ABSTRACT

This paper aimed to analyze the mental health protective factors and stressors of the pandemic in Brazil and internationally. We conducted an integrative literature review by searching for scientific publications indexed in the LILACS and MEDLINE databases from January to December 2020. Twentynine papers have been analyzed by author, year, country of study, methodology; mental health stressors and protective factors related. We concluded that people subjected to restrictive measures imposed by the COVID-19 pandemic are vulnerable to mental health problems. However, very few studies have evaluated the related psychosocial factors despite the global impact.

KEYWORDS
Mental health; Social isolation; COVID-19

Introduction

On January 30, 2020, the World Health Organization (WHO) announced the outbreak of the new Coronavirus (2019-nCoV) as a Public Health Emergency of International Concern, in which all countries have implemented measures to control and combat the COVID-19 disease. Researchers and health professionals have played a challenging role in this pandemic since the disease does not have a wholly defined clinical risk, and the accuracy of the transmission, infection, lethality, and mortality patterns is unknown²2 Pereira MD, Oliveira LC, Costa CFT, et al. A pandemia de COVID-19, o isolamento social, consequências na saúde mental e estratégias de enfrentamento: uma revisão integrativa. Reserch, Soc. Dev. 2020 [acesso em 2021 mar 22]; 9(7):e652974548. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/4548.
https://rsdjournal.org/index.php/rsd/art... .

Brazil recorded the second-highest number of accumulated cases (11,950,459) globally in Epidemiological Week 11, on March 20, 2021. Considering the level of incidence, the country had a rate of 56,435.1 cases for every 1 million inhabitants, ranking 27^th among countries with the highest incidence (cases of COVID-19 per 1 million inhabitants). The mortality coefficient stood at 138.2 deaths per 100 thousand inhabitants, ranking 17^th in the world for mortality by COVID-19. However, we should emphasize that each country is in a specific pandemic stage, where some are experiencing a significant increase in cases, as in Brazil³3 Brasil. Ministério da Saúde, Secretaria de Vigilância em Saúde. 55 Boletim epidemiológico especial. COE-COVID19. Semana epidemiológica 11 (14/3 a 20/3/2021). Brasília, DF: MS; 2006. [acesso em 2021 fev 20]. Disponível em: https://www.gov.br/saude/pt-br/media/pdf/2021/marco/25/boletim_epidemiologico_covid_55_atualizado.pdf.
https://www.gov.br/saude/pt-br/media/pdf... .

In the COVID-19 Weekly Epidemiological Update published on March 28 by the WHO, the number of deaths worldwide increased for the second consecutive week, with a growth of 5% against the previous week. The most considerable number of new cases was from Brazil (5,533,024, growth of 5%), followed by the United States (421,936, growth of 13%), and India (372,494, growth of 55%)⁴4 World Health Organization. COVID-19 Weekly Epidemiological Update. Genebra: WHO; 2021..

Besides the physical symptoms caused by the infection, the virus circulation affects people’s mental health, generating anxiety and depression⁵5 Jiao WY, Wang LN, Liu J, et al. Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. J Pediatr. 2020 [acesso em 2021 mar 22]; (221):264-266.e1. Disponível em: https://www.jpeds.com/article/S0022-3476(20)30336-X/fulltext.
https://www.jpeds.com/article/S0022-3476... . The fear of the unknown, the spread of the disease, and the impact on the economy exacerbate the anxiety of individuals with pre-existing mental health conditions and healthy individuals alike, as people tend to feel anxious and insecure when the environment changes⁶6 Usher K, Durkin J, Bhullar N. The COVID-19 pandemic and mental health impacts. Int J Ment Health Nurs. 2020 [acesso em 2021 mar 22]; 29(3):315-8. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262128/.
https://www.ncbi.nlm.nih.gov/pmc/article... .

