{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:33:58Z","timestamp":1793504038007,"version":"4.5.0"},"reference-count":103,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: The COVID-19 pandemic significantly impacted mental health and substance use patterns, particularly among young adults. Objective: This study aimed to assess changes in anxiety, depression, self-esteem, and substance use among university students in Mexico before, during, and after the pandemic. Methods: Using a repeated cross-sectional design, this study was conducted with university students in Mexico across three periods: pre-pandemic (2017 and 2019); during the pandemic (2021); and post-pandemic (2023). A total of 2167 students were interviewed during one of the three periods. Standardized scales measured anxiety, depression, self-esteem, Erotic Response and Sexual Orientation Scale (EROS), and substance use. Results: showed a marked and significant increase in the proportion of students with anxiety (40.0%, 71.7%, and 79.6%) and depression (14.4%, 61.9%, and 62.6%) during the pre-pandemic, pandemic, and post-pandemic periods, respectively. Self-esteem significantly decreased during and after the pandemic, compared to pre-pandemic, particularly among females. The proportion of students categorized as moderate\/high-risk for their substance use changed over time, showing a reduction in alcohol use (from 29.9% to 20.2%) and tobacco use (from 26.0% to 18.2%) but an increase in sedative use (from 7.1% to 11.7%), before vs after the pandemic, respectively. Multivariate analysis revealed that anxiety, low self-esteem, and increased sedative use were consistently linked to a heightened risk of depression during and after the pandemic. Notably, anxiety and depression levels remained in a proportion significantly elevated even in the post-pandemic period. Conclusions: These findings underscore the enduring impact of the COVID-19 pandemic on the mental health of university students, highlighting the urgent need for targeted interventions, early detection strategies, and customized educational programs to effectively support students\u2019 mental well-being in the ongoing post-pandemic era.<\/jats:p>","DOI":"10.3390\/diseases12120303","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T10:05:56Z","timestamp":1732701956000},"page":"303","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Substance Use and Mental Health in Emerging Adult University Students Before, During, and After the COVID-19 Pandemic in Mexico: A Comparative Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4685-3095","authenticated-orcid":false,"given":"Gustavo A.","family":"Hernandez-Fuentes","sequence":"first","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica C.","family":"Romero-Michel","sequence":"additional","affiliation":[{"name":"Faculty of Law, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica M.","family":"Guzm\u00e1n-Sandoval","sequence":"additional","affiliation":[{"name":"Faculty of Psychology, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3295-4768","authenticated-orcid":false,"given":"Janet","family":"Diaz-Martinez","sequence":"additional","affiliation":[{"name":"Research Center in a Minority Institution, Florida International University (FIU-RCMI), Miami, FL 33199, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osiris G.","family":"Delgado-Enciso","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth R.","family":"Garcia-Perez","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monserrat","family":"God\u00ednez-Medina","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Zamora-Barajas","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8198-5363","authenticated-orcid":false,"given":"Angel G.","family":"Hilerio-Lopez","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Ceja-Espiritu","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario Del","family":"Toro-Equihua","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1478-9068","authenticated-orcid":false,"given":"Margarita L.","family":"Martinez-Fierro","sequence":"additional","affiliation":[{"name":"Molecular Medicine Laboratory, Unidad Acad\u00e9mica de Medicina Humana y Ciencias de la Salud, Universidad Aut\u00f3noma de Zacatecas, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6307-1696","authenticated-orcid":false,"given":"Idalia","family":"Garza-Veloz","sequence":"additional","affiliation":[{"name":"Molecular