemic within a context in which all these measures and uncertainty over the future are causing serious personal, family, social, economic, and phys-ical and mental health consequences.

The impact of the covid-19 outbreak on the general population has been studied above all with evaluations during the pandemic, but there are barely any studies worldwide that enable a reference comparison on the physical and mental health of the same sample before and during the outbreak in order to assess its real impact. Studies from Denmark (Sønderskov KM et al., 2020) and the United Kingdom (Pierce et al., 2020) show a worsening of mental health among the population, above all among young people and women; and an increase in inequalities, above all for people who live with young children and those who work. 

In Spain, the results of the studies reported also come mainly from cross-cutting data. Therefore, we still do not know the real impact with an evaluation before and during the pandemic, which means we cannot make any accurate estimate regarding Spain’s adult population. This study aims to find out the socioeco-nomic and the physical and mental health consequences in Spain during the first nine months starting from the date that the state of alarm was decreed. The study was conducted among a representative adult population of 1,357 individuals via an online survey prior to the pandemic (December 2019) and during the pandemic, exactly one year later (December 2020).

The sample contains 54.7% of women (with an average age of 50 years), 54.4% of married people and 72.4% with a stable partner from the start of the first state of alarm. Of the total, 517 people (38.1%) took some type of test to find out if they had caught covid-19, of which 49 (9.5%) tested positive, which corre-sponds to 3.6% of the total population. The months with the most positive cases were October (26.8%) and March (20%).

Some 20.9% of survey respondents reported that their general health is a little worse and 2.1%, a lot worse, in contrast with 4.4% who informed that it is currently a little better and 2.2%, much better, than before the pandemic. The population with a more negative evolution of its general health includes those who report having had symptoms compatible with covid-19 without having taken any test to confirm the diagnosis (52.2%), followed by those who did take a test and have been diagnosed with covid-19 (24.9%). With respect specifically to physical and mental health, 8.4% of the sample saw their physical health worsen, while 5.5% has a worse state of mental health than before the pandemic.

The survey also indicates that 3.7% started smoking since the pandemic began. As regards body mass index (BMI), a large majority (79.6%) of the sample has not noted substantial changes, although in qualitative terms around 9.9% saw their BMI improve while 10.5% saw it worsen. 

Individuals diagnosed with covid-19 had an average of 4.5 symptoms. The most frequent symptoms were headache (55.1%), muscular pains (46.9%), cough (44.9%), fever (44.9%), loss of sense of smell and taste (42.9%), and severe fatigue (40.8%). Of these people, 12.2% were hospitalised, of whom 10.2% were hospitalised without and 2.04% with respiratory support.

Considering the sample in general, it is observed that, on the whole, people present more difficulties for undertaking everyday life activities due to their health conditions. These difficulties become specific when they state that they have to make a greater effort, suffer more discomfort or pain, note that they are slower or clumsier, or change their way of performing a certain activity due to these health problems.

Not all the dimensions of mental health have behaved in the same way since the start of the state of alarm. Taking into account the whole of the sample, depression has increased from 5.7% to 8.8%, anxiety from 11.6% to 17.8% and thoughts about death from 22.9% to 28.5%. In contrast, suicidal ideation and behaviour have fallen by half. Suicidal ideation has dropped from 11.3% to 6.7%, suicidal plans from 1.4% to 0.7%, and attempts at suicide from 0.7% to 0.4%.

If we consider the people who presented no mental health problems in the month of December 2019, during the pandemic 5.1% have had a first episode of depression, 9.9% a first episode of anxiety and 19.8%, frequent thoughts about death (their own, of others, or death in general) that they did not have before the pandemic. With respect to suicidal ideation and conduct, 2.0% had an episode of suicidal idea-tion and 0.2% had planned to commit suicide. 

Comparing those people who have tested positive or have had symptoms related with catching covid-19 with those who have not had related symptoms or have tested negative, we observe that the former have had a greater number of new episodes of depression (16.4% vs. 3.5%), anxiety (13.3% vs. 9.2%), thoughts about death (27.5% vs. 18.8%) and suicidal ideation (5.4% vs. 1.5%), and a much higher average of post-traumatic stress symptoms (average of symptoms, 20.5 vs. 12.5). 

Finally, the data show that the subgroups least likely to suffer a mental health problem since lockdown started were men, the over 40s, those who are married or live with a partner, and those who work, do the housework, or are retired. It is observed that resilience, understood as having better personal skills and greater control, having self-confidence, being tolerant to negative effects and changes, being strong in the face of stress and presenting secure relationships, protects us from having mental health problems during the pandemic. 

