At the end of 2019, the SARS-CoV-2 virus, which causes the coronavirus disease 2019 (COVID-19), was identified, which since then has rapidly spread throughout the world. Social confinement or isolation was the most important public health measure adopted by most countries to mitigate, attend to, and control the spread, as well as the effects of the pandemic during the first wave of COVID-19 (1). Mexico was no exception, with ~126 million inhabitants, and social confinement was based on the suspension of non-essential activities or those that would not affect the substantive activities of a public, social, or private organization such as activities in schools, offices, public works, factories, and/or some services (2). This measure was part of the so-called National Season of Healthy Distance (Jornada Nacional de Sana Distancia, in Spanish), a mandatory-yet-not legally reinforced social confinement strategy that started on 23 March 2020, postponed until 30 May 2020, and was accompanied by a modulated reopening strategy by an epidemiological traffic light starting 1 June 2020, which established the measures of social de-confinement depending on the spread of the virus in different regions of the country (3, 4). At the end of December 2020, the official data for Mexico City (CDMX), the national epicenter of the pandemic, reported around 264,000 confirmed cases of infected people (5).

More than 3 years after the start of the pandemic, we know that social confinement resulted in the partial or total cancellation of many formal or informal work activities, with strong impacts on the economy and severe consequences for the daily life routine of many families (6–10). Around the world, unemployment figures rose rapidly to double digits, with millions of people signing up for welfare payments, being women more affected than men by the economic instability (11, 12). The highest unemployment rates reported in Mexico in 2020 were located in the months of June, July, and August with an average of 2.8 million unemployed, while informal employment went from 20.7 million in April to 28.1 million in September, with a continuous increase during the following months (13). A study reported that during the same period, Mexican women were the ones most affected by unemployment and most of them have not yet recovered from it (14).

To date, various studies have explored living conditions in the context of lockdown and social distancing from an academic perspective in order to understand the aftermath that isolation has left on society (15–19). In general, we know that changes in the routine of lifestyle and the lack of physical contact with friends and family negatively affect the mental health of people of all ages (20). During the first months of the COVID-19 pandemic, stress, frustration, depression, anxiety, and panic disorder became integral parts of adult life. The presence of chronic illnesses, fear of acquiring the infection, the angst of infecting or losing a loved one, or the uncertainty of not having enough resources to survive have disrupted the dynamics of many families (21).

The social isolation and stay-at-home policies also contributed to increased vulnerabilities related to mental health, including domestic violence, which may manifest in physical, psychological, or economic forms (7, 22). In Mexico City, as in many regions of Latin America, confinement exacerbated this social phenomenon that has plagued society for decades, the domestic violence and the deterioration in mental health conditions, often related to economic recession, poverty, unemployment, school dropout, addiction, housing crisis, and reduced options for support, among other factors (23–25). The purpose of this article is to analyze the living conditions that occurred or were modified during the first wave of COVID-19 social confinement in a cohort from a metropolitan population in Mexico City. Our focus was set on exploring the presence of particular diseases, the modification of daily-life habits, the experiencing of episodes of violence, and the social support received as part of the follow-up of a group of volunteers participating in a cohort of CDMX.

This study aimed to investigate the effects of social confinement during the first wave of COVID-19 on certain living conditions of a group of volunteers participating in a cohort study of CDMX [previously described by Martínez-García et al. (29)]. Our results showed that during the first wave of COVID-19, the majority of the population that responded to our questionnaire belonged to low and medium social development strata, and the highest percentage of self-reported unemployment was among women. Men reported a higher prevalence of metabolic diseases and behavioral disorders than women. Social life and physical activity were the factors most affected during confinement, with a higher percentage of women reporting that they did not do any type of exercise at home and did not take adequate care of their diet.

Another finding of our study was that women reported a higher percentage of episodes of psychological (54.90%), verbal (36.27%), and emotional (31.37%) violence. Our results also identified different factors associated with violence, including age, unmarried status, neglect of feeding, and having presented symptoms related to COVID-19 without having undergone conclusive testing.

