{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T16:16:22Z","timestamp":1773850582553,"version":"3.50.1"},"reference-count":44,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,4,24]],"date-time":"2022-04-24T00:00:00Z","timestamp":1650758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The main objective of this study is to understand and characterize the adoption of an ecological perspective and the physical, psychological, social, and contextual health factors that may influence the adjustment to and mental health experiences during the COVID-19 pandemic. The study included 5479 participants, of which 3710 were female (67.7%), aged between 18 and 90 years old, with a mean age of 48.57 years (SD = 14.29), were considered three age groups: 21.5% up to 35 years old, 61.8% between 36 and 64 years old, and 16.7% 65 years old or more. The mental health and individual adjustment to the COVID-19 situation are explained by socio-demographic factors, health-related factors, lifestyles, attitudes and behaviors, lockdown experience, and place of residence. A better adaptation and mental health are observed among men, people with a higher educational level, people with lower sadness, nervousness, and burnout, and people whose health situation did not worsen with the pandemic. In terms of lifestyle, a better adaptation is related to a better quality of sleep, fewer nightmares, a higher practice of physical activity, and less consumption of processed foods and sweets. A better adaptation is also associated with lower levels of dependence on alcohol, TV, and SN (social networks) and a more positive experience of the lockdown imposed by the pandemic. Gender and age group differences in the described context were studied. Promoting a better adjustment and improved mental health when dealing with the COVID-19 requires an ecological understanding and multitarget interventions, targeting physical, mental, and social health together with the contextual environment.<\/jats:p>","DOI":"10.3390\/ijerph19095159","type":"journal-article","created":{"date-parts":[[2022,4,24]],"date-time":"2022-04-24T22:22:41Z","timestamp":1650838961000},"page":"5159","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Ecological Model Explaining the Psychosocial Adaptation to COVID-19"],"prefix":"10.3390","volume":"19","author":[{"given":"T\u00e2nia","family":"Gaspar","sequence":"first","affiliation":[{"name":"Sleep Medicine Center\u2014CENC, 1070-068 Lisbon, Portugal"},{"name":"Centro Lus\u00edada de Investiga\u00e7\u00e3o em Servi\u00e7o Social e Interven\u00e7\u00e3o Social (CLISSIS), Universidade Lus\u00edada, 1349-001 Lisboa, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisbon, Portugal"},{"name":"Comprehensive Health Research Center (CHRC), Nova Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7937-7841","authenticated-orcid":false,"given":"Teresa","family":"Paiva","sequence":"additional","affiliation":[{"name":"Sleep Medicine Center\u2014CENC, 1070-068 Lisbon, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisbon, Portugal"},{"name":"Comprehensive Health Research Center (CHRC), Nova Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal"}]},{"given":"Margarida Gaspar","family":"Matos","sequence":"additional","affiliation":[{"name":"Sleep Medicine Center\u2014CENC, 1070-068 Lisbon, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisbon, Portugal"},{"name":"APPSYci, ISPA\u2014University Institute, 1100-304 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Su, D., Chen, Y., He, K., Zhang, T., Tan, M., Zhang, Y., and Zhang, X. (2020). Influence of socio-ecological factors on COVID-19 risk: A cross-sectional study based on 178 countries\/regions worldwide. medRxiv, 1\u201335.","DOI":"10.1101\/2020.04.23.20077545"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s10865-020-00157-y","article-title":"Social and behavioral health responses to COVID-19: Lessons learned from four decades of an HIV pandemic","volume":"43","author":"Eaton","year":"2020","journal-title":"J. Behav. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1093\/eurpub\/ckaa226","article-title":"Demographic and public health characteristics explain large part of variability in COVID-19 mortality across countries","volume":"31","author":"Hradsky","year":"2021","journal-title":"Eur. J. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1093\/eurpub\/ckaa208","article-title":"Sleep pattern in the US and 16 European countries during the COVID-19 outbreak using crowdsourced smartphone data","volume":"31","author":"Lee","year":"2021","journal-title":"Eur. J. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"939","DOI":"10.2105\/AJPH.2020.305654","article-title":"Strengthening China\u2019s public health response system: From SARS to COVID-19","volume":"110","author":"Bouey","year":"2020","journal-title":"Am. J. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurpub\/ckaa218","article-title":"Excess mortality from COVID-19: Weekly excess death rates by age and sex for Sweden and its most affected region","volume":"31","author":"Modig","year":"2021","journal-title":"Eur. J. Public Health"},{"key":"ref_7","unstructured":"Eurofund (2021). COVID-19: Implications for Employment and Working Life."