Factors associated with stress, anxiety, and depression during social distancing in Brazil

Alex Sandro Rolland Souza, Gustavo Fonseca Albuquerque Souza, Gabriela Albuquerque Souza, Ana Lorena Nascimento Cordeiro, Gabriella Almeida Figueredo Praciano, Adricia Cristine de Souza Alves, Alan Chaves dos Santos, José Roberto Silva, Manuela Barbosa Rodrigues Souza

To estimate the prevalence of clinical signs and symptoms of severe/extreme stress, anxiety, and depression, as well as their associated factors, among Brazilians during social distancing. This is a cross-sectional study conducted in April/May 2020 with 3,200 Brazilians over 18 years old. Respondents' sociodemographic and clinical data were collected using an online questionnaire, which also included the 21-item Depression, Anxiety and Stress Scale (DASS-21) to assess emotional symptoms. Unadjusted and adjusted prevalence ratios and their respective 95% confidence intervals were estimated using Poisson regression models with robust variance. Our results show the prevalence of severe/extreme stress was 21.5%, anxiety 19.4%, and depression 21.5%. In the final model, sociodemographic, clinical, and Covid-19-related factors were associated with severe/extreme stress, anxiety, and depression in Brazilians during social distancing due to the Covid-19 pandemic. We found the main factors associated with severe/extreme depression to be young women, brown, single, not religious, sedentary, presenting reduced leisure activities, history of anxiety and depression, increased medication use, and Covid-19 symptoms. This study may help develop and systematically plan measures aimed to prevent, early identify, and properly manage clinical signs and symptoms of stress, anxiety, and depression during the Covid-19 pandemic.