Medicine Laboratory, Unidad Acad\u00e9mica de Medicina Humana y Ciencias de la Salud, Universidad Aut\u00f3noma de Zacatecas, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5988-4168","authenticated-orcid":false,"given":"Iram P.","family":"Rodriguez-Sanchez","sequence":"additional","affiliation":[{"name":"Molecular and Structural Physiology Laboratory, School of Biological Sciences, Universidad Aut\u00f3noma de Nuevo Le\u00f3n, San Nicol\u00e1s de los Garza 66455, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3525-7821","authenticated-orcid":false,"given":"Carmen A.","family":"Sanchez-Ramirez","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Ramirez-Flores","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9848-862X","authenticated-orcid":false,"given":"Ivan","family":"Delgado-Enciso","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico"},{"name":"State Cancerology Institute of Colima, Health Services of the Mexican Social 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Sex. Health Rep."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Dosil-Santamaria, M., Ozamiz-Etxebarria, N., Idoiaga Mondragon, N., Reyes-Sosa, H., and Santab\u00e1rbara, J. (2022). Emotional State of Mexican University Students in the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19042155"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"112934","DOI":"10.1016\/j.psychres.2020.112934","article-title":"The Psychological Impact of the COVID-19 Epidemic on College Students in China","volume":"287","author":"Cao","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1177\/21676968221121590","article-title":"A Qualitative Investigation of the Positive and Negative Impacts of the COVID-19 Pandemic on Post-Secondary Students\u2019 Mental Health and Well-Being","volume":"10","author":"Ewing","year":"2022","journal-title":"Emerg. Adulthood"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.2105\/AJPH.2012.301169","article-title":"A Cross-National Study on Prevalence of Mental Disorders, Service Use, and Adequacy of Treatment Among Mexican and Mexican American Populations","volume":"103","author":"Orozco","year":"2013","journal-title":"Am. J. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"69","DOI":"10.17711\/SM.0185-3325.2023.010","article-title":"An Assessment of Mental Health of Mexican and Colombian Medical Students during the COVID-19 Pandemic","volume":"46","author":"Porchia","year":"2023","journal-title":"Salud Ment."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/j.1475-6773.2005.00345.x","article-title":"Self-Medication of Mental Health Problems: New Evidence from a National Survey","volume":"40","author":"Harris","year":"2005","journal-title":"Health Serv. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jpsychires.2021.05.006","article-title":"Impact of COVID-19 Lockdown on Individuals under Treatment for Substance Use Disorders: Risk Factors for Adverse Mental Health Outcomes","volume":"139","author":"Blithikioti","year":"2021","journal-title":"J. Psychiatr. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/s41537-022-00222-2","article-title":"Facing the Pandemic and Lockdown: An Insight on Mental Health from a Longitudinal Study Using Diaries","volume":"8","author":"Mengin","year":"2022","journal-title":"Schizophrenia"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Martinez-Fierro, M.L., Ayala-Haro, A.E., Pinedo-Hurtado, M.E., Solis-Galvan, J.A., Garza-Veloz, I., Velazquez-Lopez, Z.Y., Camacho-Martinez, A.G., Avila-Carrasco, L., Vazquez-Reyes, S., and Velasco-Elizondo, P. (2022). Usefulness of a Mobile Application (Mentali) for Anxiety and Depression Screening in Medical Students and Description of the Associated Triggering Factors. Brain Sci., 12.","DOI":"10.3390\/brainsci12091223"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e24298","DOI":"10.2196\/24298","article-title":"Mental Health and Burnout Syndrome Among Postgraduate Students in Medical and Multidisciplinary Residencies During the COVID-19 Pandemic in Brazil: Protocol for a Prospective Cohort Study","volume":"10","author":"Pinho","year":"2021","journal-title":"JMIR Res. Protoc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.5664\/jcsm.9354","article-title":"Pre-Existing and Post-Pandemic Insomnia Symptoms Are Associated with High Levels of Stress, Anxiety, and