**3. Results**

The study sample comprised 3261 subjects, with a majority of women over men (81.69% versus 18.31%). The age of the participants ranged from 18 to 93, with a mean of 40.53 years (SD ± 14.05). Of the 2412 participants who were previously working or studying, 66.92% (*n* = 1614) continued working or telecommute during the home confinement phase. At the time of completing the survey, 3.25% of participants reported that they had suffered or were currently suffering from COVID-19 infection. The perception of having received insufficient information about the infection by COVID-19 was generalized, with 2043 persons reporting it. The time elapsed between the beginning of home confinement and the filling of the questionnaire ranged between 4 and 57 days. The mean differential score obtained in the OBQ was (−10.45) (SD ± 18.25).

When comparing the differential scores of the occupational balance with the sociodemographic variables, marital status, educational level, employment status, private access to the outside, and housing size were related to disturbances in occupational balance (Table 1). Widowers were the group with the lowest occupational balance during home confinement when compared with married (*p* < 0.001) and single (*p* = 0.003) people. In terms of employment status, subjects with active employment status presented a greater occupational balance than students (*p* < 0.001), unemployed people (*p* = 0.001), and retired people (*p* < 0.001). Likewise, a higher occupational balance was observed in the students in relation to the unemployed (*p* = 0.05). A greater trend toward occupational balance was observed with higher levels of education and larger housing sizes. Private access to the outside showed a strong effect size on the differential scores of the occupational balance (*p* = 0.001; η<sup>2</sup> *p* = 0.212), whereas the effect size of the employment status was minimal (*p* < 0.001; g = 0.14).

Likewise, the differential scores of occupational balance were weakly and positively correlated with age (*p* = 0.048) and the number of children under 18 years old at home (*p* = 0.003), and were weakly and negatively with the number of days in confinement (*p* < 0.001), with a greater mismatch over the days. At home, the number of people living together (*p* = 0.252), the number of dependents (*p* = 0.061), and the number of rooms (*p* = 0.232) did not show a significant relationship with the differential scores of occupational balance produced by confinement (Table 2).

The comparison of the differential scores of occupational balance according to the COVID-19-related variables showed a lower occupational balance in people who were not telecommuting previously (*p* = 0.033; g = 0.087), people who were infected by the virus (*p* = 0.004; g = 0.470) or isolated (*p* = 0.048; g = 0.165) at the time of filling in the form, and people who perceived the information received regarding the pandemic as insufficient (*p* < 0.001; g = 0.191) (Table 3). All of these factors showed a strong effect size on the differential scores of occupational balances except telecommuting, for which it was moderate.



*n*: Number of patients; OBQ: Occupational Balance Questionnaire; SD: Standard deviation; Effect size: \* Hedge's' g, \*\* Partial eta squared (n2 *p*).



OBQ: Occupational Balance Questionnaire; SD: Standard deviation.

Multivariate analysis showed that the major contributors to higher occupational balance during the confinement phase were age, the perception of having received enough information, not telecommuting, and not being infected by the COVID-19 at the time of filling out the form (Table 4). Other factors included in the regression model were not significantly associated with occupational balance.


**Table 3.** Comparison of differential scores in the OBQ according to COVID-19-related variables.

*n*: Number of patients; OBQ: Occupational Balance Questionnaire; SD: Standard deviation; Effect size: Hedge´s; COVID-19: Coronavirus disease.

**Table 4.** Multiple linear regression analysis of independent predictive factors related to COVID-19 infection for a higher occupational balance.


COVID-19: Coronavirus disease.

#### **4. Discussion**

The measures adopted to contain the spread of the COVID-19 outbreak, based on forced social distancing and home confinement, were not significantly related to occupational balance in the Spanish population. A low educational level, being unemployed, being a widower or not having a partner, living in small house without private access to the outside, having a fewer number of children under 18 years old at home, being isolated, and spending a greater number of days in home confinement were related to a lower occupational balance. Regarding the variables related to COVID-19 infection, being older, the perception of having received enough information during the pandemic, not telecommuting, and not being infected at the time of filling out the form were independent predictive factors of a higher occupational balance.

