Trajectories of common mental disorders symptoms before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 Mental Health Cohort

Soc Psychiatry Psychiatr Epidemiol. 2022 Dec;57(12):2445-2455. doi: 10.1007/s00127-022-02365-0. Epub 2022 Sep 17.


Aim: Evidence indicates most people were resilient to the impact of the COVID-19 pandemic on mental health. However, evidence also suggests the pandemic effect on mental health may be heterogeneous. Therefore, we aimed to identify groups of trajectories of common mental disorders' (CMD) symptoms assessed before (2017-19) and during the COVID-19 pandemic (2020-2021), and to investigate predictors of trajectories.

Methods: We assessed 2,705 participants of the ELSA-Brasil COVID-19 Mental Health Cohort study who reported Clinical Interview Scheduled-Revised (CIS-R) data in 2017-19 and Depression Anxiety Stress Scale-21 (DASS-21) data in May-July 2020, July-September 2020, October-December 2020, and April-June 2021. We used an equi-percentile approach to link the CIS-R total score in 2017-19 with the DASS-21 total score. Group-based trajectory modeling was used to identify CMD trajectories and adjusted multinomial logistic regression was used to investigate predictors of trajectories.

Results: Six groups of CMD symptoms trajectories were identified: low symptoms (17.6%), low-decreasing symptoms (13.7%), low-increasing symptoms (23.9%), moderate-decreasing symptoms (16.8%), low-increasing symptoms (23.3%), severe-decreasing symptoms (4.7%). The severe-decreasing trajectory was characterized by age < 60 years, female sex, low family income, sedentary behavior, previous mental disorders, and the experience of adverse events in life.

Limitations: Pre-pandemic characteristics were associated with lack of response to assessments. Our occupational cohort sample is not representative.

Conclusion: More than half of the sample presented low levels of CMD symptoms. Predictors of trajectories could be used to detect individuals at-risk for presenting CMD symptoms in the context of global adverse events.

Keywords: Anxiety; COVID-19 pandemic; Cohort study; Depression; Trajectories.

MeSH terms

  • Anxiety / epidemiology
  • Anxiety / psychology
  • COVID-19* / epidemiology
  • Cohort Studies
  • Depression / diagnosis
  • Depression / epidemiology
  • Depression / psychology
  • Female
  • Humans
  • Mental Disorders* / diagnosis
  • Mental Disorders* / epidemiology
  • Mental Disorders* / psychology
  • Mental Health
  • Middle Aged
  • Pandemics