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Lifestyle changes and mental health during the COVID-19 pandemic: A repeated, cross-sectional web survey

Publicated to:Journal Of Affective Disorders. 295 173-182 - 2021-12-01 295(), DOI: 10.1016/j.jad.2021.08.020

Authors: Cervera-Martinez, Jose; Atienza-Carbonell, Beatriz; Mota, Jurema C; Bobes-Bascaran, Teresa; Crespo-Facorro, Benedicto; Esteban, Cristina; Paz Garcia-Portilla, Maria; Gomes-da-Costa, Susana; Gonzalez-Pinto, Ana; Jaen-Moreno, M Jose; Sarramea, Fernando; Vieta, Eduard; Zorrilla, Inaki; Tabares-Seisdedos, Rafael; Kapczinski, Flavio; De Boni, Raquel B; Balanza-Martinez, Vicent

Affiliations

Centro de Investigacion Biomedica en Red de Salud Mental - Author
Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain - Author
Facultad de Medicina y Ciencias de la Salud - Author
Fundacao Oswaldo Cruz - Author
Hosp Denia Marina Salud, Alicante, Spain - Author
Hosp Univ Virgen del Rocio, IBIS, Seville, Spain - Author
Hospital de Denia Marina Salud - Author
Hospital Universitario Araba - Author
Hospital Universitario Reina Sofía - Author
HOSPITAL UNIVERSITARIO VIRGEN DEL ROCIO - Author
Inst Invest Sanitaria Principado Asturias ISPA, Serv Salud Principado Asturias SESPA, Oviedo, Spain - Author
Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Spain - Author
Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) - Author
Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) - Author
McMaster Univ, Dept Psychiat & Behav Neurosci, Mood Disorders Program, St Josephs Healthcare Hamilton, Hamilton, ON, Canada - Author
McMaster University, Faculty of Health Sciences - Author
Oswaldo Cruz Fdn FIOCRUZ, Inst Sci & Technol Commun & Informat Hlth ICICT, Rio De Janeiro, Brazil - Author
Univ Barcelona, Hosp Clin, Inst Neurosci, IDIBAPS, Barcelona, Catalonia, Spain - Author
Univ Basque Country, Hosp Univ Alava BIOARABA, Vitoria, Spain - Author
Univ Cordoba, Dept Ciencias Morfol & Sociosanitarias, Cordoba, Spain - Author
Univ Cordoba, Hosp Univ Reina Sofia, Cordoba, Spain - Author
Univ Fed Rio Grande Sul UFRGS, Inst Nacl Ciencia & Tecnol Translac Med INCT TM, Dept Psychiat, Porto Alegre, RS, Brazil - Author
Univ Oviedo, Dept Psychol, Oviedo, Spain - Author
Univ Oviedo, Sch Med, Dept Psychiat, Oviedo, Spain - Author
Univ Seville, Seville, Spain - Author
Univ Valencia, Dept Med, Teaching Unit Psychiat & Psychol Med, Blasco Ibanez 15, Valencia 46010, Spain - Author
Univ Valencia, Dept Med, Valencia, Spain - Author
Universidad de Córdoba - Author
Universidad de Oviedo - Author
Universidad de Sevilla - Author
Universidade Federal do Rio Grande do Sul - Author
Universitat de Barcelona - Author
Universitat de València - Author
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Abstract

Background: This study aimed to compare self-reported changes on lifestyle behaviors during two phases of the COVID-19 pandemic in Spain, and to evaluate clinical and sociodemographic factors associated with lifestyles. Methods: Two cross-sectional web surveys were conducted during lockdown (April 15-May 15, 2020) and seven months later (November 16-December 16, 2020). Lifestyle behaviors were self-reported by a multidimensional scale (SMILE-C). Two separate samples of respondents were analyzed. A multivariate regression model was performed to evaluate the association of SMILE-C scores with demographic and clinical variables. Results: The sample comprised, 3412 participants from the first survey (S1) and in the S1 and 3635 from the second (S2). SMILE-C score decreased across surveys (p < 0.001). The rates of positive screenings for depression and anxiety were similar between the surveys, whereas those for alcohol abuse decreased (p < 0.001). Most participants in S2 reported that their lifestyle had not changed compared to those before the pandemic. Variables independently associated with an unhealthier lifestyle were working as an essential worker, lower educational level, previous mental disease, worse self-rated health, totally/moderate changes on diet, sleep or social support, as well as positive screenings for alcohol abuse, anxiety and depression. Limitations: The cross-sectional design and recruitment by non-probabilistic methods limit inferring causality and the external validity of the results. Conclusions: Overall lifestyle worsened seven months after the lockdown in Spain. Several demographic and clinical factors were associated with lifestyle scores. The contribution of common mental disorders to unhealthier lifestyles should be considered in order to prevent the negative impact of the pandemic.

Keywords
anxietycovid-19depressionexercisegeneral populationlockdownpopulationpreventionpsychiatryresiliencesleepweb surveyAnxietyCommunicable disease controlCovid-19Cross-sectional studiesDepressionGeneral populationHumansLife styleLifestyleLifestyle mental healthMental healthPandemicsSars-cov-2Self-rated healthSurveys and questionnairesWeb survey

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Affective Disorders due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position 29/212, thus managing to position itself as a Q1 (Primer Cuartil), in the category Clinical Neurology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.93. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 3.14 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 12.81 (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-25, the following number of citations:

  • WoS: 36
  • Scopus: 38
  • Europe PMC: 19
  • OpenCitations: 35
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-25:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 237.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 237 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 10.85.
  • The number of mentions on the social network X (formerly Twitter): 7 (Altmetric).
Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Brazil; Canada.