Publication date: Jun 24, 2025
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.

| Concepts | Keywords |
|---|---|
| Adults | Adults |
| Hospitalization | Covid |
| Pandemic | Diagnosis |
| Rico | Distress |
| Hospitalization | |
| Loneliness | |
| Mental | |
| Older | |
| Psychological | |
| Puerto | |
| Related | |
| Reported | |
| Rico | |
| Srq | |
| Stressors |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | Psychological Distress |
| disease | MESH | COVID-19 |
| disease | MESH | death |
| disease | MESH | treatment delays |
| disease | MESH | loneliness |
| disease | MESH | Long Covid |