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/gwao.12506","article-title":"COVID-19 and the gender gap in work hours","volume":"28","author":"Collins","year":"2020","journal-title":"Gend. Work Organ."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/S0140-6736(20)30526-2","article-title":"COVID-19: The gendered impacts of the outbreak","volume":"395","author":"Whenam","year":"2020","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1097\/JOM.0000000000002202","article-title":"Impact of COVID-19 in Global Health and Psychosocial Risks at Work","volume":"63","author":"Gaspar","year":"2021","journal-title":"J. Occup. Environ. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1177\/0020764020961790","article-title":"Coping styles and mental health in response to societal changes during the COVID-19 pandemic","volume":"67","author":"Gurvich","year":"2020","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Hou, F., Bi, F., Jiao, R., Luo, D., and Song, K. (2020). Gender differences of depression and anxiety among social media users during the COVID-19 outbreak in China: A cross-sectional study. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09738-7"},{"key":"ref_13","first-page":"345","article-title":"Sleep disorder patients during COVID19: Preliminary results from a collaborative Portuguese network of Sleep Laboratories","volume":"29","author":"Paiva","year":"2020","journal-title":"J. Sleep Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Paiva, T., Reis, C., Feliciano, A., Canas-Simi\u00e3o, H., Machado, M.A., Gaspar, T., Tom\u00e9, G., Branquinho, C., Silva, M.R., and Ramiro, L. (2021). Sleep and Awakening Quality during COVID-19 Confinement: Complexity and Relevance for Health and Behavior. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18073506"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.3389\/fphys.2020.571416","article-title":"Aging, immunity, and COVID-19: How age influences the host immune response to coronavirus infections?","volume":"11","author":"Bajaj","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/geronb\/gbaa068","article-title":"COVID-19 worries and behavior changes in older and younger men and women","volume":"76","author":"Barber","year":"2020","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/eurpub\/ckaa249","article-title":"Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system","volume":"31","author":"Fabiani","year":"2021","journal-title":"Eur. J. Public Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1093\/geronb\/gbaa096","article-title":"The ups and downs of daily life during COVID-19: Age differences in affect, stress, and positive events","volume":"76","author":"Klaiber","year":"2021","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"100","DOI":"10.7326\/M20-1239","article-title":"Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the US outbreak: A cross-sectional survey","volume":"173","author":"Wolf","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1093\/eurpub\/ckaa238","article-title":"The impact of COVID-19 restriction measures on loneliness among older adults in Austria","volume":"31","author":"Stolz","year":"2021","journal-title":"Eur. J. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"696","DOI":"10.2105\/AJPH.2020.306095","article-title":"Projected All-Cause Deaths Attributable to COVID-19\u2013Related Unemployment in the United States","volume":"111","author":"Matthay","year":"2021","journal-title":"Am. J. Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"30342012","DOI":"10.17061\/phrp30342012","article-title":"Health literacy and disparities in COVID-19\u2013related knowledge, attitudes, beliefs and behaviors in Australia","volume":"30","author":"McCaffery","year":"2020","journal-title":"Public Health Res. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3187","DOI":"10.2147\/RMHP.S280289","article-title":"The Psychological Impact and Associated Factors of COVID-19 on the General Public in Hunan, China","volume":"13","author":"Shi","year":"2020","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C.S., and Ho, R.C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17051729"},{"key":"ref_25","first-page":"1540","article-title":"Psychological impact and associated factors during the initial stage of the coronavirus (COVID-19) pandemic among the general population in Spain","volume":"11","author":"Collado","year":"2020","journal-title":"Front. Physiol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Canas-Simi\u00e3o, H., Reis, C., Carreiras, D., Espada-Santos, P., and Paiva, T. (2022). Health-related behaviors and perceived addiction of depressed and healthy people during the COVID-19 pandemic. J. Nerv. Ment. Dis.","DOI":"10.1097\/NMD.0000000000001503"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.sleep.2020.05.011","article-title":"The enemy who sealed the world: Effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population","volume":"75","author":"Casagrande","year":"2020","journal-title":"Sleep Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e000248","DOI":"10.32892\/jmri.248","article-title":"Eating