Study assesses prevalence of psychiatric symptoms before and during COVID-19 pandemic

The COVID-19 pandemic and the situations of stress and sadness associated with it did not significantly increase the prevalence of depression and anxiety among participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil) who live in the city of São Paulo.

ELSA-Brazil has been monitoring the overall health of 15,000 officials at six universities and public research centers in Brazil since 2008. The survey of mental health during the pandemic was conducted in São Paulo and involved 2,117 staff members from the ‘University of São Paulo (USP) – active duty or retired – who participate in the national study and are between the ages of 50 and 80.

The survey is supported by the São Paulo Research Foundation – FAPESP and aims to compare mental health before and during the pandemic in healthy subjects and people with anxiety or depression.

“This is good news, but it should be noted that São Paulo has one of the highest prevalence rates of psychiatric disorders in the world, with around 20% of the population affected. Studies similar to ours conducted in the Kingdom United, for example, indicate a prevalence of 16%. The explanation could be what we call a ceiling effect: the prevalence is already so high that it cannot increase any further, “said André Brunoni, principal investigator of the project. Brunoni is a professor at the Faculty of Medicine of the University of São Paulo (FM-USP).

The results of the study are reported in an article published in Psychological medicineThey show a prevalence dropping from 23.5% to 21.1% for mental illnesses in general in 2020, from 3.3% to 2.8% for depression, and from 13.8% to 8% for ‘anxiety.

During the three periods of the year in which information was collected on participants’ mental health – May-July, July-September and October-December – the prevalence of depression, anxiety and stress is remained stable or decreased moderately.

Of course, everyone is sadder and more worried about the situation. Our questionnaire showed that 30% of respondents reported depression or symptoms of anxiety. However, these were subjective assessments. The diagnoses indicated a stability or even a reduction. The same was true for symptoms of anxiety or depression. “

André Brunoni, professor, FM-USP

According to Brunoni, psychiatrists only diagnose depression if patients have at least two major symptoms for more than two months (for example, sadness and lack of pleasure from activities previously performed) and five of the nine minor symptoms (anxiety, sleep disturbance). , weight loss or gain, thoughts of low self-esteem, and changes in libido).

The most vulnerable

The data described in the article indicate that the risk of mental illness was higher among the youngest and most socially vulnerable, such as women, those without a college degree, and non-whites. “The only risk factor that is not part of the classic elements of vulnerability in our society was age,” Brunoni said. “The risk of mental illness was highest for the youngest participants in our study, those under the age of 60. This was probably because the elderly were protected during the pandemic and did not have to go to work even after the lifting of mobility restrictions. “

Another aspect observed in the study, and which will be explored further with new analyzes, is the intensification of the double burden on women. “Mental illness did not increase among men surveyed with children at home, but among women. We now want to think about the impact of having a paid job, cleaning and caring for children. children during the lockdown, ”he explained.

Financial stability is also an important factor in maintaining mental health, even in very stressful situations. The study sample was older, with an average age of 62, and as civil servants, participants have jobs as well as other forms of social protection not available to the general population.

“We believe that age contributed more than safety to the absence of an increase in psychiatric disorders. A similar study of adolescents would likely detect an increase in the diagnosis of mental problems,” Brunoni said. The reason is that mental disorders are associated with genetic or biological vulnerability, as well as environmental factors such as external stress. “Mental illness usually peaks around the age of 20 or 30, when the subject is most exposed to the outside world. After that, it decreases.”

About 25% of the participants had been diagnosed with a psychiatric disorder. “With hindsight, these people aged 50 to 80 experienced dictatorship, hyperinflation, the Collor plan [an economic program implemented in 1990 by Fernando Collor, Brazil’s president until 1992, freezing all bank accounts, among other measures] and probably many losses in life. They have gone through a lot of adversity and may have developed mental disorders if they had a genetic predisposition, ”Brunoni said.

Loneliness during the pandemic was also covered by the study and will be explored more fully in future research. “Many respondents said technology was essential for dealing with loneliness and staying in touch with family and friends, albeit virtually,” he noted. “This was important because people who report interpersonal difficulties are at increased risk of developing symptoms of mental illness.”