So far, social distancing is the most effective measure to control the pandemic, conducted through quarantine and vaccines⁷7 Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. 2020 [acesso em 2021 mar 22]; 395(10227):912-20. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30460-8/fulltext.
https://www.thelancet.com/journals/lance... . Thus, further investigation of the psychological effects of this protection measure on the lives of those in social distancing is necessary. Moreover, we should emphasize that the approach of psychological aspects assists in the adherence to control measures such as quarantine⁸8 Cullen W, Gulati G, Kelly BD. Mental health in the COVID-19 pandemic. QJM. 2020 [acesso em 2021 mar 22]; 113(5):311-2. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2008017?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed.
https://www.nejm.org/doi/10.1056/NEJMp20... ,⁹9 Huremović D, organizador. Psychiatry of Pandemics: A Mental Health Response to Infection Outbreak. Switzerland: Springer International Publishing; 2019. [acesso em 2021 fev 20]. Disponível em: https://www.springer.com/gp/book/9783030153458.
https://www.springer.com/gp/book/9783030... .

Despite the strong relevance of psychological aspects in the population, the participation of professionals in mental health in projects related to a pandemic outbreak remains quite limited⁹9 Huremović D, organizador. Psychiatry of Pandemics: A Mental Health Response to Infection Outbreak. Switzerland: Springer International Publishing; 2019. [acesso em 2021 fev 20]. Disponível em: https://www.springer.com/gp/book/9783030153458.
https://www.springer.com/gp/book/9783030... . Furthermore, quarantine – used for infection control – has received little attention in the literature regarding its psychological effects.

Although the psychological reactions of the population play a critical role in the spread of disease and social disorder during and after the outbreak, the necessary resources are generally not provided to reduce the effects of the impact of pandemics on mental health⁸8 Cullen W, Gulati G, Kelly BD. Mental health in the COVID-19 pandemic. QJM. 2020 [acesso em 2021 mar 22]; 113(5):311-2. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2008017?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed.
https://www.nejm.org/doi/10.1056/NEJMp20... .

Based on this assumption, this paper aims to analyze the Brazilian and international literature on the effects of the COVID-19 pandemic on the mental health of adults to understand the protective factors and stressors associated with the pandemic and reflect on possible mental health intervention strategies.

Methods

This integrative review of the literature on mental health in the pandemic promotes the synthesis of knowledge through six stages underlying the elaboration process: producing the guiding question; literature search; data collection; critical analysis of the included papers; discussion of results; and, finally, presenting the integrative review¹⁰10 Souza MT, Silva MD, Carvalho R. Integrative review: what is it? How to do it? Einstein (São Paulo). 2010 [acesso em 2021 mar 22]; 8(1):102-6. Disponível em: https://doi.org/10.1590/S1679-45082010RW1134.
https://doi.org/10.1590/S1679-45082010RW... . The guiding questions are: ‘What aspects affect the mental health of adults because of the COVID-19 pandemic? What are the protective factors and stressors of mental health in the COVID-19 pandemic?’.

We collected data from secondary sources, through a survey of papers in the Latin American and Caribbean Health Sciences Literature (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases, from January to December 2020, the year the new Coronavirus was recognized as a pandemic. We selected papers in English, Portuguese, and Spanish.

The following descriptors were used to search for scientific studies corresponding to the objectives of this integrative review: “Saúde mental”, “Isolamento social” AND “Covid-19”, selected according to the Descriptors in Health Sciences (DeCS) and Medical Subject Headings (MeSH/PubMed). All were cross-referenced with each other by Boolean operators AND/OR. The search terms were (“mental health” OR “Saúde mental” OR “stress” OR “ansiedade” OR “depressão” OR “tristeza” OR “medo”) AND (“isolamento social” OR “quarentena”) AND (“COVID-19” OR “pandemias” OR “novo coronavirus”) AND (“adultos” OR “adults”).

