Brazilian mothers’ quality of life and sleep during the COVID-19 pandemicAbstract
Objective To analyze mothers’ quality of life and sleep during the COVID-19 pandemic.
Methods This cross-sectional study was conducted in August 2022 with mothers whose children are part of a birth cohort in a municipality in Paraíba, Brazil. Data collection involved sociodemographic questionnaires, such as the World Health Organization Quality of Life Index, the Pittsburgh Sleep Quality Index, and the Connor-Davidson Resilience Scale. Statistical analyses included Student’s t-test and Analysis of Variance (α 5%), using Stata 12.0.
Results Of the 126 mothers, the majority were under 34 years of age, and 80.9% reported not having been diagnosed with COVID-19. Overall quality of life was associated with better situations during the pandemic related to healthcare (p = 0.013), social support (p = 0.038), concern about the illness (p = 0.023), need for psychological care (p < 0.001), use of mental health medication (p < 0.001), sleep duration (p < 0.001), weight change (p = 0.002), and living conditions (p = 0.039). For sleep quality, these same factors were relevant, except for healthcare (p = 0.315). Confirmed COVID-19 vaccination (p = 0.013) also showed a moderator of sleep quality.
Conclusion Improved physical health, psychosocial support, and effective coping strategies during the COVID-19 pandemic had a positive impact on mothers’ quality of life and sleep quality.
Keywords
Quality of life indicators; Sleep quality; Mothers; COVID-19; Pandemics
Resumo
Objetivo Analisar a qualidade de vida e do sono de mães no contexto da pandemia de COVID-19.
Métodos Estudo transversal, realizado em agosto de 2022 com mães cujos filhos fazem parte de uma coorte de nascimento em um município da Paraíba. A coleta de dados envolveu questionários sociodemográficos, como o World Health Organization Quality of Life, o Índice de Qualidade do Sono de Pittsburgh, e a Escala de Resiliência de Connor-Davidson. Análises estatísticas incluíram o teste t de Student e Analysis of Variance (α 5%), usando Stata 12.0.
Resultados Das 126 mães, a maioria tinha menos de 34 anos de idade, e 80,9% responderam não terem sido diagnosticadas com COVID-19. A qualidade de vida geral esteve associada a melhores situações durante a pandemia relacionadas a cuidados de saúde (p = 0,013), apoio social (p = 0,038), preocupação com a doença (p = 0,023), necessidade de atendimento psicológico (p < 0,001), uso de medicamentos para a saúde mental (p < 0,001), tempo de sono (p < 0,001), mudança de peso (p = 0,002) e condições de vida (p = 0,039). Para a qualidade do sono, esses mesmos fatores foram relevantes, exceto os cuidados de saúde (p = 0,315). A vacinação confirmada contra COVID-19 (p = 0,013) também se mostrou moderador da qualidade do sono.
Conclusão As melhores condições de saúde física, suporte psicossocial e estratégias eficazes de enfrentamento durante a pandemia de COVID-19 exerceram impacto positivo na qualidade de vida e na qualidade do sono das mães.
Indicadores de qualidade de vida; Qualidade do sono; Mães; COVID-19; Pandemia
Resumen
Objetivo Analizar la calidad de vida y el sueño de las madres en el contexto de la pandemia de COVID-19.
Métodos Estudio transversal, realizado en agosto de 2022 con madres cuyos hijos forman parte de una cohorte de nacimientos en un municipio de Paraíba. La recopilación de datos incluyó cuestionarios sociodemográficos, como el de Calidad de Vida de la Organización Mundial de la Salud, el Índice de Calidad de Sueño de Pittsburgh y la Escala de Resiliencia de Connor-Davidson. Los análisis estadísticos incluyeron la prueba t de Student y el análisis de varianza (α 5 %), utilizando Stata 12.0.
Resultados De las 126 madres, la mayoría tenía menos de 34 años y el 80,9 % respondió que no había sido diagnosticada con COVID-19. La calidad de vida general se asoció con mejores situaciones durante la pandemia relacionadas con la atención sanitaria (p = 0,013), el apoyo social (p = 0,038), la preocupación por la enfermedad (p = 0,023), la necesidad de atención psicológica (p < 0,001), el uso de medicamentos para la salud mental (p < 0,001), el tiempo de sueño (p < 0,001), los cambios de peso (p = 0,002) y las condiciones de vida (p = 0,039). Para la calidad de sueño, fueron relevantes los mismos factores, excepto la atención sanitaria (p = 0,315). La vacunación confirmada contra el COVID-19 (p = 0,013) también se mostró como un moderador de la calidad de sueño.
