FAMILY BONDING IN CONFINEMENT OF THE COVID-19 PANDEMIC: A SYSTEMATIC REVIEW

Introduction: Due to the demands of the COVID-19 pandemic, the family became the primary setting in which people were confined. As a result, the family bond during confinement is an important phenomenon to study. Purpose : The purpose of this systematic review was to determine if the family bond would influence the changes in mental health brought on by confinement and the COVID-19 pandemic. Methodology : The methodological were a Systematic Review using the PRISMA model in the search engines Web of Science, Scopus, PubMed, PSYINFO, Taylor and Francis, Sciendo, Academic Search Ultimate, and Medline between September 2021 and April 2022. NOS (Newcastle-Ottawa Scale) was utilized. Results : Concerning the search results, it was possible to identify seven relevant studies for analysis: four on the variables associated with psychological well-being during the pandemic and two on the perceived changes in emotional state during the pandemic. Conclusions : the effects of confinement on mental health are characterized by an increase in negative emotions, heightened perceptions of stress, anxiety, and depression, and altered sleep patterns. Concerning the influence of the family bond on mental health, it was discovered that when the bond is perceived as positive and strong, that is, the individual perceives that their basic, social, and affective needs are covered, it becomes a protective factor for mental health, regulating the manifestation of stress, favoring the manifestation of positive emotions over negative ones, and becoming emotionally supportive.


Introduction
The COVID-19 pandemic is the most dangerous threat to global health since the 1918 H1N1 pandemic, which caused millions of deaths worldwide (Asmundson et al., 2020). In November 2019, the first outbreak would begin in Wuhan, followed by the first case in Chile in March 2020 (Godoy Echibur & Badillo Vargas, 2021); eight days later, the World Health Organization declared a pandemic (Bendersky, 2020). This new disease exhibits various unpredictable behaviors, high levels of lethality, variations in the level of contagion, and different strains throughout its duration (Arteaga Herrera, 2020), which would generate uncertainty and different problems in the stability of the various social areas, primarily in health, which would have resulted in the implementation of multiple health measures (Prada et al., 2021).
Primarily, Chile would have imparted all the recommended sanitary measures, adopting in the first instance the State of Constitutional Exception of Catastrophe; additionally, it implements the confinement based on the epidemiological behavior of the various municipalities (Colihuinca & Alejandra, 2021). The confinement caused by the virus's contagion has had a significant impact on various aspects of global stability, including the economic situation. Considering the closure of small and medium-sized businesses, the reduction of employment and the time devoted to working, the unemployment rates among informal workers would have skyrocketed, resulting in increases in poverty, food insecurity, or decreases in family income, particularly among the most vulnerable groups (Lizondo-Valencia et al., 2021;Velasco, 2021) Social isolation and confinement work as a measure to prevent the spread of COVID-19 (Gonzalez-Bernal et al., 2021;Rodríguez-Fernández et al., 2021;Seo, 2021) and its variants, however it would have some effects, as mentioned above, but they would also have affected other areas, such as mental health, since individuals mention experiencing adverse effects on a psychological level (Martínez-Líbano, 2020;Martínez-Líbano & Yeomans Cabrera, 2021;Martínez-Libano & Yeomans, 2021), due directly to the conditions of this confinement, and also to the threat of contagion (Kirk & Rifkin, 2022); this impact can produce psychological and psychiatric disorders such as post-traumatic stress (Ashby et al., 2022a;Nagarajan et al., 2022;Yunitri et al., 2022), depression, anxiety (Ashby et al., 2022bChoi et al. , 2020), frustration (Jayabalan, 2020;Muñoz-Fernández & Rodríguez-Meirinhos, 2021), panic disorders (Muñoz-Navarro et al., 2021;Nami et al., 2020) due to factors such as family separation (McAdams , 2021;Montauk & Kuhl, 2020), pain, grief, loneliness, shame, guilt, anger, fear, xenophobia, mass hysteria (Muorah, 2020;Whitehead & Whitehead, 2010), misinformation on social media (Buzzell, 2020;Tagliabue et al., 2020), financial insecurity (Cheng et al., 2021), stigmatization and other problems that would affect psychological well-being (Fernández-Abascal & Martín-Díaz, 2021;Nguyen et al., 2021). Other research details that such unprecedented isolation measures on social distancing, which prevent access to social support systems such as extended family, friends, acquaintances, and community ties, can affect mental well-being and cause a feeling of loneliness, anxiety, and depression (Alfawaz et al., 2021;Bzdok & Dunbar, 2020;Garcıá et al., 2002;Long et al., 2022) Family bonding is the inclusion of a member within the family, with all that this encompasses: admission, accommodation, and incorporation; this inclusion implies the acceptance that this member is part of the family structure; It is relevant that all family members can turn to others for support and support, especially in risky situations such as the current context Rodríguez Mateo et al., 2018). The universal and characteristic concept of the family is one of union, coexistence, and attachment among its members; however, there are circumstances in which these are not the main factors that characterize any family going through moments of stability and instability (Gough, 1959 ;Seltzer, 2000;Tomaney, 2022;Traina, 2022). From the systemic model, the different relationships established within the family system create relevance in the current context (Jamali & Mirshak, 2007;Patterson, 2002), since depending on the links formed, the effects mentioned above could be more or less profound (Walsh, 2003); a strong family leadership, defined by its upbringing, guidance, and protection, would be essential for the maintenance of stability (Committee, 2004;Walsh, 2015), however, in times of stress and uncertainty, the emotional affection and exhaustion, exhaust the caregiver resources, modifying parenting styles and weakening positive leadership, triggering a strain on the parent-child relationship Wade et al., 2020).