The COVID-19 pandemic has highlighted the need to promote self-care and healthy lifestyle habits to prevent chronic degenerative and metabolic comorbidities such as hypertension, diabetes mellitus, obesity, metabolic syndrome, and kidney disease (2). These comorbidities have been associated with the severity and worse prognosis of SARS-CoV-2 infection (31–33). In Mexico, as of March of 2022, Loza et al. reported the most prevalent comorbidities of near of six million COVID-19 confirmed cases related to hypertension (12.7%), obesity (10.5%), and diabetes (9.5%). In addition, the percentage of COVID-19-related deaths among people with diabetes and hypertension was 21.9 and 19.8%, respectively (2). Other studies have also reported that those who had died had presented with one or multiple comorbidities, nutritional deficiencies, and often had a history of smoking and a sedentary lifestyle, which could have made them more prone to serious complications (34, 35). Although the participants in our study came from a seemingly healthy population recruited well before the start of the pandemic, and at the time of applying the questionnaire, the majority neither had become ill with COVID-19 nor had their condition worsened. Our findings show that the participants already had a number of nutritional and metabolic comorbidities, as well as some mental and behavioral disorders, some of which were more prevalent in men than in women.

Exploring the effects of confinement on health habits such as eating disorders or physical activity is quite relevant in the context of a population such as the inhabitants of Mexico City, and given that in much of the Mexican population, there is a high level of food insecurity, a large problem of overweight and obesity, sedentary lifestyle, and high rates of the population with metabolic comorbidities (36–38). The preliminary reports of the study “PSY-COVID-19” (39), with more than 7,000 responses from Mexicans surveyed through a Google form, revealed that around half of the participants reduced their physical activity (more often men than women) and neglect their nutrition (more often women than men) during the first months of confinement (39). In our case, 38.31% of men and 42.78% of women did not perform any physical activity; however, 45.50% of men and 44.64% of women did take care of their nutrition. Derived from the experiences in terms of habit modification, the aforementioned study pointed out the importance of working on interventions to address situations such as appetite disorders or lack of motivation for physical activity related to adaptation to confinement and the ways of life of people (39).

On the other hand, although confinement helped to a great extent to contain the spread of COVID-19, the economic and social repercussions and the stress coping mechanisms that impacted health (e.g., excessive alcohol consumption and the use of cannabis, nicotine, and other drugs) are still being explored (40–42). In addition to impacting socioeconomic conditions, physical health, and mental health; social confinement also did so on family life and working conditions, with a greater effect on women (43). For instance, social confinement exposed gender inequalities related to the lack of employment and economic uncertainty (44). These vulnerable situations were perpetuated beyond the period of confinement and may have effects on the development of episodes of violence as those reported by the participants in this study (9.51% of prevalence of violence self-reported by women, see Table 4).

Consistent with these findings, in a recent Mexican study, based on data collected during 2020 through a remote survey of 47,819 women aged 15 years and older, Rivera et al. (25) reported an 11.5% of prevalence of violence against women, and the most reported acts were shouting, insults, or threats (4.3%) between 2020 and 2021 during the pandemic confinement. These authors also identified different factors associated with the episodes of violence, such as unemployment, being partially, and/or totally quarantined, being a family caregiver, binge drinking, and losing a family member to COVID-19 (25). The results from other studies regarding domestic violence during the same period of confinement in Mexico reported a 5.8% prevalence of episodes of violence against adult women, most of whom had already suffered some types of violence prior to the pandemic. This study revealed that the most reported acts of violence were emotional (4.3%), economical (2.1%), and physical (1.9%) (45). Unfortunately, our results also reflect this situation in some Mexican families, manifested mainly as psychological, verbal, and emotional violence, and their impact on socioeconomic vulnerabilities and mental health context has been little explored (44).

As already well-known, in situations of violence within homes, social isolation represents an opportunity to generate or maintain conditions of control and oppression, favored by the increase in contact time between the victim and the perpetrator, who is often the partner (27). Financial strain and isolation are also well-known domestic abuse risk factors, and both of these situations reduce the opportunities for people who are victims to ask for help (11). It is worth mentioning that the government of Mexico City made specific telephone lines available to the citizens for reporting gender violence and provided mental health support to those affected by the effects of confinement (23). According to Casas and Maldonado (14), there was a 45% increase in telephone complaints of domestic violence in Mexico during the second and third quarters of 2020. However, as Manrique de Lara and De Jesús Medina Arellano (44) pointed out, structural violence against women is often normalized in the Mexican context and has been exacerbated during the pandemic, affecting every sphere of society. Although health policies are being developed to provide life support services for victims of violence, the structural violence derived from the roles associated with care and domestic work that women face every day remains a neglected public health crisis in itself (44).