Conclusión Las mejores condiciones de salud física, el apoyo psicosocial y las estrategias eficaces de afrontamiento durante la pandemia de COVID-19 tuvieron un impacto positivo en la calidad de vida y en la calidad de sueño de las madres.
Indicadores de calidad de vida; Calidad del sueño; Madres; COVID-19; Pandemía
Introduction
Health-related quality of life (HRQoL) is a multifaceted construct of significant relevance in the analysis of outcomes and decision-making in the health field. Due to its multidimensional nature, a comprehensive understanding of the physical, psychological, and social domains is essential.(1)
Sleep quality (SQ) refers to an individual’s subjective satisfaction with various aspects of their sleep experience, including efficiency, onset time, and duration. Poor SQ is consistently linked to lower quality of life in various populations.(2) There are records that show a relationship between sleep patterns and HRQoL, attributing special relevance to factors such as sleep timing, duration, and quality.(3)
A study conducted during the first 50 days of COVID-19 revealed that mothers of children aged 6 to 16 were more likely to report a decrease in quality of life, compared to women without children.(4) Another similar study identified that women living with children under 14 years old and single mothers reported a significantly lower quality of life.(5) With regard to SQ, problems have been reported, such as among women of reproductive age in Ethiopia (71.3%)(6)and among postpartum women in Nepal (28.2%).(7) In the United States, among mothers of young children, SQ was rated as ranging from fair to good.(5) In these studies, SQ was associated with mental health and improvements in well-being, highlighting implications related to the need for strategies to improve mental health, education on sleep hygiene, and social support.(5) Socioeconomic conditions, social relationships, social support, physical health, psychological state, and stress levels are determinants that complexly influence HRQoL and SQ.(6,8)
Historically, it is well known that epidemics of infectious diseases have impacted the physical condition, psychological health and well-being of communities, influencing even sleep patterns.(2)In the current context, studies have highlighted the negative impact of quarantine on people’s physical and psychological well-being, which has led to possible consequences for HRQoL.(9,10) Analysis among Saudi women, comparing pre-pandemic data with periods of restriction during quarantine, highlighted the implications on various aspects of lifestyle, including sleep, mental health, physical activity, and eating habits.(11)
The impact of COVID-19 on maternal HRQoL has been addressed in recent studies.(12,13) Researchers assessed the effects of the COVID-19 pandemic on different areas of mothers’ daily routine, highlighting negative impacts on daily life.(12) In Brazil, the impact of the pandemic on healthy women was assessed. The results revealed an association between fatigue, symptoms of depression and anxiety, as well as a worsening of SQ during the first year of the pandemic. This association persisted into the second year, indicating a continuation of the adverse psychological effects resulting from the pandemic.(13)
The pandemic and subsequent restrictive measures have created a unique context for families with young children.(8) The social isolation resulting from the pandemic imposed significant and complex challenges, particularly for mothers, with a direct impact on mental health and quality of life.(14) Given the importance and scarcity of research on HRQoL and SQ in this context, the analysis of likely modulating factors is crucial to encourage the development of public policies and specific interventions that mitigate the observed negative impacts.(3)
From this perspective, this study aimed to analyze mothers’ quality of life and sleep during the COVID-19 pandemic.
Methods
This cross-sectional study, conducted with mothers whose children are part of a birth cohort in a municipality in Paraíba, aimed to investigate maternal and infant factors associated with child growth and development.(15) Follow-up was interrupted when the children were 2 years old due to the COVID-19 pandemic, at which point the research was redesigned to examine the implications of the pandemic on children’s growth and development, maternal and child HRQoL, and mothers’ nutritional status.
The study was conducted in August 2022 with mothers of children born in 2018 enrolled in early childhood education in the municipal school system of a city in the state of Paraíba. Of the initial group of participants (n = 205), 61 were discontinued during follow-up until the child was six months old,(15)and 126 were part of the current study. The children were, on average, 4 years old and attended one of the five municipal schools with preschool classes, which concentrate most of the children born in the municipality.
