The COVID-19 pandemic and the situations of stress and sadness associated with it have not significantly increased 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 civil servants at six public universities and research centers in Brazil since 2008. The survey on mental health during the pandemic was conducted in São Paulo and involved 2,117 members of the staff of the University of São Paulo (USP) – in active service or retired – who are participants in the nationwide study and aged 50-80.
The survey is supported by São Paulo Research Foundation – FAPESP and aims to compare mental health before and during the pandemic in both healthy subjects and people suffering from anxiety or depression.
“This is good news, but it’s worth noting that São Paulo has one of the highest rates of prevalence of psychiatric disorders in the world, with about 20% of the population being affected. Similar studies to ours conducted in the UK, for example, point to 16% prevalence. The explanation could be what we call a ceiling effect: prevalence is already so high that it can’t get any higher,” André Brunoni, principal investigator for the project, told. Brunoni is a professor at the University of São Paulo’s Medical School (FM-USP).
The results of the study are reported in an article published in Psychological Medicine.They show prevalence falling from 23.5% to 21.1% for mental illness generally in 2020, from 3.3% to 2.8% for depression, and from 13.8% to 8% for anxiety.
In the three periods of the year during which information was collected on the mental health of the participants – May-July, July-September, and October-December – the prevalence of depression, anxiety and stress held steady or fell moderately.
"Of course, everyone is sadder and more worried about the situation. Our questionnaire showed 30% of respondents reporting depression or symptoms of anxiety. However, these were subjective assessments. The diagnoses pointed to stability or even a reduction. The same was true of symptoms of anxiety or depression.”
André Brunoni, Professor, FM-USP
According to Brunoni, psychiatrists only diagnose depression if patients display at least two major symptoms for more than two months (e.g. sadness and lack of pleasure from activities previously enjoyed) and five out of nine minor symptoms (anxiety, sleep disorders, weight loss or gain, thoughts of low self-worth, and alterations in libido).
The most vulnerable
The data described in the article indicates that the risk of mental illness was greater among the youngest and most vulnerable socially, such as women, subjects without a university degree, and nonwhites. “The only risk factor not among the classical elements of vulnerability in our society was age,” Brunoni said. “The risk of mental illness was highest for the youngest participants in our study, the under-sixties. This was probably because older people were shielded during the pandemic and didn’t have to go out to work even after mobility restrictions were lifted.”
Another aspect observed in the study, and one that will be explored in more depth with new analyses, is the intensification of women’s double burden. “Mental illness didn’t increase among male respondents with children at home but did among women. We now want to think about the impact of having a paid job, doing the housework and caring for the children during lockdown,” he explained.
Financial stability was also an important factor in the maintenance of mental health, even in highly stressful situations. The study sample was older, with a mean age of 62, and as civil servants the participants have job tenure as well as other forms of social protection not available to the general population.
“We believe age contributed more than security to the absence of an increase in psychiatric disorders. A study of adolescents conducted along the same lines would probably 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 typically peaks around the age of 20 or 30, when the subject is most exposed to the outside world. After that, it declines.”
About 25% of the participants had been diagnosed with some kind of psychiatric disorder. “Looking back, these people aged 50-80 had been through 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’ve experienced a great many adversities 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 deeply in future research. “Many respondents said technology was key to coping with solitude and keeping in touch with family and friends, albeit virtually,” he noted. “This was important because people who report interpersonal difficulties run a heightened risk of experiencing symptoms of mental illness.”
Brunoni, A.R., et al. (2021) Prevalence and risk factors of psychiatric symptoms and diagnoses before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 mental health cohort. Psychological Medicine. doi.org/10.1017/S0033291721001719.