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Original research
Relationship between self-care activities, stress and well-being during COVID-19 lockdown: a cross-cultural mediation model
  1. Elkin Luis1,2,
  2. Elena Bermejo-Martins2,3,
  3. Martín Martinez1,2,
  4. Ainize Sarrionandia4,
  5. Cristian Cortes5,
  6. Edwin Yair Oliveros6,
  7. María Sol Garces7,
  8. José Victor Oron8,
  9. Pablo Fernández-Berrocal9
  1. 1School of Education and Psychology, University of Navarra, Pamplona, Spain
  2. 2IdiSNA, Navarre Institute of Health Research, Pamplona, Spain
  3. 3Faculty of Nursing, Department of Community Nursing and Midwifery, University of Navarra, Pamplona, Spain
  4. 4Faculty of Psychology, University of the Basque Country, Donostia, Spain
  5. 5Faculty of Psychology, Universidad del Desarrollo, Santiago de Chile, Chile
  6. 6School of Psychology, University of San Buenaventura, Bogotá, Colombia
  7. 7Neuroscience Institute, Universidad San Francisco de Quito, Quito, Ecuador
  8. 8UpToYou Fundation, Pamplona, Spain
  9. 9Faculty of Psychology, University of Malaga, Malaga, Spain
  1. Correspondence to Dr Elena Bermejo-Martins; ebermejo{at}


Objectives To examine the mediation role of self-care between stress and psychological well-being in the general population of four countries and to assess the impact of sociodemographic variables on this relationship.

Design Cross-sectional, online survey.

Participants A stratified sample of confined general population (N=1082) from four Ibero-American countries—Chile (n=261), Colombia (n=268), Ecuador (n=282) and Spain (n=271)—balanced by age and gender.

Primary outcomes measures Sociodemographic information (age, gender, country, education and income level), information related to COVID-19 lockdown (number of days in quarantine, number of people with whom the individuals live, absence/presence of adults and minors in charge and attitude towards the search of information related to COVID-19), Perceived Stress Scale-10, Ryff’s Psychological Well-Being Scale-29 and Self-Care Activities Screening Scale-14.

Results Self-care partially mediates the relationship between stress and well-being during COVID-19 confinement in the general population in the total sample (F (3,1078)=370.01, p<0.001, R2=0.507) and in each country. On the other hand, among the evaluated sociodemographic variables, only age affects this relationship.

Conclusion The results have broad implications for public health, highlighting the importance of promoting people’s active role in their own care and health behaviour to improve psychological well-being if stress management and social determinants of health are jointly addressed first. The present study provides the first transnational evidence from the earlier stages of the COVID-19 lockdown, showing that the higher perception of stress, the less self-care activities are adopted, and in turn the lower the beneficial effects on well-being.

  • COVID-19
  • mental health
  • preventive medicine
  • primary care
  • public health

Data availability statement

No data are available.

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  • Contributors EL, EB-M, AS and PF-B: contributed to the conceptualisation, data curation, formal analysis, investigation, methodology and writing - original draft. EL, EB-M and PF-B: supervision. MM: data curation, formal analysis and methodology. AS, EYO, CC, MSG and JVO: investigation, methodology and resources. EL is responsible for the overall content as the guarantor. All authors contributed to reviewing and editing the final manuscript.

  • Funding This research was partially supported by the following projects: PSI2017–84170–R to PF-B and UMA18–FEDERJA–114 to PF-B.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.