behaviors of American adults during the COVID-19 pandemic","volume":"5","author":"Kandiah","year":"2021","journal-title":"JMRI"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"105002","DOI":"10.1016\/j.appet.2020.105002","article-title":"Eating behavior and food purchases during the COVID-19 lockdown: A cross-sectional study among adults in the Netherlands","volume":"157","author":"Poelman","year":"2021","journal-title":"Appetite"},{"key":"ref_30","first-page":"e000960","article-title":"Changes in physical activity and sedentary behaviors from before to during the COVID-19 pandemic lockdown: A systematic review","volume":"7","author":"Stockwell","year":"2021","journal-title":"BMJ Open SEM"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"410","DOI":"10.3389\/fpsyg.2021.642954","article-title":"Changes in Physical Activity Pre-, During and Post-lockdown COVID-19 Restrictions in New Zealand and the Explanatory Role of Daily Hassles","volume":"12","author":"Hargreaves","year":"2021","journal-title":"Front. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Grossman, E.R., Benjamin-Neelon, S.E., and Sonnenschein, S. (2020). Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Survey of US Adults. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17249189"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Yu, H., Li, M., Li, Z., Xiang, W., Yuan, Y., Liu, Y., Li, Z., and Xiong, Z. (2020). Coping style, social support and psychological distress in the general Chinese population in the early stages of the COVID-19 epidemic. BMC Psychiatry, 20.","DOI":"10.1186\/s12888-020-02826-3"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Zhang, Y., and Ma, Z.F. (2020). Impact of the COVID-19 Pandemic on Mental Health and Quality of Life among Local Residents in Liaoning Province, China: A Cross-Sectional Study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17072381"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1007\/s11469-020-00337-6","article-title":"Coronavirus stress, optimism-pessimism, psychological inflexibility, and psychological health: Psychometric properties of the Coronavirus Stress Measure","volume":"19","author":"Arslan","year":"2020","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.jcbs.2020.07.010","article-title":"COVID-19: Psychological flexibility, coping, mental health, and wellbeing in the UK during the pandemic","volume":"17","author":"Dawson","year":"2020","journal-title":"J. Context. Behav. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Shah, S.U., Loo, E.X.L., Chua, C.E., Kew, G.S., Demutska, A., Quek, S., Wong, S., Lau, H.X., Low, E.X.S., and Loh, T.L. (2021). Association between well-being and compliance with COVID-19 preventive measures by healthcare professionals: A cross-sectional study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0252835"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/s10900-020-00877-x","article-title":"Knowledge, attitudes and practices of COVID-19 among urban and rural residents in China: A cross-sectional study","volume":"46","author":"Yue","year":"2021","journal-title":"J. Community Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1080\/21620555.2020.1814139","article-title":"Social capital and COVID-19: A multidimensional and multilevel approach","volume":"53","author":"Wu","year":"2021","journal-title":"Chin. Sociol. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"110398","DOI":"10.1016\/j.paid.2020.110398","article-title":"The influence of demographics and personality on COVID-19 coping in young adults","volume":"168","author":"Volk","year":"2021","journal-title":"Pers. Individ. Differ."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"350","DOI":"10.2105\/AJPH.2020.306110","article-title":"Preparing the Public Health Workforce for the Post\u2013COVID-19 Era","volume":"111","author":"Galea","year":"2021","journal-title":"Am. J. Public Health"},{"key":"ref_42","unstructured":"World Health Organization (2020, June 26). Mental Health and Psychosocial Considerations during COVID-19 Outbreak, Available online: https:\/\/www.who.int\/publications\/i\/item\/mental-health-and-psychosocial-considerations-during-the-covid-19-outbreak."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"S228","DOI":"10.1080\/14616696.2020.1823010","article-title":"The impact of COVID-19 on gender inequality in the labor market and gender-role attitudes","volume":"23","author":"Reichelt","year":"2021","journal-title":"Eur. Soc."},{"key":"ref_44","first-page":"158","article-title":"A Survey on Applications of Artificial Intelligence in Fighting Against COVID-19","volume":"54","author":"Jianguo","year":"2022","journal-title":"ACM Comput. Surv."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/9\/5159\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:59:40Z","timestamp":1760137180000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/9\/5159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,24]]},"references-count":44,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["ijerph19095159"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19095159","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,24]]}}}