Emotional symptoms, mental fatigue and behavioral adherence after 72 continuous days of strict lockdown during the COVID-19 pandemic in Argentina

Torrente, F.; Yoris, A. E.; Low, D. M.; Lopez, P.; Bekinschtein, P.; Vazquez, G.; Manes, F.; Cetkovich, M.

Background: An early, total, and prolonged lockdown was adopted in Argentina during the first wave of COVID-19 as the main sanitary strategy to reduce the spread of the virus in the population. Reports from early stages of the lockdown evidenced elevated emotional symptomatology. Aims: The aim of this study was to explore: 1) if the prolongation of the lockdown was associated with elevated emotional symptoms; 2) if the prolonged lockdown affected adherence, a phenomenon called 'behavioral fatigue'; and 3) how financial concerns in a developing country affected adherence to the lockdown and emotional status of the population. Method: A survey was designed to evaluate the psychological correlates of the pandemic after an average of 72 days of continuous lockdown in Argentina.. The survey included standardized questionnaires to assess the severity of depressive (PHQ-9) and anxious (GAD-7) symptoms, a questionnaire to evaluate mental fatigue, and several additional instruments to assess other variables of interest: risk perception, lockdown adherence, financial concerns, daily stress, loneliness, intolerance to uncertainty, negative repetitive thinking, and cognitive problems. Three LASSO regression analyses were carried to evaluate the predictive role of the different variables over depression, anxiety, and lockdown adherence Results: The survey was responded by 3617 individuals over the age of 18 (85.2% female) from all the provinces of Argentina. Using the Oxford stringency index, Argentina had one of the most stringent and prolonged lockdowns when the sample was collected with 63 to 77 continuous days with a stringency index of more than 85/100. 45.6% of the sample met the cut-off for depression and 27% for anxiety. Previous mental health treatment, low income, being younger, and being female were associated with higher levels of emotional symptoms. Mental fatigue, cognitive failures, and financial concerns were also associated with emotional and subjective complaints, but not with adherence to the lockdown. In the regression models, mental fatigue, cognitive failures, and loneliness were the most important variables to predict depression, meanwhile intolerance to uncertainty and lockdown difficulty were the most important in the case of anxiety. Perceived threat was the most important variable predicting lockdown adherence. Conclusions: Emotional symptoms persisted and even increased during the extended lockdown, but we found no evidence of behavioral fatigue. Instead, mental fatigue, cognitive difficulties, and financial concerns were expressions of the emotional side of the pandemic and the restrictive measures.