Predictor variables of mental health in the Spanish population confined by COVID‐19

Abstract Background Drastic changes in the lifestyle of individuals have been caused by coronarivus SARS‐CoV‐2 with lethal effects associated with COVID‐19, which acts as a stressor for the population with adverse effects on mental health status. The aim was to identify which sociodemographic variables and psychological factors predict psychological disorders in the general Spanish population. Methods The sample consisted of 699 people exposed to a confinement situation, where 402 (57.51%) were women and 297 (42.49%) were men, between 18 and 73 years old (M = 27.79; SD = 12.68). Different sociodemographic and psychological variables were assessed to see if they predicted levels of anxiety and depression. Results The results identify the predictive capacity of some sociodemographic risk variables such as sex (β = .144; IC95% = 1.341–3.376) and living with people who are ill with COVID‐19 (β = .088; IC95% = 1.157–6.785), as well as protective factors such as self‐efficacy (β = −.126; IC95% = −0.282–0.066) and hope (β = −.429; IC95% = −0.591–0.408) in mental health. In predicting anxiety levels, self‐efficacy and hope are protective factors, especially when living with people in essential services. In levels of depression, only hope is considered a protective factor in people living with patients infected by COVID‐19. Conclusions This study is the first to advance in the understanding of sociodemographic and psychological variables in a Spanish sample subjected to the stressful and traumatic effects of the SARS‐CoV‐2 viral agent.

According to the World Economic Forum's (2019) Competitiveness Index, Spain is the country with the best health system in the world, along with Singapore, Hong Kong, and Japan. However, the infectious action of COVID-19 together with these changes (population containment measures) collapsed health system, and a significant number of deaths have represented a stressful and traumatic situation for a high percentage of the Spanish population.
One aspect related to mental health is hope, conceptualized by Snyder (2002) as the perceived ability to plan a course of action towards a goal (pathway), as well as to initiate action and follow the most appropriate paths to success (self-efficacy). The positive emotions associated with the state of hope are eliminated when the assessment is not only complex but also impossible to deal with developing a state of hopelessness. A second construct that is relevant in this pandemic context is that of general self-efficacy, conceptualized as the belief in one's ability to adequately manage a wide range of stressors (Konaszewski et al., 2019). Hope and self-efficacy are related constructs, but present particular characteristics; we can conceive of hope as the perception of the capacity to plan ahead and maintain the motivation to act, if the situation is complex, and almost impossible, while self-efficacy is the perception of the capacity to be efficient when the situation is complex, but not impossible (Schwarzer & Warner, 2013). Hope and self-efficacy are directly related to the mental health of individuals (Schotanus-Dijkstra et al., 2019). More specifically, they have been positively related to psychological well-being (Pleeging et al., 2019), life satisfaction (Muñoz et al., 2016), and coping with stress (Roesch et al., 2010) and negatively to depressive symptoms (Tehranchi et al., 2018) or anxiety (Siril et al., 2020). When examining other variables that contribute to predicting the state of mental health, attention is paid to various sociodemographic variables identified in previous studies and linked to the COVID-19 such as age (C.  and sex (C. , type of activity carried out (Liang et al., 2020;C. Wang et al., 2020), care of other people (e.g., minors or elderly), family size or contact with people who are infected or susceptible to greater infection (C. . The hypothesis maintained is the effect on the state of mental health of the participants of both sociodemographic factors linked to the pandemic, as well as the cognitive and emotional capacities of the person. This information can facilitate the planning of possible lines of action aimed at limiting the psychological effects of health crises such as the current one.
To our knowledge, the psychological impact of the COVID-19 pandemic has not been studied empirically in the Spanish population.
Therefore, the aim of this paper would be to identify whether the selected sociodemographic variables and/or psychological strength factors related to motivation for action are involved in predicting levels of anxiety and depression. In the context of this work, it is hypothesized that the general goal of individuals is to cope with the various present and future personal circumstances linked to the COVID-19 pandemic and that self-efficacy and hope play a key role in this process.

Participants
A total of 700 people answered the request to participate in the online questionnaire "Emotions in time of crisis" about the psychological state of the general Spanish population in confinement by the COVID-19.
The valid responses were 699, excluding one interviewee due to incoherence in providing his or her sociodemographic data. The criteria for inclusion in the study were: (1) to be 18 years or older and (2)   infection, and living with essential service workers.

Instruments
Hospital  by Zigmond and Snaith (1983) in its Spanish version by Herrero et al. (2003). A 14-item scale was designed for the assessment of anxiety and depression in nonpsychiatric outpatient hospital services. It is a state measure containing two scales, one for anxiety and another for depression. One of its main strengths is the suppression of somatic symptoms, so that it can for the depression subscale, and .85 for the anxiety subscale (Herrero et al., 2003). In this study, the alpha on the value of the total inventory was .86, and they were also adequate for the remaining subdimensions (α Anxiety = .89; α Depression = .83). Herth (1992). The Spanish adaptation by Sánchez-Teruel et al. (2020) of this scale consists of 12 items with an answer system in a 4-point Likert scale. Items 3 and 6 are formulated inversely. It is applicable between 16 and 40 years old. It measures hope through three subdimensions: temporality and future; positive disposition and hope; and interconnection. The maximum score is 48 and the minimum is 12. Cronbach's alpha for the Spanish university sample is .89. Total alpha was .69 in this study.

