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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Factors associated with psychic symptomatology in diabetics during the COVID-19 pandemic / Fatores associados à sintomatologia psíquica em diabéticos durante a pandemia da COVID-19

Abstract Objectives: to determine the frequency and factors associated with severe / extreme signs and symptoms of stress, anxiety and depression in diabetic patients during the COVID-19 pandemic. Methods: cross-sectional study conducted in April /May 2020, which included 162 individuals with diabetes mellitus and over 18 years old. An online questionnaire was applied on social networks, composed of biological, sociodemographic, clinical characteristics and the Stress, Anxiety and Depression Scale (DASS-21). For statistical analysis, a multivariate logistic regression model was applied with a 5% significance level. Results: frequency of 37.7%, 43.3% and 45.1% were found for some symptom of stress, anxiety and depression, respectively. The factors associated with sign and symptoms of severe / extreme psychic disorders were: not having religion (stress, anxiety and depression); be at graduation (stress and anxiety); history of anxiety and depression (anxiety and depression); not practicing or decreasing physical exercises and starting, increased or continue taking sleeping medications (stress); history of contact with a suspected case of COVID-19, absence or decreased leisure (anxiety); female gender, absence of a partner, decreased family income and work or study (depression). Conclusion: the frequency of psychological disorders was higher than described in the literature on diabetic patients, being associated with biological, sociodemographic, clinical factors and aspects related to COVID-19 during the pandemic

Resumo Objetivos: determinar a frequência e os fatores associados aos sinais e sintomas de estresse, ansiedade e depressão grave/extremos em pacientes diabéticos durante a pandemia pela COVID-19. Métodos: realizou-se estudo de corte transversal em abril/maio de 2020 que incluiu 162 indivíduos com diabetes mellitus e maiores de 18 anos. Aplicou-se um questionário online divulgado nas mídias sociais, sendo composto por características biológicas, sociodemográ-ficas, clínicas e a Escala de Estresse, Ansiedade e Depressão (DASS-21). Para análise estatística foi aplicado modelo de regressão logística multivariado com nível de significância de 5%. Resultados: encontrou-se frequência de 37,7%, 43,3% e 45,1% para qualquer sinal e sintoma de estresse, ansiedade e depressão, respectivamente. Os fatores associados a sinais e sintomas psíquicos graves/extremos foram: não ter religião (estresse, ansiedade e depressão); estar na graduação (estresse e ansiedade);antecedente de ansiedade e/ou depressão (ansiedade e depressão); não realizar ou ter diminuído exercícios físicos, iniciado, aumentado ou mantido medicações para dormir (estresse); história de contato com caso suspeito da COVID-19; ausência ou diminuição de lazer (ansiedade) e sexo feminino, ausência de companheiro, diminuição da renda familiar e do trabalho ou estudo (depressão). Conclusão: a frequência de transtornos psíquicos foi maior que a descrita na literatura em pacientes diabéticos, sendo associada a fatores biológicos, sociodemográficos, clínicos e aspectos relacionados à COVID-19 durante a pandemia.

General aspects of the COVID-19 pandemic / Aspectos gerais da pandemia de COVID-19

Abstract Objectives: to review the available literature on the general aspects of SARS-CoV-2 infec-tion. Methods: this is a narrative literature review carried out from March to September 2020. Results: COVID-19 caused by the new coronavirus or SARS-CoV-2, grows with devas-tating effects worldwide. The literature describes epidemiological data and mortality risk groups of the disease, which presents a high rate of transmission. Prevention is the most effective way to fight the disease, persisting the absence of strong evidence on the treatment. Vaccines are not yet available. Dexamethasone is effective in reducing mortality in severe forms. Conclusions: despite great efforts, as the number of confirmed cases increases, evidence on transmission, incidence, disease progression, lethality, effects and outcomes remain limited and without any high levels of evidence. Studies are still necessary for all aspects of the disease.

Resumo Objetivos: revisar a literatura disponível sobre os aspectos gerais dainfecção por SARS-CoV-2. Métodos: trata-se de uma revisão narrativa de literatura realizada nos meses de março asetembro de 2020. Resultados: a COVID-19, causada pelo novo coronavírus ou SARS-CoV-2, cresce com efeitos devastadores em todo o mundo. A literetura descreve dados epidemiológicos e sobre grupos de riscos para mortalidade da doença, a qual apresenta uma alta velocidade de trans-missão. A prevenção é a forma mais eficaz de combate à doença, persistindo ausências de fortes evidências sobre o tratamento. Vacinas ainda não estão disponíveis A dexametasona é efetiva para redução da mortalidade nas formas graves. Conclusão: apesar dos grandes esforços, à medida que o número de casos confirmados aumenta, evidências sobre transmissão, incidência, evolução da doença, letalidade, efeitos e os desfechos permanecem limitados e sem grandes níveis de evidência. Estudos ainda são necessários sobre todos os aspectos da doença.

