# Learning the hard way: What COVID-19 teaches us about the social determinants of mental health among the urban poor

## TL;DR

This study explores how the COVID-19 pandemic worsened mental health among urban-poor homemakers in Chile, highlighting financial stress and schooling challenges as key factors.

## Contribution

The study introduces a novel longitudinal analysis of social determinants of mental health during and after the pandemic in a marginalized urban population.

## Key findings

- Depressive symptoms were strongly linked to home-schooling difficulties during lockdown.
- Post-lockdown, financial stressors like debt and food insecurity were major contributors to poor mental health.
- Household conflicts over space consistently correlated with depressive symptoms.

## Abstract

The COVID-19 health crisis rapidly escalated into a broader social and economic emergency, affecting physical and mental health beyond the disease itself and placing a disproportionate burden on vulnerable populations. This study investigates the determinants of poor mental health related to COVID-19 among urban-poor homemakers residing in a social housing villa located on the outskirts of Santiago de Chile, a metropolitan city characterized by pronounced sociospatial segregation.

Capitalizing on the ongoing RUCAS cohort study, we introduced a COVID-19 module into the biannual RUCAS survey to assess the associations between COVID-19-related social determinants of poor mental health and symptoms of depression during and after the 2020 lockdown among 413 homemakers. We describe the prevalence and distribution of COVID-19-related social determinants of poor mental health, and longitudinally examine their associations with depressive symptoms, measured using the Patient Health Questionnaire-2 (PHQ-2). Modified Poisson regression models were used to estimate prevalence ratios (PRs) and their corresponding 95% confidence intervals, including an interaction between the independent variable and the measurement wave for the longitudinal assessment.

During lockdown, symptoms of depression among homemakers were most strongly associated with students in the household facing difficulties in completing schoolwork during homeschooling (PR: 2.62; 1.60–4.30). After lockdown, the strongest associations were observed with employment (being out of the labor force (PR: 1.59; 1.04–2.44); receiving reduced income from work (PR: 1.95; 1.22–3.11)), and the financial situation of the household: indebtedness (wave 4: acquisition of new debts, PR: 1.48; 1.04–2.11; wave 5: low debt-payment capacity, PR: 1.44; 1.01–2.07), and food insecurity (wave 4, PR: 1.92; 1.38–2.65; wave 5, PR: 1.59; 1.12–2.26). Household conflicts over space were associated with depressive symptoms in both waves (wave 4, PR: 1.43; 1.01–2.02; wave 5, PR: 1.74; 1.23–2.46). No association was found with being or living with a COVID-19 case.

In addition to the central role of financial stressors in shaping mental health outcomes during the COVID-19 pandemic, our results underscore the importance of home-schooling challenges as a critical source of psychological distress among peripheralized homemakers. These findings offer valuable insights for enhancing multisectoral preparedness in future crises, emphasizing the need to integrate social, economic, and educational support strategies for peripheralized urban-poor populations and to prevent or mitigate the deepening of existing social inequalities.

The online version contains supplementary material available at 10.1186/s12889-025-25815-1.