Individual health has been dramatically affected when the COVID-19 pandemic started, due to the great extent of restrictions that each country imposed in order to reduce the spread of SARS-CoV-2. This crisis, which began in 2020, has limited human freedom due to the decrease of local and international mobility, confinement, and the prohibition of mass gatherings (1, 2). Rapid adoption of home isolation and quarantine, on the one side, has reduced infection and death increase; and, on the other hand, it has seriously affected economy worldwide (3, 4).

However, quarantines have been unequal among countries. COVID-19 has led to social isolation in short periods in several countries (5); while in others, it has extended over many months (6). Quarantines have also been subject to qualitative and quantitative factors that have impacted the comfort or discomfort during the lockdowns all around the world (7). Thus, higher-income populations with more resources and spaces have not shown significant changes in their well-being according to what some studies report (8, 9), however, a comprehensive analysis of families across different countries has not yet been conducted.

COVID-19 lockdowns have negatively impacted mental health in general population (10, 11) and quarantines have caused neuropsychiatric disorders in several parts of the world (12), which have worsened quality of life (QoL) (13, 14). QoL refers to an individual’s overall well-being and satisfaction with various aspects of their existence, including physical health, psychological state, social relationships, and living conditions (15). QoL encompasses subjective perceptions and objective measures that contribute to one’s overall life experience and sense of fulfillment. This QoL change can vary according to the characteristics of the population, which include family composition, as well as the quarantine period.

This study sought to assess the QoL of individuals, and families during the mandatory home quarantine related to the COVID-19 pandemic. A primary objective was to compare the results of QoL among countries during the 2020 COVID-19 outbreak. The research also aimed to understand the QoL between members of the family and inter-family’s QoL that were forced to live together under quarantine during the ongoing pandemic.

The international study, conducted during the first outbreak of COVID-19, showed a sharp drop in QoL in all seven countries. The countries most affected by COVID-19 are those with the lowest overall QoL (Japan in Asia, Russia and Spain in Europe), showing differences in maintaining high scores on the social dimension. In addition, subgroup analysis demonstrated that QoL was reduced regardless of family structure.

The main strength of the study is that, to the best of our knowledge, this is the first international study that has compared the QoL at the start of the pandemic in 2020 between countries in Europe and America. In addition, there are several reports (14, 27, 28) that have quantified the QoL of life during the pandemic but have not focused their analysis according to the type of family during the first outbreak of SARS-CoV-2, in this sense this study contributes to understanding the initial effects of COVID-19 on the quality of life of populations. Although mental health has been a recurring theme during the lockdown, some previous studies have not estimated the impact of the pandemic on QoL (20), while others have not delved into a multidimensional analysis of QoL (29–31). However, as in this study, the investigations that have used the WHOQOL-BREF have managed to delve into the components of the QoL and carry out a comprehensive assessment of its status (20–23, 32, 33).

Prolonged isolation, social distancing, and government policies can negatively impact QoL in populations (30, 34). Confinement can reduce the quality of sleep, daily physical activity, and social relationships, negatively impacting the well-being of the general population (35). Our results show that the impact of preventive measures, as well as the consequences of the pandemic in terms of deaths and daily infections, worsened the QoL following a geographic mark. In other words, where the peaks of infections occurred, the QoL was more lowered, as in Spain, while the countries with few cases or with the establishment of the lockdown due to COVID-19 had slightly higher levels. Although, all the countries assessed presented low levels of QoL (<50 points in WHOQOL-BREF), coinciding with studies in other countries (10, 11, 27, 29, 36).

Community indicators (infection rate) can affect and reduce QoL (33). In our study, we have seen that there is a marked reduction in countries with high rates of infections and deaths from COVID-19, although we did not show significant differences with countries with lower indicators of infection (South American countries). This may be explained at the multidimensional level of the QoL since interestingly the highest dimension was social relationships, even in Spain where the averages were low, and the pandemic had high peaks in infections and deaths, an average of 40 points in the QoL score. Social relationships have been seen to be maintained during confinement, and these relationships have been important vehicles for communication and emotional support worldwide, and as such, they have been preserved (32, 33, 37). During the period of restrictions established by the health emergency, populations must be protected and provided with truthful information and economic and social support (36). This issue is key to avoiding post-lockdown costs and problems that can cause a “wave” of damages after the aggressive event.