Depression Globally during the COVID-19 Pandemic","volume":"17","author":"Meaklim","year":"2021","journal-title":"J. Clin. Sleep Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.ccm.2022.11.021","article-title":"Lessons Learned from Health Disparities in Coronavirus Disease-2019 in the United States","volume":"44","author":"Diaz","year":"2023","journal-title":"Clin. Chest Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/GCO.0000000000000485","article-title":"The Use of Technology in the Sexual Health Education Especially among Minority Adolescent Girls in the United States","volume":"30","author":"Brayboy","year":"2018","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"107179","DOI":"10.1016\/j.addbeh.2021.107179","article-title":"E-Cigarette Devices, Brands, and Flavors Attract Youth: Informing FDA\u2019s Policies and Priorities to Close Critical Gaps","volume":"126","author":"Gaiha","year":"2022","journal-title":"Addict. Behav."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.jadohealth.2020.06.018","article-title":"What Does Adolescent Substance Use Look Like During the COVID-19 Pandemic? Examining Changes in Frequency, Social Contexts, and Pandemic-Related Predictors","volume":"67","author":"Dumas","year":"2020","journal-title":"J. Adolesc. Health"},{"key":"ref_17","first-page":"2106","article-title":"Dutch Youth\u2019s Smoking Behaviour during a Partial Covid-19 Lockdown","volume":"11","author":"Kunst","year":"2022","journal-title":"J. Public Health Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"107326","DOI":"10.1016\/j.addbeh.2022.107326","article-title":"Lockdown, Bottoms up? Changes in Adolescent Substance Use across the COVID-19 Pandemic","volume":"131","author":"Dumas","year":"2022","journal-title":"Addict. Behav."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Upton, J. (2020). Beck Depression Inventory (BDI). Encyclopedia of Behavioral Medicine, Springer International Publishing.","DOI":"10.1007\/978-3-030-39903-0_441"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/MLR.0b013e318160d093","article-title":"Validation and Standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the General Population","volume":"46","author":"Decker","year":"2008","journal-title":"Med. Care"},{"key":"ref_21","first-page":"14","article-title":"The Structure of the Rosenberg Self-Esteem Scale","volume":"226","author":"Gnambs","year":"2018","journal-title":"Z. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1111\/j.1530-0277.1997.tb03811.x","article-title":"A Review of Research on the Alcohol Use Disorders Identification Test (AUDIT)","volume":"21","author":"Allen","year":"1997","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/S0306-4603(00)00065-4","article-title":"Screening of Drug Use in a Teenage Brazilian Sample Using the Drug Use Screening Inventory (Dusi)","volume":"25","author":"Formigoni","year":"2000","journal-title":"Addict. Behav."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2276","DOI":"10.2146\/ajhp070364","article-title":"Validity and Reliability of Measurement Instruments Used in Research","volume":"65","author":"Kimberlin","year":"2008","journal-title":"Am. J. Health-Syst. Pharm."},{"key":"ref_25","unstructured":"Rosner, B. (2011). Fundamentals of Biostatistics\/Bernard Rosner, Brooks\/Cole, Cengage Learning, c2011. [7th ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/ajps.12095","article-title":"An Effective Approach to the Repeated Cross-Sectional Design","volume":"59","author":"Lebo","year":"2015","journal-title":"Am. J. Pol. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"C\u00e1rdenas, S., Lomel\u00ed, D., and Ruelas, I. (2022). COVID-19 and Post-Pandemic Educational Policies in Mexico. What Is at Stake?. Primary and Secondary Education During Covid-19, Springer International Publishing.","DOI":"10.1007\/978-3-030-81500-4_6"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ibarrola-Pe\u00f1a, J.C., Barbosa-Camacho, F.J., Almanza-Mena, Y.L., Chejfec-Ciociano, J.M., Reyes-Elizalde, E.A., Romero-Lim\u00f3n, O.M., Zaragoza-Organista, R., Cervantes-P\u00e9rez, E., Sapi\u00e9n-Fern\u00e1ndez, J.H., and Guzm\u00e1n-Barba, J.A. (2022). Preventive Measures against the COVID-19 Pandemic in Mexico: A Cross-Sectional Study. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.932010"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Vandenbroucke, J.P., von Elm, E., Altman, D.G., G\u00f8tzsche, P.C., Mulrow, C.D., Pocock, S.J., Poole, C., Schlesselman, J.J., and Egger, M. (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040297"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1001\/jama.2015.15281","article-title":"Multiple Imputation","volume":"314","author":"Li","year":"2015","journal-title":"J. Am. Med. Assoc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.rmta.2017.05.001","article-title":"Validation of the Hospital Anxiety and Depression Scale in Mexican Population with Eating Disorders","volume":"8","year":"2017","journal-title":"Rev. Mex. Trastor. Aliment."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"494","DOI":"10.6018\/analesps.31.2.172701","article-title":"Revisi\u00f3n de Estudios de La Escala de Ansiedad y Depresi\u00f3n Hospitalaria (HAD) En Muestras Espa\u00f1olas","volume":"31","year":"2015","journal-title":"An. Psicol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.jsxm.2020.10.008","article-title":"Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout","volume":"18","author":"Mollaioli","year":"2021","journal-title":"J. Sex. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/j.brat.2005.08.006","article-title":"The Impact of Anxiety on Sexual Arousal in Women","volume":"44","author":"Bradford","year":"2006","journal-title":"Behav. Res. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Carcedo, R.J., Fern\u00e1ndez-Rouco, N., Fern\u00e1ndez-Fuertes, A.A., and Mart\u00ednez-\u00c1lvarez, J.L. (2020). Association between Sexual Satisfaction and Depression and Anxiety in Adolescents and Young Adults. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17030841"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Vilca, L.W., Chambi-Mamani, E.L., Quispe-Kana, E.D., Hern\u00e1ndez-L\u00f3pez, M., and Caycho-Rodr\u00edguez, T. (2022). Functioning of the EROS-R Scale in a Clinical Sample of Psychiatric Patients: New Psychometric Evidence from the Classical Test Theory and the Item Response Theory. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191610062"},{"key":"ref_37","first-page":"177","article-title":"La Formaci\u00f3n Del Alumnado Universitario En G\u00e9nero y Sexualidad Como Estrategia Preventiva Del Sexismo En Las Aulas","volume":"25","author":"Rojas","year":"2022","journal-title":"Rev. Electr\u00f3n. Interuniv. Form. Profr."},{"key":"ref_38","first-page":"9","article-title":"Adaptaci\u00f3n Del Cuestionario Sexual Opinion Survey: Encuesta Revisada de Opini\u00f3n Sexual","volume":"11","year":"2013","journal-title":"Rev. Int. Androl."},{"key":"ref_39","first-page":"83","article-title":"Determination of the Representative Socioeconomic Level by BSA in the Mexican Republic","volume":"5","year":"2018","journal-title":"Rev. Perspect. Empres."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1177\/0003122412444720","article-title":"Social Stratification in Mexico","volume":"77","author":"Flores","year":"2012","journal-title":"Am Sociol Rev"},{"key":"ref_41","first-page":"36","article-title":"Sexting, Grooming, Acoso y Hostigamiento Sexual En Adolescentes de Bachillerato En M\u00e9xico","volume":"15","author":"Rosales","year":"2024","journal-title":"Rev. Psicol. Cienc. Comport. Unidad Acad. Cienc. Jur\u00edd. Soc."},{"key":"ref_42","first-page":"47","article-title":"Estad\u00edstica Con La Encuesta Nacional de Ingresos y Gastos de Los Hogares y El Paquete Libre R","volume":"7","year":"2024","journal-title":"Rev. Latinoam. Investig. Soc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jth.2016.11.005","article-title":"The Effect of Mobility Loss and Car Ownership on the Feeling of Depression, Happiness, and Loneliness","volume":"4","author":"Deka","year":"2017","journal-title":"J. Transp. Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1093\/geront\/gnu116","article-title":"Depressive Symptoms Among Older Adults Who Do Not Drive: Association With Mobility Resources and Perceived Transportation Barriers","volume":"56","author":"Choi","year":"2016","journal-title":"Gerontologist"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s13178-019-00403-2","article-title":"The Automobile as a Sexual Enhancer: How Having a Car Affects the Sexual Behavior of Emerging Adults That Are University Students","volume":"17","year":"2020","journal-title":"Sex. Res. Soc. Policy"},{"key":"ref_46","first-page":"9","article-title":"An\u00e1lisis Psicom\u00e9trico de La Escala de Autoestima de Rosenberg En Una Muestra de Estudiantes Universitarios","volume":"8","year":"2010","journal-title":"Rev. Electr\u00f3nica Trab. Soc."