**1. Introduction**

In 2019, the world was surprised by a pandemic caused by the new coronavirus (SARS-CoV-2), which was called COVID-19. COVID-19 began in Wuhan, China, and soon spread to the rest of the world. As of February 2021, there were 111,102,016 cases of infection by the new coronavirus and 2,462,911 deaths worldwide [1]. In Portugal, the number of confirmed cases of COVID-19 infection is 798,074 and the number of deaths is 16,023 [2]. Being an unknown virus, much research has been done in relation to it and

Gómez-Salgado, J.; Martins, R.; Allande-Cussó, R.; Ruiz-Frutos, C.; Frade, J. Impact on the Mental and Physical Health of the Portuguese Population during the COVID-19 Confinement. *J. Clin. Med.* **2021**, *10*, 4464. https://doi.org/ 10.3390/jcm10194464

**Citation:** Frade, F.; Jacobsohn, L.;

Academic Editor: Michele Roccella

Received: 27 July 2021 Accepted: 22 September 2021 Published: 28 September 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/).

also in relation to the impact it has had on the physical and psychological health of people living through the pandemic caused by it. The main physical signs and symptoms of the infection are fever, dry cough, dyspnea, odynophagia, headache, myalgia, chills, nausea, vomiting, diarrhoea, hemoptysis, and conjunctival congestion. The main psychological effects of the virus influence people's mental health, causing higher levels of stress, anxiety, psychological distress, and depression [3–8].

In the specific case of Portugal, in response to the rapid epidemiological evolution of the COVID-19 disease, and with the aim of containing the virus and moderating the social, health, and economic impact of the pandemic, a state of alarm was declared on 18 March 2020 [9]. During the state of emergency, mandatory confinement measures were adopted for infection control, like the limitation of free movement of citizens, favoring teleworking (except for essential professions for basic needs like health, food, and safety), face-to-face teaching activities were suspended in favor of online teaching (in different levels of education), and cultural, sporting, and religious activities were suspended. The obligation to maintain social distance, use of masks, and compliance with respiratory etiquette was maintained. Deconfinement began at the beginning of May. At this stage, the general infection control measures included the mandatory use of a mask; compliance with respiratory etiquette; maintaining social distance; avoiding contact with people who present symptoms suggestive of COVID-19; working from home whenever possible (telework); prioritizing using the telephone or electronic services to get in touch with other services, such as supermarkets, pharmacies, or other; contacting the health services in advance in case of need for medical care; and avoiding crowded places, unnecessary contacts (inside or outside the home), and promotion of or participation in events that bring together many people [2,9].

The impact of the COVID-19 pandemic on the physical and mental health of the population is undeniable, and the published evidence describes it as such [10]. Thus, it is estimated that 38.2% of the European population has psychological disorders related to COVID-19 [11]. Social distancing and self-isolation during the COVID-19 pandemic have challenged people's mental health and general well-being, contributing to increased mental health problems which include depression, anxiety, mood disorder, psychological distress, post-traumatic stress disorder, insomnia, fear, stigma, lack of self-esteem, and lack of self-control [12].

The risk factors that compromise the psychological well-being of people experiencing the COVID-19 pandemic are fear of not having economic conditions for the goods of first necessity and for food, fear of quarantine, level of health perception, degree of risk control, and risk perception. Other studies reveal, as risk factors for psychological wellbeing, the perception of increased risk of SARS, a history of contact with people tested positive, feeling symptoms similar to those of SARS, loss of social contact and breaking of family routines, and increase of sedentary behaviors [7,12–16]. Given the variability in the risk factors for developing psychological distress, and the protective factors identified, it is worth considering the need for further studies to refine these results. Despite the agreement on the presence of psychological distress during the COVID-19 pandemic situation, the characteristics of the population are disparate, and more variables need to be controlled [13].

In Portugal, the few studies conducted during the COVID-19 pandemic show that the Portuguese population deteriorated in their mental health conditions during the pandemic, and the percentage of anxiety and depression is evident [14]. Other symptoms presented by the Portuguese population are poor sleep quality, insomnia, fear, anxiety, depression, and obsessive-compulsive symptoms due to COVID-19 [15,16].

Studies carried out in Portugal have focused on identifying the percentages of psychological factors in the Portuguese population during the pandemic and listing different symptoms. In our study, in addition to identifying the psychological factors present in the Portuguese population, we also identify the factors that predict their development, thus making it possible to plan action measures that can be implemented with the aim of

reducing the presence of these factors in other pandemic situations. Thus, the aim of this study is to analyze psychological distress in a Portuguese population sample during the COVID-19 pandemic to identify the existence of related sociodemographic and specific health factors.