Data collection was carried out using a structured questionnaire composed of validated instruments and specific questions to capture maternal and infant information. The following questionnaires were applied: sociodemographic questionnaire; Connor-Davidson Resilience Scale (CD-RISC-10); World Health Organization Quality of Life (WHOQOL-bref); and the Pittsburgh Sleep Quality Index. Moreover, 13 closed-ended questions about behaviors and repercussions of the COVID-19 pandemic were included, as well as three open-ended questions to explore maternal perceptions of the pandemic’s impacts.
The sociodemographic questionnaire included sex and education level. The education level section had five response options: i) complete higher education; i) complete high school/incomplete higher education; ii) complete middle school/incomplete high school; iii) complete elementary school/incomplete middle school; iv) illiterate/incomplete elementary school. For analysis, the responses were grouped into the categories complete high school or higher education (options i and ii), or incomplete high school or lower education.
The CD-RISC-10, validated for the Brazilian population, was used to assess the level of resilience. This scale measures individuals’ ability to adapt to change and overcome obstacles. Composed of ten items, the responses range from 0 (never true) to 4 (always true), totaling a score of 0 to 40 points, where high scores indicate high resilience.(16) The classification into resilient and non-resilient groups was conducted using cluster analysis (K-means cluster/two groups), validated by canonical discriminant analysis.(17)
To obtain information about behaviors and repercussions related to the COVID-19 pandemic during its duration, the following questions were asked: (a) During the COVID-19 pandemic, did you stay home in social isolation and, when you left home, did you wear a mask and have a habit of sanitizing your hands (very often, a little, or very little)?; (b) Were you vaccinated against COVID-19?; (c) Were you ever diagnosed with COVID-19?; (d) During the COVID-19 pandemic, did any family member lose their job and/or was there a reduction in household income?; (e) During the COVID-19 pandemic, could you count on someone if you needed help?; (f) How worried or upset were you about COVID-19?; (g) Did you feel the need for psychological support during the COVID-19 pandemic?; (h) Did you need to use medication for mental health during the COVID-19 pandemic?; (i) Did your sleep schedule change during the COVID-19 pandemic?; (j) Did you notice any changes in your weight during the COVID-19 pandemic?; (k) Have your living conditions improved, worsened, or remained the same during the COVID-19 pandemic?; (l) During the COVID-19 pandemic, when social distancing restrictions began to be implemented, was there a time when you were concerned about not being able to pay your rent or other bills on time?; (m) Are you worried about the possibility of not being able to pay your rent or other bills on time in the next six months?
To assess HRQoL, the WHOQOL-bref, validated for the Brazilian population, was used. The short version consists of 26 questions: two related to the overall perception of quality of life and 24 distributed across four domains (physical, psychological, social relationships, and environment). Responses follow a scale of 1 to 5, with inverted values in questions 3, 4, and 26 (1 = 5; 2 = 4; 3 = 3; 4 = 2; 5 = 1), according to the instrument’s recommendations. Scores for each domain were converted to a scale of 0 to 100 and expressed as means, where higher scores indicate a better perception of quality of life.(1,18)
Sleep assessment utilized the Pittsburgh Sleep Quality Index, validated for Brazilian adults.(19) The instrument describes SQ and possible disturbances in the last month, encompassing seven components: subjective quality; sleep latency; sleep duration; sleep efficiency; sleep disturbances; medication use; and daily dysfunction. This study focused on the “sleep disturbances” component, with responses on a scale of 0 to 3 (0 = never, 1 = less than once a week, 2 = once or twice a week, 3 = three or more times a week), resulting in a maximum score of 27 points, which indicates the worst situation. The scores are categorized into four groups: 0 = 0; 1 to 9 = 1; 10 to 18 = 2; and 19 to 27 = 3.(19,20) In this study, categories 2 and 3 were grouped together to indicate sleep disorder.
Moreover, three open-ended questions were directed to the mothers: (a) Please share any information you consider important about how COVID-19 and the social distancing measures for its control impacted your family’s life; (b) What lasting or permanent consequences do you think COVID-19 will leave on your family’s life?; and (c) What did you learn from the pandemic? After the quantitative responses were complete, the mothers answered the subjective questions. They were instructed to provide short answers, without interference or direction from the researchers, preserving the reports’ spontaneity and authenticity.