People are born with an innate occupational nature, which drives them to occupy themselves and build their occupational identity. However, heterogeneity in what each person considers important makes it difficult to determine who is most vulnerable to suffering disturbances in occupational balance [34].

Despite being one of the first studies to describe the factors related to the occupational balance during home confinement, some research has already explored the differences between sociodemographic groups. Matuska et al. [13] observed that the profile of the people with a higher occupational balance was those 61 years or older, who had earned a master´s degree, and who had children under their care. Similar results were found in this study.

People with active employment, including those who went to the workplace in person and those who telecommuted from home, did not suffer a revealing disturbance in occupational balance compared to those who were unemployed, retired, or students. This result is consistent with previous research, in which financial security, provided by having a job, was a determining factor in achieving balance with occupations and with life [34,35].

The study by Wagman et al. [34], whose objective was to explore the factors that people consider to be more or less relevant to occupational balance, showed the importance of social relationships. A systematic review by Kamalakannan and Chakraborty [36] highlighted the limited attention paid to occupations during the COVID-19 outbreak compared to previous pandemics. In addition, these authors observed that people whose most significant occupations were related to social and leisure activities were most affected by home confinement. In this study, despite the lack of evidence of a significant relationship between the number of people living at home and occupational balance, widowers showed lower occupational balance than single people and people who lived with a partner, as well as those who were isolated in a single room at some point in home confinement. These findings reiterate the importance of social relationships in achieving occupational balance, highlighting the interpersonal perspective mentioned above [11].

There is a trend for a worse occupational balance as the days of home confinement progress, probably due to increased levels of stress, anxiety and depression [23]. Occupational balance is significantly and positively correlated with physical and mental health [6,22,34,37] and predicts the perceived stress by the general population [13], with a higher incidence in so-called risk groups [38].

In a recent study carried out in the Spanish population, it was shown that certain sociodemographic characteristics, such as being female, having minor children, and having a low educational level, increased the perception of threat of COVID-19 infection, facilitating the appearance of symptoms of anxiety or stress [38]. The results of another study, whose objective was to analyze the relation between the psychological impact of the pandemic and the national confinement experienced in Spain, concluded that excessive exposure to the mass media, living with individuals with chronical illness, and living with children under 12 years old increased fears of COVID-19 infection and its emotional consequences. However, an older age, a higher income level, working outside the home, having a private garden at home, and having positive affection have been considered protective factors [39]. The abovementioned results partially coincide with those obtained in this study, since factors such as age, the perception of having received enough information, working outside the home, and not being infected by COVID-19 at the time of filling out the form contributed to a better occupational balance during home confinement.

This study gives a picture of the occupational balance of the Spanish population during the COVID-19 pandemic. However, the study findings must be considered within the context of their limitations. Despite the large sample size, it was not possible to overcome the limitation of a cross-sectional study, and we were unable to determine a causal relationship between the variables. The use of an online survey presented a selection bias in participant recruitment, which was expressed by some characteristics of the sample, such as the high number of females. Measuring occupational balance on a single occasion, but referring to two different moments in time, may have influenced the responses given by the participants. However, using this data collection strategy made it possible to determine the occupational balance of the participants prior to the forced social distancing phase to avoid the participants´ loss during the follow-up period. The use of a convenience sampling may have induced the collection of responses primarily from people who felt strongly about the considered issue. Also, the lack of studies on this topic made it difficult to contrast the results obtained. These limitations can reduce the generalizability of the findings and may have influenced the results of the study. The strengths of this study include the collection of data on a large sample of Spanish adults and the

analysis of a wide set of variables, including novel data such as length of confinement, telecommuting, and private access to the outside.

This type of research can promote social and health initiatives for the prevention and treatment of the possible effects of the pandemic and home confinement on the most vulnerable population, for example, by providing psychological and social support, promoting access to resources that reduce social isolation, or proposing measures to stop COVID-19 that take into account the needs of the population which affect their life balance.

Future studies are recommended to help understand and analyze the effects of the COVID-19 pandemic on people's occupational and mental health.
