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

Brunoni, André Russowsky; Suen, Paulo Jeng Chian; Bacchi, Pedro Starzynski; Razza, Lais Boralli; Klein, Izio; dos Santos, Leonardo Afonso; de Souza Santos, Itamar; da Costa Lane Valiengo, Leandro; Gallucci-Neto, José; Moreno, Marina Lopes; Pinto, Bianca Silva; de Cássia Silva Félix, Larissa; de Sousa, Juliana Pereira; Viana, Maria Carmen; Forte, Pamela Marques; de Altisent Oliveira Cardoso, Marcia Cristina; Bittencourt, Marcio Sommer; Pelosof, Rebeca; de Siqueira, Luciana Lima; Fatori, Daniel; Bellini, Helena; Bueno, Priscila Vilela Silveira; Passos, Ives Cavalcante; Nunes, Maria Angelica; Salum, Giovanni Abrahão; Bauermeister, Sarah; Smoller, Jordan W.; Lotufo, Paulo Andrade; Benseñor, Isabela Martins

BACKGROUND: There is mixed evidence on increasing rates of psychiatric disorders and symptoms during the coronavirus disease 2019 (COVID-19) pandemic in 2020. We evaluated pandemic-related psychopathology and psychiatry diagnoses and their determinants in the Brazilian Longitudinal Study of Health (ELSA-Brasil) São Paulo Research Center. METHODS: Between pre-pandemic ELSA-Brasil assessments in 2008–2010 (wave-1), 2012–2014 (wave-2), 2016–2018 (wave-3) and three pandemic assessments in 2020 (COVID-19 waves in May–July, July–September, and October–December), rates of common psychiatric symptoms, and depressive, anxiety, and common mental disorders (CMDs) were compared using the Clinical Interview Scheduled-Revised (CIS-R) and the Depression Anxiety Stress Scale-21 (DASS-21). Multivariable generalized linear models, adjusted by age, gender, educational level, and ethnicity identified variables associated with an elevated risk for mental disorders. RESULTS: In 2117 participants (mean age 62.3 years, 58.2% females), rates of CMDs and depressive disorders did not significantly change over time, oscillating from 23.5% to 21.1%, and 3.3% to 2.8%, respectively; whereas rate of anxiety disorders significantly decreased (2008–2010: 13.8%; 2016–2018: 9.8%; 2020: 8%). There was a decrease along three wave-COVID assessments for depression [β = −0.37, 99.5% confidence interval (CI) −0.50 to −0.23], anxiety (β = −0.37, 99.5% CI −0.48 to −0.26), and stress (β = −0.48, 99.5% CI −0.64 to −0.33) symptoms (all ps < 0.001). Younger age, female sex, lower educational level, non-white ethnicity, and previous psychiatric disorders were associated with increased odds for psychiatric disorders, whereas self-evaluated good health and good quality of relationships with decreased risk. CONCLUSION: No consistent evidence of pandemic-related worsening psychopathology in our cohort was found. Indeed, psychiatric symptoms slightly decreased along 2020. Risk factors representing socioeconomic disadvantages were associated with increased odds of psychiatric disorders.