To characterize women, the following independent variables were considered: age (≤ 34, > 34); education (complete high school or higher, incomplete high school or lower); and resilience (resilient, non-resilient). Furthermore, behaviors and repercussions related to the COVID-19 pandemic were analyzed, such as healthcare (isolation, mask use, and hand hygiene (very, little/very little)), vaccination (yes, no), disease diagnosis (no, yes), death of a close person due to the disease (no, yes), social support (yes, no), concern about the disease (little/very little, a lot), need for psychological care (no, yes), need to use medication for mental health (no, yes), sleep time (no change, increased, decreased), weight change (no change, decreased, increased), living conditions (improved, no change, worsened), job and/or income loss of a family member (no, yes), concern about bills (no, yes), concern about future bills (no, yes, do not know). The presence of sleep disorder (no, yes) was also considered an independent variable for HRQoL indicators.
Data normality was verified using the Kolmogorov-Smirnov test. To identify differences in the means of quality of life (physical, psychological, social relationships, environment, and overall) and sleep domains, according to the variables of interest, Student’s t-test was used for dichotomous variables, and Analysis of Variance (ANOVA) for variables with three categories. After confirming the ANOVA assumptions, the F-test was applied, followed by the Bonferroni post-hoc test, to assess the differences among categories. The means of the quality of life domains were also compared in relation to the presence of sleep disorders using Student’s t-test. The statistical significance criterion adopted was p < 0.05. The analyses were performed using the statistical software Stata version 12.0 (StataCorp LP; College Station, TX, USA).
For the analysis of responses to the study’s open-ended questions, a thematic analysis approach was used. After coding, data were analyzed, interpreted, and grouped into patterns (common topics) with a description of each identified aspect.
The work was conducted under the guidelines of Resolution 466/2012 of the Brazilian National Health Council. The mothers of the children signed the Informed Consent Form as a prerequisite for participating in the study, after being informed about the objectives, procedures, and advantages of their participation. The research projects were approved by the Universidade Estadual da Paraíba Research Ethics Committee (Certificate of Presentation for Ethical Consideration 81216417.0.0000.5187, Opinion 2,447,509; and Certificate of Presentation for Ethical Consideration 53281421.8.0000.5187, Opinion 5,137,768).
Results
Table 1 presents the characteristics of the women in the study, addressing behaviors and impacts related to the COVID-19 pandemic. Of the 126 mothers, 60.3% reported “little/very little” healthcare during the pandemic; 96.0% were vaccinated; and 80.9% had never been diagnosed with COVID-19. The majority of women reported not having experienced the death of a close person due to the disease (73.8%). Furthermore, 72.2% reported significant concern about the disease, and 49.2% required psychological support during the pandemic. Regarding resilience, 77.0% of mothers were classified as non-resilient. During the pandemic, 61.9% of participants reported changes in sleep patterns, and 48.4% experienced sleep disturbances after lockdown. Weight gain during the pandemic was reported by 47.6% of mothers. The worsening of living conditions and the loss of employment and/or income of a family member during the pandemic were reported in 45.2% and 53.2% of cases, respectively. Regarding concerns about finances, the majority reported having these concerns both during the pandemic (72.2%) and in the future (57.1%).
Characteristics of women in the study focusing on behaviors and repercussions related to the COVID-19 pandemic.
Table 2 reveals associations between HRQoL and its domains with independent variables. Complete high school or higher was significantly associated with higher scores in social relationships (p = 0.013) and environment (p = 0.004), compared to incomplete high school or lower. Adequate healthcare during the pandemic, as reported by mothers in the study, was associated with higher means in overall HRQoL (p = 0.013), as well as in the psychological (p = 0.023), social relationships (p = 0.005), and environment (p = 0.009) domains. Decreased sleep time during the pandemic resulted in lower means for physical (p < 0.001), psychological (p = 0.004), and overall (p < 0.001) quality of life, while the absence of weight changes during the pandemic resulted in higher means for these same indicators. During the pandemic, lack of social support, concern about the illness, the need for psychological care and medication for mental health, worsening living conditions, job and/or income loss for a family member, and concern about bills were factors that resulted in lower mean HRQoL scores based on all indicators of interest. Meanwhile, for resilience, the opposite result was observed. A diagnosis of post-pandemic lockdown sleep disorders resulted in a lower overall HRQoL score (p < 0.001). All HRQoL domains also showed a worse situation in the presence of sleep disorders.
During the pandemic, not having been vaccinated against COVID-19 (p = 0.013), lack of social support (p = 0.043), great concern about the disease (p = 0.009), need for psychological care (p = 0.002), and use of medication for mental health (p < 0.001) represented detrimental situations in SQ. Furthermore, women who reported not experiencing changes in sleep time (p = 0.048) and weight (p = 0.006), improvement in living conditions (p = 0.003), no loss of employment/family income (p = 0.017), and lack of concern about current (p = 0.023) and future (p < 0.001) bills had better SQ (Table 3).
