Anxiety, depression, attitudes, and internet addiction during the initial phase of the 2019 coronavirus disease (COVID-19) epidemic: A cross-sectional study in México
Authors: Priego-Parra Bryan Adrián , Triana-Romero Arturo , Pinto-Gálvez Samanta Mayanin , Ramos Cristina Durán , Salas-Nolasco Omar , Reyes Marisol Manriquez , Ramos-de-la-Medina Antonio , Remes-Troche Jose María 
Published: May 2020

AbstractObjectivesTo describe the prevalence and distribution of anxiety and depression among Mexican population, and to examine its association with internet addiction during the COVID-19 outbreak.DesignA web-based cross-sectional study.SettingGeneral population in México.Participants561 subjects were recruited (71% female, mean age 30.7 ± 10.6 years).InterventionsAn online survey to assess personal attitudes and perceptions towards COVID-19, sleep-disorders related, the Mexican version of the Hospital Anxiety and Depression Scale (HADS) and the Internet Addiction Test (IAT) was applied.Primary and secondary outcome measuresPrevalence of anxiety, depression, internet addiction and sleep disorders and associated factors. Also, prevalence for anxiety and depression were compared to an historic control group.ResultsDuring the initial phase of the COVID-19 pandemic the prevalence for anxiety and depression was 50% (95% CI, 45.6% to 54.1%) and 27.6%, (95% CI 23.8% to 31.4%), respectively. We found a 51% (33% to 50%) increase in anxiety and up to 86% increase in depression during the initial weeks of the lock-down compared to the control group. According to the IAT questionnaire, 62.7% (95% CI 58.6% to 68.8%) of our population had some degree of internet addiction. Odds ratio for development of anxiety symptoms was 2.02 (95% CI1.56-2.1, p=0.0001) and for depression was 2.15 (95% CI 1.59-2.9, p=0.0001). In the multivariate analysis, younger age (p=0.006), sleep problems (p=0.000), and internet addiction (p=0.000) were associated with anxiety and depression.ConclusionsOur study provides valuable information on the psychological impact that the COVID-19 pandemic has had on the Mexican population. As in other parts of the globe, in Mexico, fear of SARS-CoV-2 infection has had devastating consequences on mental health, such as anxiety, depression and sleeping disturbances. Internet abuse and the consequent overexposure to rapidly spreading misinformation (infodemia) are associated to anxiety and depression.Strengths and limitations of this studyOur study have addressed the immediate psychological effect of the pandemic in the general population in a Latin American country, specifically in Mexico, a nation with high population density.Using the IAT (a specific tool to assess internet dependency), we found internet addiction was highly prevalent and correlated to anxiety and depression.We used the snowball sampling strategy; thus, our population is biased and may not reflect the actual pattern of general population.We decided to compare anxiety and depression with an historic cohort, and although this control group is not exactly matched to our studied population, the prevalence of anxiety and mood disorders are like those reported previously in Mexico.Other limitations include response bias due to fewer older subjects participating, the fact that sleep problems were not rigorously evaluated with a specific tool, and some states in our country were not represented in this work.