The following inclusion and exclusion criteria were used for the selection of papers. Papers that address mental health in the COVID-19 pandemic as the central theme, published in the databases in the defined period in Portuguese, English, or Spanish, were included. The purposeful exclusion criteria were the following: 1. papers that do not address mental health, pandemic, and social restriction; 2. studies that do not address the relationship between psychological factors and restrictive measures; 3. studies in which only secondary results address the issue of mental health; 4. studies carried out with specific populations; surveys with people under 18 years of age; 5. studies with the older adults, subjects with chronic diseases or severely hospitalized subjects.

The search result summary in the researched databases is systematized in the flowchart below (figure 1). When starting the full-text reading of the papers, we noted that 12 of them did not meet the review’s objective and were, thus, excluded from the study, leaving out 29 full-text papers for the critical analysis.

Results

Seventeen countries of the 29 papers that make up this review were listed, giving a global scale of the pandemic. This mosaic allowed for diversified research on the effects of the pandemic on mental health from a global perspective, comparing the protective factors and stressors cited in different world regions.

Among the articles selected for the review, seven were from Spain; China and India each had three; the United Kingdom and the United States each had two; and Brazil, Italy, Lebanon, New Zealand, Kuwait, Jordan, Colombia, Canada, Germany, Belgium, Austria, and Ecuador each had one. Most works were quantitative cross-sectional studies due to the need to produce data to assist in planning COVID-19 coping actions. However, cross-sectional studies prevent the use of causal inferences, generating only a hypothesis of possible associations. All studies included subjects of both sexes.

Two thematic lines were established as emerging categories in the analysis of the papers: 1. Mental health stressors; 2. Mental health protective factors. Each paper was analyzed by year of publication, journal, and country of study according to these lines. Moreover, the objectives of each study are also presented. The items mentioned above are systematized in table 1.

Discussion

We understand health not as the lack of disease, but as biopsychosocial well-being, within an integrative vision. Therefore, it is crucial to understand the factors associated with mental health during the COVID-19 pandemic globally. To this end, we chose two major thematic groups for discussing the papers: 1. Mental health stressors; 2. Mental health protective factors.