The testing for COVID-19 in symptomatic patients as a protective factor against stress, anxiety, and depression / Testagem para a COVID-19 em pacientes sintomáticos como fator protetivo contra estresse, ansiedade e depressão

Abstract Objectives: to determine the frequency of stress, anxiety, and depression symptoms in symptomatic patients for COVID-19. To evaluate the associated factors involved in these variants. Methods: between May/June of 2020, it was conducted a prospective cross-section study with symptomatic participants for COVID-19 (n=300). It was applied an online questionnaire and the DASS-21 to evaluate the mental health of participants. Results: it was observed that 28.6%, 29.7% and 27% of the participants showed severe/extreme levels symptoms of stress, anxiety, and depression, respectively. The testing for COVID-19 application had constituted a protective factor for the development of psychiatric morbidity, once it had shown significant association in the low frequencies of severe/extreme depression [Odds Ratio (OR)]= 0.26; p=0.002) and stress (OR=0.39; p=0.01). Conclusion: individuals that are symptomatic for COVID-19 are a vulnerable group that may present high symptomatology for depression, anxiety, and stress. The identification of psychiatric morbidity frequency and its associated factors may contribute for the development of mental health strategies aiming at the prevention and mitigation of psychological impact in COVID-19 symptomatic population during the pandemic.

Resumo Objetivos: determinar a frequência de sintomas de estresse, ansiedade e depressão em pacientes sintomáticos para COVID-19 e avaliar os fatores associados. Métodos: entre maio / junho de 2020, foi realizado um estudo transversal prospectivo com participantes sintomáticos para COVID-19 (n = 300). Foi aplicado um questionário online e o DASS-21 para avaliar a saúde mental dos participantes. Resultados: observou-se que 28,6%, 29,7% e 27% dos participantes apresentaram sintomas graves/extremos para estresse, ansiedade e depressão, respectivamente. A realização do teste para a COVID-19 constituiu-se como fator de proteção para o desenvolvimento de sintomatologia psíquica, uma vez que mostrou associação significativa nas baixas frequências de depressão grave/extrema [odds ratio (OR)]= 0,26; p=0,002) e de estresse (OR=0,39; p=0,01). Conclusão: os indivíduos sintomáticos para COVID-19 constituem um grupo vulnerável que podem apresentar elevada sintomatologia para depressão, ansiedade e estresse. A identificação da frequência de morbidade psiquiátrica e seus fatores associados podem contribuir para o desenvolvimento de estratégias de saúde mental visando a prevenção e mitigação do impacto psicológico na população sintomática de COVID-19 durante a pandemia.

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

ABSTRACT OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.

COVID-19 and Pregnancy / COVID-19 e Gravidez

Abstract Objectives: reviewing the available literature on COVID-19 infection and the maternal and perinatal outcomes. Methods: this is a narrative review of the literature carried out from March to September 2020, usingthe MESH: coronavirus, Covid 19, SARS-CoV-2, pregnancy, gravidity, pregnancy complications and pregnancy complications infectius. All study designs, reviews, recommendations and technical notes were included, without distinction of language and that would bring the approach of the new coronavirus in the gestational and perinatal scenario. Results: the COVID-19 pandemic has had devastating effects, affecting millions of people and claiming almost a million lives worldwide. Initially, pregnant women were not seen as a risk group for the disease, however as the proportion of women affected during the pregnancy-puerperal cycle increased, several studies were published showing an increased risk of complications. Brazilian studies have also warned of a high number of maternal deaths, associated with the presence of comorbidities but, above all, with the social determinants of the disease and serious failures in care. Conclusion: the need for new studies with an adequate research design was observed, as many studies are only letters or small series of cases, in addition expert recommendations, without the necessary scientific rigor.

Resumo Objetivos: revisar a literatura disponível sobre a COVID-19 e seus aspectos maternos e perinatais. Métodos: urna revisão narrativa de literatura foi realizada nos meses de março a setembro de 2020, utilizando os descritores, coronavirus, Covid 19, SARS-CoV-2, pregnancy, gravidity, pregnancy complications e pregnancy complications infectius. Foram incluidos todos os desenhos de estudo, revisões, recomendações e notas técnicas, sem distinção de idioma e que trouxessem a abordagem do novo coronavírus no cenárlo gestacional e perinatal. Resultados: a pandemia de COVID-19 vem apresentando efeitos devastadores, acometendo milhões depessoas e ceifando quase um milhão de vidas em todo o mundo. Inicialmente as gestantes não er am vistas como grupo de risco para a doença, porém na medida em que aumentou a proporção de mulheres acometidas durante o ciclo gravídico-puerperal diversos estudos foram publicados demostrando risco aumentado de complicações. Estudos brasileiros também alertaram para um número elevado de mortes maternas, associados à presença de comorbidades, mas, sobretudo, aos determinantes sociais da doença e a falhas graves da assistência. Conclusão: observou-se a necessidade de novos estudos com adequado delineamento de pesquisa, pois muitos estudos são apenas cartas ou pequenas séries de casos, além de recomendações de especialistas, sem o rigor científico necessário.