**1. Introduction**

COVID-19, with an onset at the end of 2019 in Wuhan, China, was declared by the WHO as an international public health emergency in January 2020 [1] and as a global pandemic in March 2020 [2]. It spread rapidly throughout Latin American countries, leading the WHO to declare the region as an epicenter of the pandemic in May 2020 [3].

It has been estimated that in Latin American countries, including Chile, despite the fact that preventive measures against COVID-19 were implemented without delay, these have not had the expected effects due to, among other causes, deficiencies in the contact tracking and follow-up system, as well as problems prior to the pandemic, such as the characteristics of the health system, social inequalities, high rates of informal employment, and little or late establishment of economic support measures [4].

Regarding health inequities, proven to exist in Chile, and the finding of higher mortality rates in the metropolitan area of Chile, observing a direct association between mortality

**Citation:** Ruiz-Frutos, C.; Delgado-García, D.; Ortega-Moreno, M.; Duclos-Bastías, D.; Escobar-Gómez, D.; García-Iglesias, J.J.; Gómez-Salgado, J. Factors Related to Psychological Distress during the First Stage of the COVID-19 Pandemic on the Chilean Population. *J. Clin. Med.* **2021**, *10*, 5137. https:// doi.org/10.3390/jcm10215137

Academic Editors: Giacomo Mancini and Michele Roccella

Received: 22 September 2021 Accepted: 29 October 2021 Published: 31 October 2021

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

from COVID-19 and poverty [5]. The social determinants of health, in particular the multidimensional poverty index and the use of public transport, play an important role in explaining the differences in outcomes [6], both in the incidence of COVID-19 and in mortality [7].

On the other hand, the influence of the economy on health is an aspect of special relevance. In this regard, analyses of the effects of the containment measures on Chile's economic activity have been carried out [8]. One of these analyses, that covered the response to the pandemic by several Latin American governments, including Chile, has found that while wealthier municipalities introduce technological innovations comparable to those in developed countries, smaller or less advantaged areas have more difficulty maintaining service delivery while in an unprecedented socio-economic context, as is the one experienced during the pandemic [9]. However, it has been found that this health situation has not affected all population sectors in Chile equally [10]. Thus, as for the indigenous population, the vulnerability indicators previously detected have increased since it is a group that already had inequalities in health [11,12].

Overall, the impact of the COVID-19 pandemic in Chile has been significant. According to official data, as of 19 May 2021, 1,292,096 cases had been confirmed (6.81% of the general population), with 27,934 deaths and 39.78% of the country's total population fully vaccinated. This last figure is much higher than in the countries that surround Chile as well as some of the European continent, such as Spain [13].

Regarding the effects of the physiological symptoms of the disease, cough, dyspnea, anosmia, generalized fatigue, and respiratory type problems predominate, as well as an increased risk of thromboembolic events as a result of the inflammatory state generated by the cytokine storm [14–17], although many infected persons remain asymptomatic [18]. As for the adoption of preventive measures, it has been shown that they have contributed to reducing the impact of the pandemic in those countries where they have been adopted early, with Chile having carried out a high number of diagnostic tests [19]. Several studies have been carried out to determine the factors that influence the use of preventive measures to prevent COVID-19 and their association with the development of psychological distress. It has been determined that "hand washing" was the most widely used preventive measure in Spain during the first phase of the pandemic [20], that preventive measures will depend on the risk perception acquired [21], and that psychological distress depends on the high perceived costs of adherence to the preventive measures [22], uncomfortable feeling of wearing personal protective equipment, or the public ignorance of preventive measures [23].

One of the main characteristics of the COVID-19 pandemic is that it has been classified as a "psychological pandemic", with great effects on the mental health of the general population and, especially, on health professionals, who have been directly involved in the care of patients with COVID-19 [16,24–26]. In this sense, greater psychological affectation has been shown in professionals who were quarantined, who worked in COVID-19 units, or had a family member or friend infected with COVID-19. These effects manifested more through greater depression, anxiety, frustration, fear, and post-traumatic stress than in those persons who did not have such experience [27].

Regarding the general population, women [24], young people, the self-employed, individuals with previous psychological issues whose follow-up was interrupted [28], immigrants, or workers of essential activities and in contact with the public were the most affected strata [26,29]. Higher levels of stress, depression, or anxiety have been found in these groups [15,24,30–32], as well as somatization [24] and psychiatric disorders [17], especially in those patients with previous mental problems [33,34]. However, a study conducted in 21 countries, including Chile, did not find an increase in the number of suicides in the first months of the pandemic [35]. The psychological impact of the pandemic has manifested itself even in countries with low infection rates and good initial management of the outbreak, such as South Korea. In this population, symptoms of stress, anxiety, depression, and sleeping difficulties have been reported, albeit to a minimal or moderate degree. [36].

Among these findings, it is noteworthy that, although older people have a higher risk of suffering from serious illness due to COVID-19, they show fewer negative effects on their emotional health than young people [37], something also proven in other countries [38]. However, the elderly population is more vulnerable to stigma related to COVID-19. As an at-risk population, they are known to be more likely to be affected by the disease and this can lead to stigmatization, resulting in social rejection, isolation, and discrimination [39].

These works, carried out at the international level, provide an overview of the state of mental health among the population during the COVID-19 pandemic. However, there is currently no data that records this situation in Chile, that is, the psychological impact of the pandemic on the Chilean population has not been described. Thus, the novelty of this work lies in being the first to study this problem in Chile. The results would help measure and describe the impact of the pandemic, guide strategies for managing and addressing the crisis, and design interventions adapted to the needs of the Chilean population, as well as to develop a prevention plan for similar future situations.

Therefore, the objective of this article is to present the effects of the first wave of the COVID-19 pandemic on the mental health of Chileans, in particular, in the development of psychological distress. In this sense, it is intended to analyze the possible association with sociodemographic variables, perception of health, physical symptoms, having required health care, having received diagnostic tests, adoption of preventive measures, or contact history, among others.