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1097\/MLR.0000000000000985","article-title":"Health Care Access and Physical and Behavioral Health Among Undocumented Latinos in California","volume":"56","author":"Ortega","year":"2018","journal-title":"Med. Care"},{"key":"ref_48","first-page":"179","article-title":"Validaci\u00f3n de La Escala de Autoestima de Rosenberg En Poblaci\u00f3n General y En Poblaci\u00f3n Cl\u00ednica de La Ciudad de Buenos Aires","volume":"1","author":"Casullo","year":"2009","journal-title":"Rev. Iberoam. Diagn. Eval.-E Aval. Psicol."},{"key":"ref_49","first-page":"36","article-title":"Perfil Psicopatol\u00f3gico de Pacientes Con Dependencia Emocional","volume":"116","author":"Merino","year":"2015","journal-title":"Cuad. Med. Psicosom. Psiquiatr. Enlace"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4067\/S0718-48082012000200006","article-title":"Estilo de Apego, Empat\u00eda y Autoestima En Agresores de Pareja","volume":"30","author":"Loinaz","year":"2012","journal-title":"Ter. Psicol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"291","DOI":"10.20882\/adicciones.27","article-title":"Evidencia de Validez En Chile Del Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)","volume":"26","year":"2014","journal-title":"Adicciones"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"19","DOI":"10.20882\/adicciones.786","article-title":"Validity and Reliability of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) in University Students","volume":"28","year":"2016","journal-title":"Adicciones"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1136\/bmj.327.7407.154","article-title":"WHO Framework Convention on Tobacco Control: Development of an Evidence Based Global Public Health Treaty","volume":"327","author":"Shibuya","year":"2003","journal-title":"BMJ"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"iii65","DOI":"10.1136\/tc.2005.013276","article-title":"Socioeconomic and Country Variations in Knowledge of Health Risks of Tobacco Smoking and Toxic Constituents of Smoke: Results from the 2002 International Tobacco Control (ITC) Four Country Survey","volume":"15","author":"Siahpush","year":"2006","journal-title":"Tob. Control"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Diaz-Martinez, J., Delgado-Enciso, I., Campa, A., Tamargo, J.A., Martin, H.R., Johnson, A., Siminski, S., Gorbach, P.M., and Baum, M.K. (2022). Stress Increases the Association between Cigarette Smoking and Mental Disorders, as Measured by the COVID-19-Related Worry Scale, in the Miami Adult Studies on HIV (MASH) Cohort during the Pandemic. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19138207"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jad.2023.03.010","article-title":"Generalized Anxiety among Finnish Youth from 2013 to 2021\u2014Trend and the Impact of COVID-19","volume":"330","author":"Kiviruusu","year":"2023","journal-title":"J. Affect. Disord."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/00006199-200401000-00009","article-title":"SPSS and SAS Programming for the Testing of Mediation Models","volume":"53","author":"Dudley","year":"2004","journal-title":"Nurs. Res."},{"key":"ref_58","unstructured":"ClinCalc.com \u00abStatistics\u00bb Post-Hoc Power Calculator Post-Hoc Power Calculator (2023, April 28). Evaluate Statistical Power of an Existing Study. Available online: https:\/\/clincalc.com\/stats\/Power.aspx."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jad.2020.08.001","article-title":"Impact of COVID-19 Pandemic on Mental Health in the General Population: A Systematic Review","volume":"277","author":"Xiong","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jpsychires.2021.07.040","article-title":"Alcohol Use, Cannabis Use, and Psychopathology Symptoms among College Students before and after COVID-19","volume":"142","author":"Schepis","year":"2021","journal-title":"J. Psychiatr. Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.15585\/mmwr.mm6932a1","article-title":"Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic\u2014United States, June 24\u201330, 2020","volume":"69","author":"Czeisler","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"155","DOI":"10.17711\/SM.0185-3325.2023.020","article-title":"Perceived Academic Stress in Mexican Medical Students. The Role of Sex Emotional Distress, Burnout, Academic-Social Support, Current Abuse Experiences, and Coping Strategies","volume":"46","year":"2023","journal-title":"Salud Ment."