With respect to partner violence, it is observed that, of the 1,017 people (75% of the sample) who have or have had a partner since the start of the state of alarm, 8.6% have experienced fear of their partner and 3.6% have suffered some kind of aggression from them. The most violent conducts since the start of the state of alarm have been blaming the victim for the aggressor’s violent conduct (2.3%) and receiving some kind of insult (1.6%).

As for social relations during the pandemic, some 62.7% of the sample were quite or very concerned about the possibility of having become infected and 87.8% have been very or quite concerned about having in-fected other people (whether infected or not); 54.1% have been concerned about not being able to help their loved ones; 50% have suffered problems caused by being socially isolated; 25.5% have experienced moderately or significantly increased arguments with their loved ones and 21.5% have been quite or very worried about associated economic problems.

As for employment aspects, since lockdown began, some 3.1% have changed from working (or working and studying) to being unemployed, 2.6% have lost their job permanently and 1.2% of workers have been temporarily laid off (ERTE). Among them, 56% were not paid the 30% that their company should have paid them and 41.1% had already been in this situation longer than 6 months.

Of the people receiving some type of income, 18.4% of the total sample have had a lower income since the state of alarm began, 16.9% fear that their hours of work will be reduced and 47.4% have not been able to take sick leave every time they have needed to. Finally, some 10.2% of those working have had to go to work while suffering symptoms compatible with having caught covid-19.

The average economic cost for the individual, or for the healthcare system, represented by one person making a visit to a healthcare professional or service, or taking sick leave, has been €106.10 per month since the start of the pandemic. The average costs per person with the greatest impact within the global cost composition have been hospital admissions, with a cost of €207.90, and leave from work, with a cost of €468.40. If we extrapolate this to the Spanish adult population, the economic cost for the whole of Spain is estimated to total €37,239,846,377.

The other items included in the evaluation carried out though the survey are visits to a primary care doctor (with an average cost of €59.2), visits to a nurse (€14.9) and admissions to the ICU (€48.5). Finally, private personal spending on health products such as face coverings or alcoholic gel has been €26. This evaluation does not include the economic cost of prescribed drugs and of vaccination.

This longitudinal study shows that, during the pandemic, there has been a substantial increase among the Spanish population of new cases of depression and anxiety and, in general, worse physical and mental health and greater difficulty in undertaking everyday activities due to health problems. The pandemic has not affected equally the mental health of population groups based on sex, age, civil status or employment situation. In the employment and economic sphere, the pandemic has caused greater job instability and a loss of employment rights. Furthermore, 3.6 % of people have been victims of violence from their partner. Finally, it is estimated that the average economic cost per month per person has been €106.10. 

The increase detected in physical and mental health problems shows that it is urgent and necessary to establish public health policies, economic incentives and programmes to protect victims from their part-ners.

Since the data in the study are self-reported (interviews conducted via an online survey), it is important to point out that some may have less validity than others. Thus, for example, the study did not carry out any antigen tests to confirm or rule out the diagnosis provided. In the case of evaluation of mental disorders and problems, this could not be carried out by any professional with knowledge and experience. Moreo-ver, it was not possible to evaluate the costs of medications and vaccinations with any independent eco-nomic calculation.  

Article based on data originating from the study “The longitudinal impact on a socioeconomic level and on physical and mental health among Spain’s adult population comparing their status before and during the covid-19 pandemic”, conducted by Pere Castellví Obiols, Andrea Miranda Mendizábal, Silvia Recoder Fer-nández, David Leiva Ureña, Rumen Manolov, Antonio Solanas Pérez, Nuria Matilla Santander, Marc Casajuana Closas, Esther Calbo Sebastián and Carlos García Forero (2021) with a representative sample of 1,357 Spanish adults and  two evaluations (December 2019 / December 2020).The survey was carried out with the  support, through a competitive call, of the Social Observatory of the ”la Caixa” Foundation. 

PIERCE, M., H. HOPE, T. FORD et al. (2020): «Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population», The Lancet Psychiatry, 7(10). 

SØNDERSKOV, K.M., P.T. DINESEN, Z.I. SANTINI and S.D. ØSTERGAARD (2020): «The depressive state of Denmark during the COVID-19 pandemic», Acta Neuropsychiatrica, 32(4).