Association between Increased Perceived Stress and Decreased Self-Rated Health among Adults in Puerto Rico during COVID-19: A Puerto Rico-CEAL Study

Abstract

Objective: To examine how perceived changes in stress among adults during the COVID-19 pandemic are associated with changes in self-rated health (SRH) in Puerto Rico. Methods: This cross-sectional analysis used data from the Puerto Rico Community Engagement Alliance (Puerto Rico-CEAL). Adults aged ≥ 18 years (n = 654) completed an online survey from December 2021 through February 2022. One item assessed perceived changes in psychological stress throughout the pandemic. Two separate items assessed SRH (rated from poor to excellent) before and during the pandemic; changes in SRH ratings were calculated. Adjusted Poisson regression models were used to estimate prevalence ratios (PRs) of decreased SRH. Results: Overall, 72.8% of the sample perceived an increase in psychological stress during the pandemic and 39.6% experienced decreased SRH. In adjusted models, participants reporting perceived increases in stress were more likely to experience decreases in SRH (PR = 2.44; 95% CI, 1.71–3.45) during the pandemic compared with those reporting no change in stress. Conclusion: Perceived increases in psychological stress during the pandemic were associated with decreased SRH among participants in this Puerto Rico-based sample. Studies are needed to identify stress management strategies during public health emergencies.