COVID-19 and family health in Mexico: a multicenter study on family perception in the face of illness

Background: The COVID-19 pandemic has disrupted global health not only at a biological level but also within the psychosocial and family spheres. As a flexible and adaptive system, the family has undergone significant transformations to maintain its functionality and cohesion. However, the perception of family health may vary depending on the severity of illness experienced by one of its members. Objective: To evaluate and compare the self-perception of family health among ambulatory and hospitalized patients diagnosed with COVID-19 in five Mexican states. Methods: A multicenter, cross-sectional, comparative analytical study was conducted with 1,110 IMSS beneficiaries aged 18 and older across Chiapas, Nuevo León, San Luis Potosí, Quintana Roo, and Mexico City. Participants were selected using stratified random sampling based on confirmed COVID-19 cases registered in SINOLAVE and SIMF systems. Data were collected through a 59-item self-administered questionnaire, including the validated Family Health Perception Scale (Cronbach's alpha = 0.81). Descriptive statistics, Chi-square tests, and Student's t-tests were applied using SPSS v.25. Results: Among ambulatory patients (n = 979), 71.5% reported good family health perception, versus 42.0% in hospitalized patients (n = 131) (p = 0.01). Significant differences were also found in all family functioning dimensions (climate, integrity, resilience, coping) and in age. Geographically, Chiapas and Mexico City showed the highest positive perceptions (>90%), while Quintana Roo showed the lowest (31%). Most families were in the independence (30.3%) or dispersion (30.3%) phases of the family life cycle. Conclusion: COVID-19 severity significantly affects family health self-perception, with lower scores among hospitalized patients. These findings highlight the need for family-centered approaches in primary care, especially during and after severe illness. Understanding how families perceive their health is essential for designing post-pandemic support strategies and strengthening resilience within the family system.