As we discussed, we found that suffering episodes of violence were significantly associated with being unmarried, as well as age, neglected feeding habits, or physical activity, and having had symptomatic COVID-19 infections. In connection to these issues, some studies have explored the effect of marital status (specifically, being unmarried) in relation to mental health during the lockdown from the beginning of the pandemic, but reports on the relationship with violence are somewhat limited. Ahmed et al. (46) found that women, students, unmarried individuals, and younger people were in more vulnerable positions in terms of demographics related to mental health during the pandemic in Bangladesh. Elhadi et al. (47) in turn, showed through multivariate analysis that being younger, women, unmarried, educated, or victims of domestic violence or abuse, having work suspension or increased workload, financial issues, suicidal thoughts, or a family member hospitalized due to COVID-19 were significantly associated with a high likelihood of mental disorders during the first months of the pandemic among the Libyan population. Additionally, Lee et al. (48) reported that higher levels of adverse mental health symptoms were associated with people who were single, reported a lower household income, had decreased support from friends or family, and increased stress at work or home during the COVID-19 pandemic in South Korea. Further studies may reveal how marital status may influence the observed effects of social confinement, particularly in the context of mental health. In fact, the medium- to long-term effects of social confinement on mental health are suspected to be substantial and remain far from being resolved (49).

The results of the present study further confirm some of these known trends and help contextualize them to highlight the interrelationship between biological, social, and emotional health conditions. In brief, this study has exposed some of the effects that social confinement during the COVID-19 pandemic had on certain living conditions, habits related to food, sleep, and physical activity, as well as people's daily lives and family relationships. This highlights the importance of interdisciplinary analysis, whose sole objective is to highlight the dimension of social vulnerabilities and their articulation with biological and mental factors for the generation of comprehensive health interventions.

The main living conditions modified among the volunteers were related to work, exercise, and food. With respect to violence and support networks, we consider them as a result of higher or structural categories. For example, different forms of violence can be related to historical–social processes that our society shares with the rest of Latin America, as well as being closely related to inequalities based on age, gender, and social capital (50, 51). Although some public policies have been implemented in Mexico to support victims of violence, it is largely unknown what effect they have had on the population during the pandemic (25). Within this study, we found that emotional and psychological conditions related to in-house violence were particularly salient. This highlights the importance of addressing mental health through public policies in our country in the post-pandemic era (52).

The findings of the present study revealed gender and socioeconomic differences in relation to the COVID-19 lockdown established in Mexico. These differences were observed in terms of places of work, the prevalence of metabolic diseases, mental, behavioral, and developmental disorders, as well as modified patterns of physical activity and social life.

The results of multivariate logistic models used to analyze the association between at-home violence episodes and various factors showed that such episodes were associated with age, being unmarried, neglecting self-care (including eating habits), and having suffered from COVID-19 infection with symptoms. All of these factors suggest potential vulnerability. Although the prevalence of violence, in general, was similar between men and women, certain types of violence were significantly more prevalent among women, including economic, emotional, psychological, and verbal violence.

We have also noticed that although some public policy measures were implemented to support both the general and vulnerable populations during the lockdown, < 10% of the participants (with no statistically significant gender differences) reported receiving any support. This fact underscores the need to evaluate and redesign such support policies to maximize their social impact. Studies like this one can continue to provide evidence for the ongoing monitoring and improvement of social support policies and raise awareness of the often-overlooked living conditions of vulnerable populations.

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

The studies involving human participants were reviewed and approved by IRB of the National Institute of Cardiology Ignacio Chavez (protocol code 13-802). The patients/participants provided their written informed consent to participate in this study.

SS-G performed the survey, organized the data, analyzed the data, and drafted the manuscript. AB-R performed the survey and organized the data. GG-E pre-processed and organized the data. EG-M supervised the survey and organized the data. MM-G devised and coordinated the project, contributed to the methodological strategy, performed calculations, analyzed the data, integrated the results, discussed results, drafted the manuscript, and co-supervised the project. EH-L designed the methodological approach, developed code, performed calculations, analyzed the data, discussed results, edited the manuscript, and co-supervised the project. All authors have read and approved the final manuscript.