Purpose
The purpose of this systematic review was to determine if the family bond would influence the changes in mental health brought on by confinement and the COVID-19 pandemic.

Methodology
A systematic review was conducted to identify English and Spanish-written articles published between September 2021 and April 2022 in the databases Web of Science, Scopus, PubMed, ISSN 2612-2138 PSYINFO, Taylor and Francis, Scielo, Academic Search Ultimate, and Medline.

Selection Criteria and Study Eligibility
Each article's titles and abstracts were screened, then the full text was evaluated for eligibility. Studies were eligible for inclusion if the following conditions were met: 1) the population was adolescent or adult; and 2) the population size was adequate. 2) with the use of clinical and non-clinical instruments; 3) with both positive and negative outcomes; 4) field studies. 5) texts in English and Spanish; 6) studies that assess family-related variables; 7) If the data for the article was collected during the COVID-19 pandemic. 1) studies not related to the COVID-19 pandemic; 2) subjects living in isolation; 3) academic notes, letters to the editor, or reflections; and 4) systematic reviews were excluded. 5) individuals with specific diseases.

Quality Assessment
The quality of the studies was evaluated using a modified version of the Newcastle-Ottawa Scale (NOS) for cross-sectional research. The NOS evaluates quality on the basis of its content, design, and interpretation with greater reliability and validity than other scales (Cascaes da Silva et al. al., 2013). The scale has three components: selection, comparability, and outcome. There are seven categories that evaluate the representativeness of the sample, the rationale for sample size, comparability between respondents and non-respondents, exposure determinations, comparability based on study design or analysis, result evaluation, and statistical analysis adequacy. Maximums of four stars for the Selection dimension, two stars for the Comparability dimension, and three stars for the Comparability dimension can be awarded if a study meets certain criteria (Epstein et al., 2018)