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"102492","DOI":"10.1016\/j.econedurev.2023.102492","article-title":"Learning Losses during the COVID-19 Pandemic: Evidence from Mexico","volume":"98","author":"Alasino","year":"2024","journal-title":"Econ. Educ. Rev."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Su\u00e1rez-Rico, B.V., Estrada-Gutierrez, G., S\u00e1nchez-Mart\u00ednez, M., Perichart-Perera, O., Rodr\u00edguez-Hern\u00e1ndez, C., Gonz\u00e1lez-Leyva, C., Osorio-Valencia, E., Cardona-P\u00e9rez, A., Helguera-Repetto, A.C., and Espino y Sosa, S. (2021). Prevalence of Depression, Anxiety, and Perceived Stress in Postpartum Mexican Women during the COVID-19 Lockdown. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18094627"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.apnu.2022.08.005","article-title":"Anxiety in Mexican Adults throughout the COVID-19 Pandemic: A Cross Sectional Study","volume":"41","year":"2022","journal-title":"Arch. Psychiatr. Nurs."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1753-2000-7-16","article-title":"The Face of Appearance-Related Social Pressure: Gender, Age and Body Mass Variations in Peer and Parental Pressure during Adolescence","volume":"7","author":"Helfert","year":"2013","journal-title":"Child Adolesc. Psychiatry Ment. Health"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"101319","DOI":"10.1016\/j.tele.2019.101319","article-title":"A Feminine Burden of Perfection? Appearance-Related Pressures on Social Networking Sites","volume":"46","author":"Koivula","year":"2020","journal-title":"Telemat. Inform."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s10567-022-00404-5","article-title":"The Perfect Storm: A Developmental\u2013Sociocultural Framework for the Role of Social Media in Adolescent Girls\u2019 Body Image Concerns and Mental Health","volume":"25","author":"Roberts","year":"2022","journal-title":"Clin. Child Fam. Psychol. Rev."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2026","DOI":"10.1016\/j.addbeh.2013.01.005","article-title":"Alcohol Use among Mexican American U.S.\u2013Mexico Border Residents: Differences between Those Who Drink and Who Do Not Drink in Mexico","volume":"38","author":"Caetano","year":"2013","journal-title":"Addict. Behav."},{"key":"ref_70","first-page":"177","article-title":"Gender Differences in Alcohol Consumption in Mexico City","volume":"41","year":"1999","journal-title":"Salud Publica Mex."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Ramalho, R., Adiukwu, F., Gashi Byty\u00e7i, D., El Hayek, S., Gonzalez-Diaz, J.M., Larnaout, A., Orsolini, L., Pereira-Sanchez, V., Pinto da Costa, M., and Ransing, R. (2021). Alcohol and Tobacco Use During the COVID-19 Pandemic. A Call for Local Actions for Global Impact. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.634254"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e141","DOI":"10.15190\/d.2021.20","article-title":"Substance Use during COVID-19 Pandemic: Impact on the Underserved Communities","volume":"9","author":"Chacon","year":"2021","journal-title":"Discoveries"},{"key":"ref_73","first-page":"78","article-title":"H\u00e1bitos Alimenticios y Sus Alteraciones En Estudiantes En Confinamiento Por Covid-19","volume":"Volume 1","year":"2022","journal-title":"Textos Universitarios Sobre Cultura F\u00edsica y Juventudes"},{"key":"ref_74","first-page":"112","article-title":"Socioeconomic Disparities and Self-Reported Substance Abuse-Related Problems","volume":"10","author":"Hossain","year":"2018","journal-title":"Addict. Health"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Gerra, G., Benedetti, E., Resce, G., Potente, R., Cutilli, A., and Molinaro, S. (2020). Socioeconomic Status, Parental Education, School Connectedness and Individual Socio-Cultural Resources in Vulnerability for Drug Use among Students. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17041306"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Zhao, R., Lv, J., Gao, Y., Li, Y., Shi, H., Zhang, J., Wu, J., and Wang, L. (2023). Association between Family Environment and Adolescents\u2019 Sexual Adaptability: Based on the Latent Profile Analysis of Personality Traits. Children, 10.","DOI":"10.3390\/children10020191"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e17518","DOI":"10.1097\/MD.0000000000017518","article-title":"The Relationship between Levels of Self-Esteem and the Development of Depression in Young Adults with Mild Depressive Symptoms","volume":"98","author":"Choi","year":"2019","journal-title":"Medicine"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1177\/2631831820971900","article-title":"Sexual Behavior During the Times of COVID-19-Related Lockdown in India: Results From an Online Survey","volume":"2","author":"Gondwal","year":"2020","journal-title":"J. Psychosexual Health"},{"key":"ref_79","first-page":"200","article-title":"Trabajo Sexual y Pandemia de La COVID-19: Salud Sexual y Mental de Una Muestra de Trabajadoras Sexuales de Colombia","volume":"53","year":"2022","journal-title":"Rev. Latinoam. Psicol."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Acoba, E.F. (2024). Social Support and Mental Health: The Mediating Role of Perceived Stress. Front. Psychol., 15.","DOI":"10.3389\/fpsyg.2024.1330720"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"102451","DOI":"10.1016\/j.jksus.2022.102451","article-title":"Community Behavioral Change and Management of COVID-19 Pandemic: Evidence from Indonesia","volume":"35","author":"Tjahjadi","year":"2023","journal-title":"J. King Saud Univ. Sci."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Alothman, S.A., Alshehri, M.M., Almasud, A.A., Aljubairi, M.S., Alrashed, I., Abu Shaphe, M., and Alghannam, A.F. (2022). Virtual Behavioral Intervention to Promote Healthy Lifestyle Behaviors: A Feasibility RCT during COVID-19 Pandemic. Healthcare, 11.","DOI":"10.3390\/healthcare11010091"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Requenes, J.I.G., Aguirre, M.d.R.R., Gonz\u00e1lez, G.d.P.D., Ibarra, J.O.F., and Varela, M.E.V. (2023). Impact of COVID-19 on Education in Mexico. Pathways to Knowledge: Exploring the Horizons of Education, Seven Editora.","DOI":"10.56238\/ptoketheeducati-047"},{"key":"ref_84","first-page":"139","article-title":"Impacto de La Covid-19 En Estudiantes de Preparatoria En Comunidades Rurales, M\u00e9xico","volume":"21","year":"2023","journal-title":"Rev. Latinoam. Cienc. Soc. Ni\u00f1ez Juv."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Morales Bonilla, Y., and Bustamante Peralta, K.E. (2021). Retos de La Ense\u00f1anza En La Pandemia Por COVID 19 En M\u00e9xico. Dilemas Contemp. Educ. Pol\u00edtica Valores, 8.","DOI":"10.46377\/dilemas.v9i1.2873"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Maciel-Saldierna, M., Elizondo-Hern\u00e1ndez, E., Cervantes-Guevara, G., Cervantes-P\u00e9rez, E., Cervantes-Cardona, G.A., Guzm\u00e1n-Ram\u00edrez, B.G., Brancaccio-P\u00e9rez, I.V., Chejfec-Ciociano, J.M., Guzm\u00e1n-Ruvalcaba, M.J., and Cifuentes-Andrade, L.R. (2022). Prevalence of Depression, Anxiety, and Stress in Junior High School Students in Guadalajara, Mexico: A Cross-Sectional Survey Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192315463"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21926\/obm.neurobiol.2403237","article-title":"COVID-19 Impact on Substance Use (Tobacco, Alcohol, Cannabis) and Stress in Medical Students","volume":"8","author":"Muselli","year":"2024","journal-title":"OBM Neurobiol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1017\/S2045796021000767","article-title":"Mental Disorder Symptoms during the COVID-19 Pandemic in Latin America\u2014A Systematic Review and Meta-Analysis","volume":"31","author":"Zhang","year":"2022","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"110650","DOI":"10.1016\/j.forsciint.2020.110650","article-title":"Violence against Women in the Covid-19 Pandemic: A Review of the Literature and a Call for Shared Strategies to Tackle Health and Social Emergencies","volume":"319","author":"Viero","year":"2021","journal-title":"Forensic Sci. Int."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"114902","DOI":"10.1016\/j.psychres.2022.114902","article-title":"Depression and Anxiety in Later COVID-19 Waves across Europe: New Evidence from the European COvid Survey (ECOS)","volume":"317","author":"Hajek","year":"2022","journal-title":"Psychiatry Res."