Procedure
The dissemination of the study and request for participation was carried out between April 15 and 22, 2020. The link https://forms.gle/ kAU1sr84uCTHCfMu8 was used for this purpose. The procedure followed was like a "snowball" consisting of contacting the members of the authors' social networks, also requesting that they disseminate it to their own contacts in other groups. The questionnaires were completed through an online survey platform (Google Forms, license from the University of Spain). Previously, the approval of the Ethics Committee of the University of Spain had been requested and obtained (code: ABR.20/4.PRY), which also complies with the principles enshrined in the Declaration of Helsinki. Before completing the survey, the interviewees provided their voluntary and informed consent.

Data analysis
Dependent variables were also self-reported anxiety and depression symptoms (HADT), anxiety symptoms (

RESULTS
In relation to the scale (groups 1, 2, and 3) and gender of the participants, men with anxiety symptoms are 83 (11.87%) of the total

DISCUSSION
The objectives of this work were to identify whether sociodemographic variables and psychosocial factors (self-efficacy and hope) related to motivation for action, participate in predicting levels of anxiety and depression in the general Spanish population subjected to the COVID-19 pandemic.
The comparison of the results from this study in relation to the incidence of cases of anxiety (53.64%) indicates that the number of cases reaching the cut-off point is higher than that found by C.  and Y. . The percentages are also generally higher in the groups with mild (25.89%) or moderate (18.45%) symptoms. In addition, C.  did not identify cases in the severe anxiety group (Group 3), although they have been identified in this study (9.30%). The categorization of depression offers more comparable results between studies, although the frequency of cases (25.78%) in the moderate and severe groups is higher than reported by C.  and lower when compared at these levels with the data from Y. . The data were obtained between April The relationship between anxiety, depression, and sex is complex and further mediated by age, with usually more anxiety symptoms in women in the early stages of life until the incidence of sex progressively balances out at later ages (Curran et al., 2020). The inclusion of sex as a predictor of anxiety was also obtained by C. Wang et al.
(2020) although not in the prediction of depression scores. Another sociodemographic element in the prediction models is the contact maintained with other people. In this paper, a distinction is made between contact with people who are ill with COVID-19 and people B, non-standardized coefficient; β, result of the regression or beta equation; C.I., confidence intervals; ConCov, living with COVID-19 sick persons; ConSer, living with essential service persons; F, contrast statistics (ANOVA); ns, not significant; g.l., degrees of freedom; GSE, general self-efficacy; HHI, hope; L.I., lower limit; SE, standard error; S.L. ,upper limit; R 2 , corrected determination coefficient; t, predictive variable contrast statistics. *p < 0.05;**p < 0.01.
who are at greater risk of contracting the illness (essential services personnel). The first of these factors is involved in predicting depression and the second in predicting anxiety. In contact with a sick person, the situation is threatening and uncontrollable, while contact with essential personnel is also assessed as threatening but more controllable. The perception of uncontrollability has traditionally been linked to depressive states. Living with potential patients also plays a role in predicting distress (total scale of anxiety and depression). In this prediction, the assessment of the uncontrollability of the situation is likely to extend to concerns about contagion among family members (C. .
Moreover, noteworthy in this study is the exclusion of other sociodemographic factors, such as the occupation of the participants or factors considered linked to that state of mental health, such as care of the elderly, care of minors, or the number of family members cared for during confinement. Its absence in the regression models is linked to the contribution that the psychological variables of the individuals have in these models, supporting the idea that a good level of motivation for acting in difficult situations can counteract the influence of these sociodemographic factors.
Hope refers to the individual's expectation that he or she can cope with difficult situations, identifying ways of acting, and feeling motivated to do so, while self-efficacy relates to the expectation of being effective in implementing action strategies. These two factors contribute significantly to the prediction of the level of general distress as well as anxiety in a negative relationship. The relationship between hope and anxiety has been well established in the previous literature (Gallagher et al., 2020) as well as between anxiety and self-efficacy (Ng & Lovibond, 2019). A low level of hope contributed to the prediction of This study has some limitations. On the one hand, we used a crosssectional design, which cannot provide strong evidence of causality. Secondly, this study used self-reported questionnaires, which have problems of subjectivity. Furthermore, due to snowball sampling, these findings may not represent the entire Spanish population, although the number of participants can be considered significant (Centre for Sociological Studies, 2020). In addition, more women took part than men.
Female participation over male participation is common in psychological research, which may be explained by the greater frequency with which women actively face problems and make more requests for help than men (Liddon et al., 2017). This would be an area for improvement in future research.

CONCLUSIONS
Coping with a traumatic/stressful experience, such as that associated with a pandemic by a highly infectious agent such as COVID-19, is complex for individuals. Its effects depend on the circumstances in which we have to deal with it, and the personal resources available to us are involved in this process in a relevant way. The contribution of hope and self-efficacy to the maintenance and/or improvement of the state of mental health highlights avenues of action with a twofold objective. We consider that the arrival of new pandemics associated with the high globalization experienced in the planet, which promotes the spread of infectious agents in different countries, is foreseeable. This forecast suggests the need for countries to be prepared for the arrival of new pandemics. One form of preparation, we believe, should include the psychological strengthening of their population.

AUTHOR CONTRIBUTIONS
All authors have contributed equally. The authors approved the final version of the manuscript.

DATA AVAILABILITY STATEMENT
The dataset generated and analyzed for this study is not publicly available due to the restrictions claimed in the document of the research permission and ethical approval.