Search results
Family Bonding during the confinement of the COVID-19 pandemic was the subject of 46 publications in total. Five were eliminated due to being duplicates. After reading the title and abstract of 21 articles, the remaining 12 were eliminated after reading the full text. Thus, six articles that satisfied the inclusion criteria were chosen for the systematic review. Table 1 is a summary of the study's characteristics and this review's findings. The sample sizes of the six articles ranged from 208 to 3,960 family members, for a total of 9,343. Brazil (n = 1), Peru (n = 1), the United States (n = 1), Saudi Arabia (n = 1), Spain (n = 1), and Turkey (n = 1) each conducted one of the six studies.  Table 2 presents the results of the evaluation of the methodological quality of the studies. The quality of the included studies ranged from satisfactory to good, earning between 4 and 7 stars. There were two seven-star studies (Livia et al., 2021;Tuason et al., 2021), two six-star studies (Alfawaz et al., 2021;López-Nez et al., 2021), and two five-star studies (Giannini et al., 2022;ENGÜN & TOPTA, 2020).

Incidence of the family bond during confinement by COVID-19
Among the effects that the family bond had on the changes experienced during the confinement of the COVID-19 pandemic, we discovered that conflicting family relationships increase emotional states of anxiety (n = 3); conflictive family relationships increase emotional states of sadness (n = 2); better family functioning preserves mental well-being (n = 2); family relationships regulate the perception of stress (n = 2); and better family functioning increases positive emotions (n = 2)

Discussion
The systematic review carried out to explore the incidence of family ties in the context of the COVID-19 pandemic. At the end of this review, it can be concluded that family bonding, when perceived as good, tends to protect and improve mental health. Particularly, confinement generates a change in individuals. It is mentioned that 93.3% of adolescents notice changes in their routine, mentioning increased anxiety and depression (Giannini et al., 2022), which oscillates with 92% perception of the effects of psychological aspects of the pandemic (ŞENGÜN & TOPTAŞ, 2020); it is noted that there is a significant difference in the appearance of negative emotions, exceeding the average in relation to positive emotions (Livia et al., 2021), considering, in turn, the loneliness and the diminished sense of agency and generated by psychological discomfort (Tuason et al. al., 2021), the indicators associated with mental health consider the presence of anxiety 58.1%, depression 50.2%, insomnia 32.2% (Alfawaz et al., 2021) and satisfaction with life 19% (López-Núñez et al., 2021). This may be due to the fact that, due to confinement, the members of a family group have experienced radical changes that are evidently perceptible in their usual routine, both at the family level and in educational, work, and social environment aspects, which has generated an emotional and psychological impact, depending on the stage of development in which they are and the support they perceive from the family environment (Cifuentes Carcelén & Navas Cajamarca, 2021), which is complemented by concern for their own health and that of people in their social circle, considering, the fear of becoming infected or infecting others; and in addition, the vulnerability to economic problems caused by confinement, job loss, and income reduction, would generate uncertainty about obtaining food and access to education, adding stressors that put the mental health of individuals at risk, which could even modify eating habits and sleep (Vásquez et al., 2020).
Within the aspects influenced by the family bond, present in the studies of the change perceived during the confinement of the COVID-19 pandemic, it is mentioned that when considered, this bond as conflictive, would cause an increase in the emotional states associated with sadness and anxiety, this taking into account that the increase in coexistence with family members would have caused moments of greater stress (Giannini et al., 2022), which is mentioned in other studies, in which interpersonal conflicts resulting from family life closest and limiting privacy, would be associated with emotional suffering, characterized by fear, anxiety, irritability, sadness and stress (Brooks et al., 2020). On the other hand, the consideration of difficult times associated with the pandemic would have provided opportunities to increase sharing time, generating stronger ties and improving the perception of the family relationship (Giannini et al., 2022), which coincides with the influence that the family bond had on the psychological impact of confinement since better family functioning would generate more positive emotions and fewer negative emotions, becoming a protective factor for the psychological well-being of the members mainly, these positive emotions would be associated with indicators of satisfaction perceived with the response of the family to expressions of affection and their response to feelings of love and sadness (Livia et al., 2021); therefore, it is pointed out that the family becomes one of the most important environments, valuing that it is the main environment in which one interacts and receives support (Arias et al., 2013).
Among the studies cited, estrangement from family members, that is, a member of the family nucleus who had to endure confinement far from the other family members, is considered a precedent for elevated stress indices (Lukács, 2021). In light of the aforementioned, this is due to the fact that the possibility that our health or that of our family members will be affected is a natural source of concern and anxiety ( Valero-Cedeo et al., 2020). Furthermore, emotional stress is associated with the narrative ideas of the most tragic situations experienced during the context of the COVID-19 pandemic and the subsequent confinement, which has resulted in the loss of relatives without being able to say goodbye, along with the loss of (Discua Cruz & Hamilton, 2022).
Regarding perceived stress in the context of pandemic and confinement, according to research, family bonding is presented as a coping mechanism (Tuason et al., 2021) because, during the pandemic, social loneliness and isolation are associated with an increase in the stress experienced, and that solid relationships should be regarded as keys to mental health (van Bavel ISSN 2612-2138; In a similar vein, Lukács et al. (2002) note that distancing oneself from one's family would increase anxiety about contagion, thereby heightening stress levels.
It is believed that strengthening family ties and interactions would reduce the risk of presenting anxious and depressive symptoms, with a higher prevalence rate in women (Alfawaz et al., 2021). Close relationships within the family nucleus and the maintenance of strong ties with high resilience capacities in unfavorable times would aid in coping with the effects of changes in the risk context that is experienced  In contrast, it is stated that individuals would benefit from living with their families during a pandemic (ENGÜN & TOPTA, 2020).
Cross-sectional research would have evaluated family bonding and mental health only in a pandemic, closing the space to compare with a pre-confinement state, consulting it only retrospectively, or increasing the risk of recalling more biases (Lukács, 2021). In addition, the majority of the studies used online questionnaires that were not standardized and were created with specific purposes for each study, which could lead to biases; this demonstrates the need to create standardized surveys and use them on a larger scale to add and validate findings (Alfawaz et al., 2021) All of the aforementioned should continue to motivate us to continue studying the effects of the containment of the COVID-19 pandemic on mental health and how the family manages to protect against negative effects or increase positive emotions in the different social contexts around the world and for the faithful, increase state support for families, and promote family ties, given that the family is a fundamental pillar of society

