An alternative approach to acute respiratory illness through a sex-based analysis, psychosocial attitudes, mood, and self-perceived health

To examine the role of psychosocial attitudes in the relationship between mood and self-rated health by sex during COVID-19 pandemic. A cross-sectional design was used with data from residents of Zaragoza (Spain) aged 16 years and older, collected during the initial lockdown (Phase I) and 20 months later (Phase II). Mediation analyses were conducted using three regression models to assess the role of psychosocial attitudes. Psychosocial attitudes explained 30–55% of the variance in the relationship between mood and self-rated health in both sexes. Significant direct effects of mood on self-rated health were found in men and women (Phase I: βmen: 0.293, p < .001; βwomen: 0.226, p < .001; Phase II: βmen: 0.266, p < .001; β_women = 0.292, p < .001), as well as significant effects of psychosocial attitudes (Phase I: βmen: 0.054, p < .001; βwomen: 0.052, p < .001; Phase II: βmen = 0.042, p < .001; βwomen: 0.049, p < .001). Indirect effects of mood through psychosocial attitudes were also significant (Phase I: βmen: 0.224; βwomen: 0.273; Phase II: βmen: 0.163, p < .001; βwomen: 0.193, p < .001). Women consistently reported worse moods and lower self-rated health than men across both phases. Promoting healthy behaviours is essential, particularly for women and other vulnerable groups, to reduce health disparities and support public health.