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"e87","DOI":"10.1192\/j.eurpsy.2023.2467","article-title":"Changes in Anxiety and Depression during the COVID-19 Pandemic in the European Population: A Meta-Analysis of Changes and Associations with Restriction Policies","volume":"66","author":"Lok","year":"2023","journal-title":"Eur. Psychiatry"},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Caycho-Rodr\u00edguez, T., Tom\u00e1s, J.M., Vilca, L.W., Carbajal-Le\u00f3n, C., Cervigni, M., Gallegos, M., Martino, P., Bar\u00e9s, I., Calandra, M., and Anacona, C.A.R. (2021). Socio-Demographic Variables, Fear of COVID-19, Anxiety, and Depression: Prevalence, Relationships and Explanatory Model in the General Population of Seven Latin American Countries. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.695989"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"101832","DOI":"10.1016\/j.legalmed.2020.101832","article-title":"Legal Scenarios in the Coronavirus Time: Medico Legal Implications in the Aspects of Governance","volume":"48","author":"Bonvicini","year":"2021","journal-title":"Leg. Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"101718","DOI":"10.1016\/j.legalmed.2020.101718","article-title":"COVID-19: The Wrong Target for Healthcare Liability Claims","volume":"46","author":"Parisi","year":"2020","journal-title":"Leg. Med."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"737","DOI":"10.32870\/sincronia.axxv.n80.32b21","article-title":"Brecha Educativa Con Las Clases Virtuales En M\u00e9xico Durante La Pandemia Del Covid-19","volume":"XXV","year":"2021","journal-title":"Sincron\u00eda"},{"key":"ref_96","first-page":"57","article-title":"Estudiantes \u201cPre y Post Pandemia\u201d Diferencias, Necesidades y Estrategias Empleadas En El \u00c1rea de Ciencias Exactas y Experimentales","volume":"Volume 1","year":"2023","journal-title":"Nueva Presencialidad Escolar: Una Mirada Desde la Docencia"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Guest, G., Namey, E., O\u2019Regan, A., Godwin, C., and Taylor, J. (2020). Comparing Interview and Focus Group Data Collected in Person and Online, Europe PMC.","DOI":"10.25302\/05.2020.ME.1403117064"},{"key":"ref_98","first-page":"121","article-title":"Cannabis-Induced Mania Following COVID-19 Self-Medication: A Wake-Up Call to Improve Community Awareness","volume":"14","author":"Kaggwa","year":"2021","journal-title":"Int. Med. Case Rep. J."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"113952","DOI":"10.1016\/j.jep.2021.113952","article-title":"Self-Treatment and Adverse Reactions with Herbal Products for Treating Symptoms Associated with Anxiety and Depression in Adults from the Central-Western Region of Mexico during the Covid-19 Pandemic","volume":"272","author":"Carranza","year":"2021","journal-title":"J. Ethnopharmacol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1080\/02791072.2023.2255182","article-title":"Therapeutic Effects of Ceremonial Ayahuasca Use for Methamphetamine Use Disorders and Other Mental Health Challenges: Case Studies in an Indigenous Community in Sonora, Mexico","volume":"55","author":"Giovannetti","year":"2023","journal-title":"J. Psychoact. Drugs"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"901","DOI":"10.2147\/RMHP.S300656","article-title":"The Use of Classic Hallucinogens\/Psychedelics in a Therapeutic Context: Healthcare Policy Opportunities and Challenges","volume":"14","author":"Bouso","year":"2021","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"528","DOI":"10.3325\/cmj.2021.62.528","article-title":"A Potential Effect of Psilocybin on Anxiety in Neurotic Personality Structures in Adolescents","volume":"62","author":"Bogadi","year":"2021","journal-title":"Croat. Med. J."},{"key":"ref_103","first-page":"210","article-title":"The Role and Place of Medicinal Plants in the Strategies for Disease Prevention","volume":"10","author":"Sofowora","year":"2013","journal-title":"Afr. J. Tradit. Complement. Altern. Med."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/12\/12\/303\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:40:58Z","timestamp":1760114458000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/12\/12\/303"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,27]]},"references-count":103,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["diseases12120303"],"URL":"https:\/\/doi.org\/10.3390\/diseases12120303","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,27]]}}}