Limitations and Strengths of the Study Strengths
This is the first systematic review that examines and summarizes the existing literature on the prevalence of family ties and the effects of the COVID-19 pandemic's containment on the adult and adolescent population.

Limitations
This systematic review has certain limitations, as all of the reviewed studies relied on selfreports, which can lead to responses that are socially desirable. Similarly, as online studies were conducted, it is possible that a portion of the population could not access the evaluation. The majority of studies were cross-sectional, meaning that they were measured at a specific time, making it difficult to extrapolate these results to the general population and preventing causal inferences; the longitudinal study does not provide detailed information on the indicators prior to confinement. Similarly, the majority of studies had a larger proportion of women in their samples, which could impede the data analysis. Regarding this systematic review, the majority of the articles utilized non-standardized questionnaires, which could understate the data's reliability. Furthermore, the articles did not provide specific statistical data, such as prevalence, leaving a gap in knowledge

Conclusions
We can conclude that a number of studies include family bonding as one of their variables; however, it is not examined in depth, especially in terms of the factors that may interfere with it. In contrast, there is a paucity of research on this topic in Latin America and Chile. According to the reviewed studies, the effects on mental health caused by the containment of the COVID-19 pandemic would be associated with the appearance of negative emotions, feelings of stress, anxiety, depression, changes in sleep hours, and uncertainty; these would have been exacerbated by the above-mentioned health situation. Regarding the influence of the family bond on these changes, it has been observed that when it is perceived as positive and strong, this aspect becomes a protective factor for mental health, regulating the manifestation of stress, promoting the manifestation of positive emotions and reducing the manifestation of negative emotions, and serving as emotional support. It is necessary to emphasize the significance of the family unit in coping with high-risk situations like the COVID-19 pandemic. The promotion of this region must be the responsibility of social institutions.