Prevalence and Incidence of Stress, Depression and Anxiety Symptoms among Brazilians in Quarantine across the early phases of the COVID-19 Crisis

ObjectiveThe aim of this study was to measure the prevalence and incidence of stress, depression, and anxiety symptoms in Brazilians during the COVID-19 pandemic. MethodWe assessed 103 (54 women, 49 men) participants online in three periods of the epidemic curve: time 1 (T1; first cases of community transmission; March 20 to 25, 2020), time 2 (T2; acceleration; April 15 to 20, 2020) and time 3 (T3; continued acceleration; June 25 to 30, 2020). The criteria adopted for calculating prevalence and incidence was identifying participants with scores two standard deviations above the mean compared to normative data. Stress was measured using the Perceived Stress Scale (PSS-10), depression was measured using the Filgueiras Depression Index (FDI), and anxiety was measured using the State-Trait Anxiety Inventory - State Subscale (STAI-S). ResultsInitially, 89% of individuals were free of severe stress, anxiety, and depression, which dropped to 35% by T3. Prevalence of stress increased from 1.9% (95% CI [0.5, 6.8]) at T1 to 7.8% (95% CI [4.0, 14.6]) at T2, and 28.2% (95% CI [20.4, 37.5]) at T3. Depression prevalence increased from 0% (95% CI [0, 3.6]) at T1 to 23.3% (95% CI [16.2, 32.3]) at T2 and 25.2% (95% CI [17.8, 34.4]) at T3. The prevalence of severe anxiety-state symptoms increased from 10.7% (95% CI [6.1, 18.1]) at T1 to 11.7% (95% CI [6.8, 19.3]) at T2 and 45.6% (95% CI [36.3, 55.2]) at T3. Stress incidence increased by 7.8% (95% CI = [4, 14.6]) from time 1 to time 2, 23.3% (95% CI [16.2, 32.3]) from time 2 to time 3, and 26.2% (95% CI [18.7, 35.5]) from time 1 to time 3. Depression incidence increased by 23.3% (95% CI [16.2, 32.3]) from T1 to T2, 15.5 (95% CI [9.8, 23.8]) T2 to T3, and 25.2% (95% CI [17.8, 34.4]) from T1 to T3. Anxiety incidence increased by 9.7% (95% CI [5.4, 17]) from T1 to T2, 39.8% (95%CI [30.9, 49.5]) from T2 to T3, and 35.9% (95% CI [27.3, 45.5]) from T1 to T3. The severity of stress significantly increased from 16.1{+/-}8.7 at T1 to 23.5{+/-}8.4 at T2, and 30.3{+/-}6.0 at T3. Depression severity significantly increased from 48.5{+/-}20.5 at T1 to 64.7{+/-}30.2 at T2, and 75.9{+/-}26.1 at T3. Anxiety increased from 49.0{+/-}13.4 at T1 to 53.5{+/-}12.5 at T2 and 62.3{+/-}13.4 at T3. Females and individuals without comorbidities that increased COVID-19 lethality had higher anxiety scores than males and individuals with comorbidities. Age was inversely associated with mental health outcomes at baseline. ConclusionThe prevalence and severity of stress, depression, and anxiety significantly increased throughout the course of the pandemic. Anxiety seems to be sensitive to gender and risk status, where females and individuals without pre-existing comorbidities had higher anxiety by the final collection point. Depression and stress increased throughout time but were not different between genders or risk status. HighlightsO_LIPerceived stress, depression and anxiety symptoms were assessed in 103 participants at three points in the COVID-19 pandemic C_LIO_LIParticipants showed higher prevalence of depression, stress, and anxiety throughout progression of the pandemic C_LIO_LIOnly 35% of individuals were free of severe stress, anxiety, and depression the third data collection point - even though 89% were free of these conditions at the start C_LIO_LIFemale and individuals without a comorbidity that increased risk of COVID-19 fatality had greater anxiety by the third time point compared to males, and those with a comorbidity C_LI