Relationship between self-care activities, stress and well-being during COVID-19 lockdown: a cross-cultural mediation model.

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 ( (3,1078)=370.01, p<0.001, R=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.