Journal Article

Learning the hard way: What COVID-19 teaches us about the social determinants of mental health among the urban poor

Vives Vergara, Alejandra, Valdebenito Montenegro, Roxana, Orlando Romero, Laura, González López, Francisca, Diaz Concha, Ignacio

2026

Overview

Background The COVID-19 health crisis rapidly escalated into a broader social and economic emergency, affecting physical and mental health beyond the disease itself and placing a disproportionate burden on vulnerable populations. This study investigates the determinants of poor mental health related to COVID-19 among urban-poor homemakers residing in a social housing villa located on the outskirts of Santiago de Chile, a metropolitan city characterized by pronounced sociospatial segregation. Methods Capitalizing on the ongoing RUCAS cohort study, we introduced a COVID-19 module into the biannual RUCAS survey to assess the associations between COVID-19-related social determinants of poor mental health and symptoms of depression during and after the 2020 lockdown among 413 homemakers. We describe the prevalence and distribution of COVID-19-related social determinants of poor mental health, and longitudinally examine their associations with depressive symptoms, measured using the Patient Health Questionnaire-2 (PHQ-2). Modified Poisson regression models were used to estimate prevalence ratios (PRs) and their corresponding 95% confidence intervals, including an interaction between the independent variable and the measurement wave for the longitudinal assessment. Results During lockdown, symptoms of depression among homemakers were most strongly associated with students in the household facing difficulties in completing schoolwork during homeschooling (PR: 2.62; 1.60–4.30). After lockdown, the strongest associations were observed with employment (being out of the labor force (PR: 1.59; 1.04–2.44); receiving reduced income from work (PR: 1.95; 1.22–3.11)), and the financial situation of the household: indebtedness (wave 4: acquisition of new debts, PR: 1.48; 1.04–2.11; wave 5: low debt-payment capacity, PR: 1.44; 1.01–2.07), and food insecurity (wave 4, PR: 1.92; 1.38–2.65; wave 5, PR: 1.59; 1.12–2.26). Household conflicts over space were associated with depressive symptoms in both waves (wave 4, PR: 1.43; 1.01–2.02; wave 5, PR: 1.74; 1.23–2.46). No association was found with being or living with a COVID-19 case. Conclusions In addition to the central role of financial stressors in shaping mental health outcomes during the COVID-19 pandemic, our results underscore the importance of home-schooling challenges as a critical source of psychological distress among peripheralized homemakers. These findings offer valuable insights for enhancing multisectoral preparedness in future crises, emphasizing the need to integrate social, economic, and educational support strategies for peripheralized urban-poor populations and to prevent or mitigate the deepening of existing social inequalities.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Anxiety / At risk populations / Biostatistics / Care and treatment / Chile / Chile - epidemiology / Cohort analysis / Confidence intervals / Coronavirus Infections - epidemiology / Coronavirus Infections - psychology / COVID-19 / COVID-19 - epidemiology / COVID-19 - psychology / COVID-19 pandemic / Crises / Depression - epidemiology / Diagnosis / Economic aspects / Economics / Employment / Environmental Health / Epidemics / Epidemiology / Female / Financial stress / Food insecurity / Food security / Health aspects / Health surveys / Home education / Homemakers / Homeschooling / Households / Housing / Humans / Independent variables / Labor force / Lockdown / Longitudinal studies / Male / Medicine / Medicine & Public Health / Mental depression / Mental health / Mental Health - statistics & numerical data / Middle Aged / Pandemics / Pneumonia, Viral - epidemiology / Pneumonia, Viral - psychology / Population studies / Populations / Poverty - psychology / Psychological aspects / Psychological stress / Public Health / Public housing / Public relations / Regression analysis / Regression models / SARS-CoV-2 / Segregation / Signs and symptoms / Social aspects / Social Determinants of Health / Social inequality / Statistical analysis / Surveys / Symtoms of depression/Mental health / Urban Population - statistics & numerical data / Urban populations / Urban poverty / Urban-poor homemakers / Vaccine