Psychological Distress in Older Adults Living in Puerto Rico during COVID-19.

Few studies have addressed the impact of COVID-19 on mental health in low resource settings. This study examines the association of COVID-19-related stressors with psychological distress in older adults in Puerto Rico. Data are from a 2021 Knowledge, Attitudes and Practices survey about COVID-19 with adults aged 60 + in Puerto Rico (n = 213). We used the Self-Reporting Questionnaire-20 (SRQ-20) to assess distress. Stressors included COVID-19 diagnosis, hospitalization, or death of someone close, treatment delays, and loneliness. We used negative binomial regression with a log linear link function to model the effects of demographics and pandemic-related social and health stressors on distress. Almost one-third (31%) of participants reported clinically significant distress; 44.3% reported a loved one diagnosed with COVID-19, 32.4% had lost someone close, 25.8% reported treatment delays, and 39.4% experienced loneliness. A COVID-19 diagnosis of someone close without hospitalization [Adjusted Incidence Rate Ratio (AIRR) = 1.55; 95% CI 1.08, 2.22] and loneliness [AIRR = 1.20; 95% CI 1.09, 1.32] were associated with greater SRQ-20 scores. We consider the nexus of cultural and contextual factors (e.g., outmigration, under-resourced healthcare system, fatalism etc.) that are likely to influence short- and longer-term effects of COVID-19-related distress among older adults in Puerto Rico. Interdisciplinary collaborations are needed to enhance Covid-19-related support and to implement culturally appropriate and contextually feasible evidence-based interventions that will reduce high rates of mental health challenges and prevent their long-term effects.