On the other hand, the imprint left by the pandemic in 2020 has also been affecting the well-being of its population, as the QoL remained low throughout the pandemic once it started (32, 38). As the COVID-19 outbreaks moved from Asia to Europe and the Americas, the QoL scores showed the effects of the pandemic on their low scores. The study was conducted at a time when European countries were being hit hard by COVID-19, which could explain the striking differences we found in mental, physical and environmental health. As the wake of the pandemic swept across Asia and Europe, a surge in mental health issues such as depression and anxiety ensued, precipitating a decline in the well-being of the affected population (39–41). In Latin America, the pandemic has triggered a substantial outbreak, prompting varied health responses with varying degrees of efficacy (17). These communities may face heightened mental health challenges due to a lack of culturally appropriate action policies (42, 43), which leads to significantly increased suicide risk has been reported (44). Indeed, the indigenous and rural Andean populations in Latin America have witnessed a reduction in their QOL, coupled with an upswing in mental health concerns such as anxiety, depression, and stress (38, 45). Further research should focus on comprehensively understanding the impact of COVID-19 on the well-being of populations worldwide.

Analysis of families revealed some differences in quality of life in terms of physical and mental health. Several studies have shown that QoL varies by family type (46), however, this study is the first of its kind to identify QoL levels in families in quarantine. The pandemic has affected families, mainly family leaders and women, by reducing their wellbeing (47). These results are consistent with our findings showing lower overall QoL among households. This family psychological distress may be exacerbated if your family members have chronic illnesses, as they experience greater psychiatric problems and lower quality of life during isolation (31). These effects have been seen in sibling family members (46) and will depend on family membership and pre-existing conditions. Consistent with our findings, several investigations have shown that women’s quality of life deteriorated during the pandemic (27, 29, 32, 36, 47). In addition, there are disparities between relatives in different age groups (8, 27, 30, 35), and we show differences in physical and mental health between young and old. These family characteristics are determinative of family well-being and may contribute to the persistence, reduction, or worsening of pre-existing conditions in certain sibling family members (31, 48–50).

This study had limitations. First, the generalizability of the findings was limited by participant selection bias, as only those with access to the virtual survey participated. While language was not an issue, as WHOQOL-BREF is available for research in several languages, samples were drawn voluntarily from each country and differences were found in the numbers of participants, which could have affected the conclusions of the study. Also, QoL is a concept that may be limited by survey understanding, but we were not able to assess it. Another limitation of this cross-sectional study is the inability to establish a causal relationship between the variables studied. This has prevented us from differentiating the effect of COVID-19 on pre-existing QoL, making it worse or better (38). Nonetheless, our inclusion of demographic and household data potentially facilitated participants’ accurate responses. Another aspect to consider is the temporal factor; the prevailing conditions related to COVID-19, as dictated by local and governmental measures (restrictions), might have influenced participants’ QoL responses. However, the effectiveness of the WHOQOL-BREF (19, 21–23) has managed to provide a quick overview of the QoL among families in the seven countries evaluated. Although the WHOQOL-BREF questionnaire is self-reported, this is one of the best instruments to assess QoL in the general population for clinical and research propose (51–53). Lastly, it is worth noting that a significant portion (around 76%) of participants were employed as health professionals, which could have conceivably impacted their questionnaire responses. The impact of the pandemic on healthcare workers has been profound, giving rise to a multitude of mental health challenges stemming from the overwhelming responsibilities, close interaction with patients, mobility constraints, and the persistent fear of contracting and transmitting the virus (2, 17, 54–56). While it is acknowledged that our findings may potentially bear the influence of these circumstances within the population, it’s crucial to underscore that our study also encompassed the assessment of QoL in family members. This broader scope allows us to contextualize well-being on a global over-individual scale. In the pursuit of a comprehensive understanding, it is imperative for future research to delve into a comparative analysis of our results with families not affiliated with healthcare professions. This comparative approach will provide valuable insights into the potential variations or parallels in QoL, thus contributing to a more nuanced comprehension of the factors at play.

Families from seven countries in Europe, Asia, and South America reported poor QoL during the first outbreak of COVID-19. This indicates that the pandemic prevention measures and disease burden impacted population well-being. However, the scores for social relations have been high, regardless of the social and epidemiological scenario of each country. In this sense, communication networks must also be key tools to face the debacle of the health of families in quarantine. This information can be used to inform international policymakers about how the deterioration of well-being during the lockdown has escalated to propose the development of personalized support services, adapted to each society and culture, and that cover the needs health of these families.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by Ethics approval was granted by the Universidad Norbert Wiener Research Ethics Committee (Registry No. 2020-146-121-RRR-UNW). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.

JM-S primarily carried out the study, wrote first drafts, and revised all documentation. JM-S, HC-P, and JM-E equally contributed to the design and supervision of the study and revised all study documentation, and the manuscript. EC-H, AJ-Q, and BC provided advice during the study and helped revise study documentation. EC-H, HC-P, and JM-S reviewed the manuscript. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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