This study provides the first evidence of mental distress and its predictors in Brazil during the COVID-19 epidemic. The researchers conducted a survey of 638 adults in Brazil one month after the first confirmed case of COVID-19 in Sao Paulo, the epicenter of the Brazilian outbreak. They found that 52% of the sampled adults experienced moderate distress, and 18.8% suffered severe distress. Female, younger, more educated adults reported higher levels of distress. The distance from Sao Paulo, age, and workplace attendance predicted levels of distress. The “typhoon eye effect,” in which people closer to the epicenter experience less distress, was stronger for older people or people who went to their workplace less. Adults most vulnerable to distress were far from the epicenter and did not go to work a week before the survey. Identifying these predictors may help mental health services to find and help vulnerable adults during the ongoing COVID-19 crisis.
The researchers wanted to provide the first evidence of mental distress and its predictors in adults during the ongoing COVID-19 crisis in Brazil.
COVID-19 has quickly spread across Brazil starting in February 2020. Research has suggested that large-scale mental health issues have the potential to break out during the crisis. Early evidence from China suggests a higher prevalence of mental health issues during the COVID-19 outbreak. This study explores several predictors of distress that have been reported in other countries, especially distance from the epicenter of the epidemic. Identifying these predictors could help mental health professionals locate mentally vulnerable individuals and provide assistance online or over the phone.
Of the participants, 57.7% were female and 42.3% were male. 78.7% reported negative for COVID-19, 0.9% reported positive, and 20.4% were unsure. 57.5% had not exercised in the past week, while 21.9%, 6.9%, 5.2%, and 4.1% of the participants reported exercising 1, 2, 3, and 5+ hours per day respectively. 60.0% did not attend their workplace at all in the past week, 28.5% were in the office for fewer than five days, 7.9% went to the office for five days, and 3.3% went for six or seven days.
The average COVID-19 Peritraumatic Stress Index (CPDI) score was 37.64, which was higher than China (23.65) and lower than Iran (34.54). Based on cut-off values of distress in CPDI, 52.0% experienced mild to moderate distress, and 18.8% experienced severe distress compared to 47.0% and 14.1% in Iran and 29.3% and 5.1% in China respectively.
Predictors of individuals’ COVID-19 Peritraumatic Stress Index (CPDI)
Females experienced more distress than males. Younger people reported a higher level of distress. Adults who were more educated and exercised less reported a higher level of distress. Family size and workplace attendance did not directly predict CPDI.
The researchers analyzed the relationship between individuals’ distance from Sao Paulo and CPDI, and how this relationship related to age and workplace attendance. A “typhoon eye effect” was observed, such that mental health issues increased with increased distance from the epicenter. This effect was stronger in older adults, and the relationship between the distance from the epicenter and distress was positive. This relationship also depended on workplace attendance, and was significantly positive for adults who did not go to their workplace at all. This relationship was negative for those who went to their workplace every single day, showing a “ripple” effect in which distress decreased with increased distance from the epicenter.
Predicted scores of individuals’ COVID-19 Peritraumatic Distress Index (CPDI)
In general, predicted values for CPDI in many groups were higher than the cutoff value for moderate distress.
CPDI was also predicted based on the interaction between age and distance from the epicenter. Individuals aged 18-25 years who were in the epicenter had the highest level of distress. Individuals aged 65 and above who were 3,300 km from the epicenter reported the second highest level. The least distressed group was people older than 65 in the epicenter.
CPDI was also predicted based on the interaction between workplace attendance and distance from the epicenter. Individuals far from the epicenter and did not go to their workplace in the past week had the highest level of distress. Distress was lowest among people who lived 3,300km from the epicenter and went to their workplace every day during the past week.
The study shows a high amount of distress in adults during the early stage of the COVID-19 outbreak in Brazil. Mean CPDI was worse than China and Iran. Individuals who were female, younger, more educated, or exercised less had more distress.
Studies concerning the role of distance from the epicenter as a predictor of mental health are emerging. This study found that this distance’s effect on mental health depended on age and workplace attendance. The “typhoon eye” effect was only significant in age groups of 46 years and above, which could be because mortality by COVID-19 varies by age. This effect seemed to become a “ripple” effect for those who attended their workplace every day in the last week. Possible explanations could include fulfillment associated with work, social interactions at work, and less time online and on social media.
The study also found that gender, age, education, exercise, and distance predicted distress in adults in Brazil during the COVID-19 epidemic.
The researchers hope that this study helps mental health professionals and encourages more research on mental health conditions and predictors during the COVID-19 crisis worldwide.