From the analysis of the open-ended questions, three main topics emerged: 1. The COVID-19 pandemic instilled fear, anxiety, and stress, with possible long-term effects; 2. The crisis highlighted the need for important healthcare; 3. The importance of valuing family, family life, and solidarity among people was emphasized during the COVID-19 pandemic.
Discussion
This study advances the understanding of complex modulators in maternal HRQoL and SQ by highlighting the pandemic context, giving it a pioneering character. HRQoL and SQ scores were higher in mothers who reported favorable contexts during the pandemic in aspects such as healthcare, social support, concern about the illness, mental health, sleep time, weight change, living conditions, and food security. Furthermore, maternal education and resilience also influenced HRQoL.
Other results, such as the present one, have shown a better quality of life among mothers with higher levels of education.(21) The social, emotional, and physical harm caused by dropping out of school, as well as the presence of stress and high burden among home caregivers, can significantly impact HRQoL.(21)
An online survey conducted with Spanish women revealed the complementarity between HRQoL and resilience.(22) This relationship was also found among participants in the current study, and may be related to lifestyle, mental health, and emotional support.(22) Resilience can act as a mediator of the effects of various stressors and in women’s estimation of their quality of life,(22)possibly more markedly among low-income mothers, especially with regard to work-family balance and social support.(5)
Health-promoting behaviors exert a positive influence on HRQoL in women,(23)which may explain the relationship between healthcare during the COVID-19 pandemic and this outcome in the study participants. In turn, COVID-19 vaccination was associated with better SQ among the mothers in this research, aligning with a previous study.(24) Despite the scarcity of data, it is speculated that vaccination may have contributed to a reduction in stress levels and improvements in psychological well-being and SQ.(24) Strategies for promoting health and health literacy are emphasized due to their importance in driving adequate healthcare.(25)
The results presented here highlighted the influence of social support during the pandemic on HRQoL, in agreement with previous studies.(26,27) Social support provides important emotional, material and informational assistance for preserving well-being and coping with challenging situations,(28)representing an attribute of resilience that increases the ability to be resilient and prevent mental health problems.(29) During the pandemic, the importance of social support became even more evident, considering that social isolation increased the need for external support.(29) Low-income families, such as those predominant in the sample of this study, disproportionately experience social and economic stressors, which negatively contributes to maternal mental health and SQ.(28)
Still within the psychosocial sphere, less concern about COVID-19 and the reduced need for psychological interventions led to better HRQoL scores, reinforcing previous results.(8,22) Therefore, the importance of mental health and psychological support in promoting HRQoL is emphasized, since mental health directly influences the subjective perception of well-being. Thus, the HRQoL approach should be essentially holistic.(26)
Conditions related to women’s psychological well-being in this study also showed their determination in SQ, aligning with results obtained in other contexts.(12,13,30,31) Among American women, for instance, a lack of social support increased the risk of depression and problems with social intelligence.(30) In Nepal, evidence showed that mothers with a history of depressive symptoms experienced more concern-related sleep problems during the pandemic.(12) In Brazil, a longitudinal study also reported that anxiety increased sleep problems.(13) It can be inferred that gender inequality, increased violence against women, and heightened concerns about COVID-19 during the isolation period may interfere with SQ.(12,13,30)
In this sample, decreased sleep time and SQ during the pandemic was associated with lower mean HRQoL scores, while sleep time also influenced SQ. Both reduced duration and SQ can negatively impact mental health and quality of life. This should be assessed in light of a broad concept called sleep health, which encompasses factors such as duration, timing, regularity, efficiency, and satisfaction.(32) Research that analyzed the effects of sleep on Czech participants between 2018 and 2020 concluded that SQ is a more important indicator of quality of life than sleep duration, contributing to the maintenance of mental health, concentration capacity, improved mood, and sociability.(32) Quantity and SQ are interconnected, representing fundamental processes of healthy sleep.(32) During the pandemic, isolation and social distancing led to widespread and unique lifestyle changes that can cause sleep and mental health problems.(32)
Most mothers in this study experienced weight gain during the pandemic, which is consistent with previous findings.(33) Another study based on longitudinal data revealed divergent results, where approximately half of participants reported no weight changes and a reduced risk of weight gain with longer sleep duration during confinement.(11) These variations can be attributed to different levels of restrictions between countries, as well as to diverse cultures and dietary patterns.(11) Furthermore, it is worth highlighting the potential differences in lifestyle changes that justify weight gain, such as reduced physical activity and increased screen time. The long-term repercussions of these weight changes during the pandemic may persist, requiring strategies to prevent obesity-related complications.(11)
