**4. Discussion**

As previously mentioned, the development of psychological effects, especially PD, is an event that is closely related to the occurrence of the COVID-19 pandemic. In the present study, a high percentage of people with a high level of PD (78.83%) has been observed, with a ≥ 3 cut-off point in the GHQ-12, data that are above those obtained in Spain (71.98%) with a similar study methodology and cut-off point [20]. The choice of cut-off point at this given level (≥3) should be considered when comparing with other studies. These results are consistent with those obtained in previous similar studies [43–45].

It has been suggested that once key responses are adopted at the public health level, such as diagnostic testing, contact tracking, lockdown, and the management of confirmed cases of COVID-19, perhaps it is time to prioritize measures to safeguard the mental health of Chileans [46]. Even more, with the knowledge that the percentage of the population fully vaccinated has achieved higher levels than in other countries of the same geographical environment [13]. However, the speed in vaccinating the population may have caused an unjustified optimism that led to the abandonment of preventive measures after the first dose of the vaccine and, as the PAHO Director stated, "the vaccine alone is not going to stop the pandemic" [47].

Therefore, it seems that there is still time to prevent serious effects on mental health, since studies conducted in 21 countries, including Chile, have not observed, for instance, that high levels of PD, as the ones found in the study at hand, have led to an increase in the number of suicides in the first months of the pandemic [35].

In a somewhat contradictory way, a high percentage of the studied population claims to have an excellent self-perception of health during the last 14 days (76.8%), being the variable that mostly predicts PD, in the same way that it is known that PD is a highly reliable predictor of mortality [42]. This leads to a certain degree of optimism if measures are taken in time to enhance protective factors and mitigate the effects of the foreseeable economic recession resulting from this health crisis [35].

Differences have been seen between the symptoms found in a group of Latin American countries, the most common being cough (60.1%), fatigue/tiredness (52.0%), sore throat (50.3%), and fever (44.2%) [16], while in the present study, the most frequent symptoms have been: headache (53.6%), rhinitis (34.8%), muscle pain (26.2%), cough (20.0%), and sore throat (19.4%). In a study carried out in Spain with the same methodology, both headache and muscle pain had similar figures, but sore throat and cough had significantly higher values, while rhinitis occurred at higher rates in Chile [40]. This difference could be explained to some extent by the sociodemographic variables, the different information received by the populations of these countries, or even by being in different climatic seasons derived from belonging to the northern or southern hemisphere. In the study at hand, the three symptoms that predict PD are diarrhea, headache, and muscle pain.

The sex and age variables, as well as living with children, predict the level of PD, as has been also referred to in the literature [24,28,29,38,48–51].

Having a history of contact is associated with the presence of PD, both through contact with contaminated people or material, or with infected relatives, but it is the variable "having been in casual contact with an infected person" that mostly predicts PD, something already corroborated in previous studies [27].

It is well known that the proper and early use of preventive measures to avoid COVID-19 produces benefits in terms of health [52]. In this sense, the preventive measures with a higher valuation are: "wearing a mask regardless of the presence of symptoms" and "washing hands with soap and water". This second measure coincides with the study carried out in Spain [20], but the use of a mask receives a much higher value in Chile. This could be explained by the fact that the data collection was carried out in Spain in earlier dates than in Chile, and during the first months of the pandemic, in Spain there was no such recommendation for the widespread use of the mask, and there were even supply problems.

On the other hand, in other studies carried out in Chile, it was found that males and people under 60 years of age were the most compliant groups with the preventive measures established by the Government, while in Colombia or Ecuador, it was women and the elderly who complied the most [48].

When designing public health policies, the stressors identified in the literature, which are related to financial, academic, and family concerns, should be taken into account, the stress of confinement being a clear predictor of mental health [24], and obviously influencing the conditions of the home of the confined person. In the present study, we have found that PD is associated with living in houses with no exterior exit (house without a balcony, terrace, yard, or garden), identifying this as the most potentially stressful type of housing, an issue that would be convenient to consider when planning urban development.

Living without a partner and not having children are other stressor variables identified in this study, which highlight the importance of family support in pandemic situations, as the importance of social support has been observed with other health problems [53].

Compared with all six Latin American countries that have been studied (Argentina, Brazil, Chile, Colombia, Mexico, and Peru), Chile is the country shown to have positive variables against COVID-19, since it has a lower percentage of poverty, higher level of schooling, and the best health system. On the contrary, it has a high percentage of the population over 65 years of age, and it adopted a partial and not total lockdown, unlike other surrounding countries [54]. Another positive factor is the fast pace of vaccination administration, higher not only than other Latin American countries, but even higher than some European countries, such as Spain [13].

On the other hand, health professionals, as previously mentioned, are a group with high levels of PD and other indicators of poor mental health [16,33], while in the present study, show a lower percentage of PD than non-health professionals. One possible explanation may be the invisibility of non-health workers in situations of risk (e.g., delivery staff, cleaners, drivers, law enforcement bodies), who, being essential jobs, have had to continue performing their work during lockdown, being in contact with contaminated people or objects and for whom vaccination has not been established as a priority, as has been the case with health professionals. Other explanations may be the effect of teleworking, increased lockdown, or greater effects on the economy, with its consequent impact on PD [55] or the social support they have had during the pandemic [56], although the latter has not been observed in other studies [57].

In this socio-economic context, and based on the levels of PD found in the study, the adoption of preventive measures focused on the prevention of possible mental effects in high-risk populations is considered of special relevance.

The limitations of this research are the same as those of all descriptive studies without randomized sampling, along with those related to online access to data, which leave out groups without internet access or without knowledge for its use. This can be seen in that 59.25% of the participants had a university level of education or higher. Moreover, online data collection does not guarantee a homogeneous territorial distribution, with some areas of the country being more affected than others. However, the characteristics of the study advised applying the sampling used. In addition, this research has been carried out with the same methodology in 18 countries in Latin America and Europe, which will facilitate comparisons in the near future that will allow increasing the available evidence on the issue

studied. This methodology was also chosen for the Eurofound study and promoted by the European Union [40], but its results did not allow for causal associations to be obtained and will require future studies with more appropriate designs to test the hypotheses detected. Another limitation is the difficulty in answering certain questions, such as "whether having touched contaminated objects" or "having been in contact with sick people during the previous 14 days". Similarly, the GHQ is a general measure of mental health, although it is a widely used and highly reliable indicator. In our study, it obtained an α-Cronbach's score = 0.910.
