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

Psychol Med. 2023 Jan;53(2):446-457. doi: 10.1017/S0033291721001719. Epub 2021 Apr 21.


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.

Keywords: Anxiety; COVID-19; cohort study; depression; mental health; pandemic.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anxiety / epidemiology
  • Anxiety / psychology
  • Brazil / epidemiology
  • COVID-19* / epidemiology
  • Depression / epidemiology
  • Depression / psychology
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Mental Disorders* / epidemiology
  • Mental Disorders* / psychology
  • Mental Health
  • Middle Aged
  • Pandemics
  • Prevalence
  • Risk Factors