Improved living conditions during the pandemic also showed their influence on the HRQoL of women in the current study, confirming the association found in women in Spain.(22) Another study with mothers revealed that approximately 22% of them reported that the pandemic had a negative effect on their economic situation and family context, with negative consequences on SQ,(12) in line with the findings of the current study. Both quality of life and SQ can be impacted by unfavorable socioeconomic scenarios. Lack of access to resources, poor stress management, and difficulty in maintaining healthy habits can be determining factors in this relationship.(22)
Analysis of responses to the open-ended questions revealed three main topics that highlight the multifaceted impacts of the COVID-19 pandemic on the women participating in the study. Mothers reported fear, anxiety, and stress induced by the pandemic, supporting a phenomenological study on mothers’ experiences during COVID-19.(34) These authors attribute this scenario to a lack of knowledge about the disease and the increase in confirmed cases, which intensified psychological distress.(34) In the long term, these conditions can result in persistent psychological disorders, indicating the need for early intervention strategies and ongoing psychological support.(34)
Furthermore, participants emphasized the need to maintain healthcare. This finding underscores the importance of public policies that guarantee access to quality healthcare services. Moreover, public health programs focused on prevention are fundamental to strengthening community health and reducing vulnerability to future resurgences of COVID-19 cases.(22) However, the COVID-19 pandemic affected the provision of consultations, examinations, and group activities in primary care, especially for the most vulnerable population. For healthcare professionals, the pandemic period generated physical and emotional consequences that harmed their own health and the development of their professions, in addition to the displacement of professionals to other units and/or functions supporting COVID-19 care.(35)
The third topic raised by mothers highlights the importance of family interaction and solidarity during the pandemic. A multicenter qualitative study conducted in two phases demonstrated that interpersonal acts of solidarity are important, but not sustainable without consistent institutional support. As the pandemic progressed, respondents expressed a longing for more institutionalized forms of solidarity.(35) This reinforces the need to develop and implement public policies that promote structured and continuous social support for families.(22) Thus, it is shown how important it is to pay attention to the family and maternal context, especially in circumstances of economic vulnerability that are particularly conducive to poorer mental health and SQ, due to the increase in economic and social stressors associated with adverse events such as the pandemic.(35)
Our qualitative findings support those found in quantitative analyses, which infer the relevance of coping capacity, healthcare, and social support as stress moderators and promoters of well-being, possibly impacting the quality of life and sleep of this population. Hence, the COVID-19 pandemic exacerbated maternal overload, leading to changes in living conditions and behaviors that added stressors to the routine with possible consequences for mental health, sleep hygiene, and quality of life.(35) This knowledge is relevant for improving policies, social services, and professionals’ work in the pursuit of a better quality of life for marginalized families.
A limitation is the complexity of the pandemic context, characterized by multiple confounding factors that may have influenced maternal perception of quality of life and sleep, making it difficult to distinguish between the effects of COVID-19 and other concomitant stressors. However, a key advantage is the use of validated instruments recommended by health authorities, allowing for the analysis of outcome variables not previously explored in this specific population.
Conclusion
The results of this study show that mothers’ HRQoL and SQ were affected by several negative factors during the COVID-19 pandemic. Insufficient social support, concern about the illness, need for psychological care, use of mental health medication, insufficient sleep, weight gain, and financial worries determined lower HRQoL and SQ scores. Furthermore, low levels of resilience and the lack of routine healthcare adoption during the pandemic influenced HRQoL, while SQ was also negatively affected by non-vaccination. The presence of sleep disorders after confinement discriminated against a worse situation for all dimensions of HRQoL. These findings highlight the need for multifaceted and integrated interventions to mitigate the negative impacts on these outcomes in the context of health crises.
Finally, this study offers relevant contributions to nursing practice by strengthening comprehensive care through the identification of the psychosocial impacts of the pandemic, guiding interventions aimed at emotional support and mental health promotion. It highlights the importance of professional training for the early identification and management of psychological distress, as well as the strengthening of community care through the articulation of support networks and health education initiatives.
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