Mental health stressors in the COVID-19 pandemic

The mental health aspects investigated in the scientific papers were anxiety, depression, stress, loneliness, and mental distress. We have majority consensus on the stressors addressed in the literature regarding gender, age, income and work. Schooling level, sharing housing, previous history of health problems, and marital status were also identified as stressors. Thus, 16 papers (55%) mention women¹¹11 Smith L, Jacob L, Yakkundi A, et al. Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (291):113138-113138. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258801/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹²12 Duarte MQ, Santo MAS, Lima CP, et al. Covid-19 and the impacts on mental health: a sample from Rio Grande do Sul, Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2021 mar 22]; 25(9):3401-11. Disponível em: https://doi.org/10.1590/1413-81232020259.16472020.
https://doi.org/10.1590/1413-81232020259... ,¹³13 Mazza C, Ricci E, Biondi S, et al. A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(9). Disponível em: https://dx.doi.org/10.3390/ijerph17093165.
https://dx.doi.org/10.3390/ijerph1709316... ,¹⁴14 Lei L, Huang X, Zhang S, et al. Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine During the COVID-19 Epidemic in Southwestern China. Med Sci Monit. 2020 [acesso em 2021 mar 22]; (26):e924609-e924609. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199435/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹⁵15 Gopal A, Sharma AJ, Subramanyam MA. Dynamics of psychological responses to COVID-19 in India: A longitudinal study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(10):e0240650-e0240650. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553269/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹⁶16 Lee CM, Cadigan JM, Rhew IC. Increases in Loneliness Among Young Adults During the COVID-19 Pandemic and Association With Increases in Mental Health Problems. J Adolesc Health. 2020 [acesso em 2021 mar 22]; 67(5):714-7. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576375/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹⁷17 Hidalgo MD, Balluerka N, Gorostiaga A, et al. The Psychological Consequences of COVID-19 and Lockdown in the Spanish Population: An Exploratory Sequential Design. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(22). Disponível em: https://dx.doi.org/10.3390/ijerph17228578.
https://dx.doi.org/10.3390/ijerph1722857... ,¹⁸18 Burhamah W, AlKhayyat A, Oroszlányová M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020 [acesso em 2021 mar 22]; (277):977-85. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476447/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹⁹19 Massad I, Al-Taher R, Massad F, et al. The impact of the COVID-19 pandemic on mental health: early quarantine-related anxiety and its correlates among Jordanians. East Mediterr Health J. 2020 [acesso em 2021 mar 22]; 26(10):1165-72. Disponível em: https://applications.emro.who.int/emhj/v26/10/1020-3397-2020-2610-1165-1172-eng.pdf.
https://applications.emro.who.int/emhj/v... ,²⁰20 Martínez J, Bolívar Y, Yanez-Peñúñuri L, et al. Tendencias de la investigación sobre síntomas de trastornos mentales durante la pandemia por COVID-19. Med UPB. 2020 [acesso em 2021 mar 22]; 39(2):24-33. Disponível em: https://revistas.upb.edu.co/index.php/medicina/article/view/5336.
https://revistas.upb.edu.co/index.php/me... ,²¹21 Pandey D, Bansal S, Goyal S, et al. Psychological impact of mass quarantine on population during pandemics-The COVID-19 Lock-Down (COLD) study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(10):e0240501-e0240501. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240501.
https://journals.plos.org/plosone/articl... ,²²22 Benke C, Autenrieth LK, Asselmann E, et al. Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113462-113462. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500345/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²³23 Pieh C, O Rourke T, Budimir S, et al. Relationship quality and mental health during COVID-19 lockdown. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0238906-e0238906. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238906.
https://journals.plos.org/plosone/articl... ,²⁴24 Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. 2020 [acesso em 2021 mar 22]; (186):31-4. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405905/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁵25 Paz C, Mascialino G, Adana-Díaz L, et al. Behavioral and sociodemographic predictors of anxiety and depression in patients under epidemiological surveillance for COVID-19 in Ecuador. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0240008-e0240008. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240008.
https://journals.plos.org/plosone/articl... ,²⁶26 Gómez-Salgado J, Andrés-Villas M, Domínguez-Salas S, et al. Related Health Factors of Psychological Distress During the COVID-19 Pandemic in Spain. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(11). Disponível em: https://dx.doi.org/10.3390/ijerph17113947.
https://dx.doi.org/10.3390/ijerph1711394... ; 20 papers (69%), the youngest age¹¹11 Smith L, Jacob L, Yakkundi A, et al. Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (291):113138-113138. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258801/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹²12 Duarte MQ, Santo MAS, Lima CP, et al. Covid-19 and the impacts on mental health: a sample from Rio Grande do Sul, Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2021 mar 22]; 25(9):3401-11. Disponível em: https://doi.org/10.1590/1413-81232020259.16472020.
https://doi.org/10.1590/1413-81232020259... ,¹³13 Mazza C, Ricci E, Biondi S, et al. A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(9). Disponível em: https://dx.doi.org/10.3390/ijerph17093165.
https://dx.doi.org/10.3390/ijerph1709316... ,¹⁴14 Lei L, Huang X, Zhang S, et al. Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine During the COVID-19 Epidemic in Southwestern China. Med Sci Monit. 2020 [acesso em 2021 mar 22]; (26):e924609-e924609. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199435/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹⁷17 Hidalgo MD, Balluerka N, Gorostiaga A, et al. The Psychological Consequences of COVID-19 and Lockdown in the Spanish Population: An Exploratory Sequential Design. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(22). Disponível em: https://dx.doi.org/10.3390/ijerph17228578.
https://dx.doi.org/10.3390/ijerph1722857... ,¹⁸18 Burhamah W, AlKhayyat A, Oroszlányová M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020 [acesso em 2021 mar 22]; (277):977-85. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476447/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹⁹19 Massad I, Al-Taher R, Massad F, et al. The impact of the COVID-19 pandemic on mental health: early quarantine-related anxiety and its correlates among Jordanians. East Mediterr Health J. 2020 [acesso em 2021 mar 22]; 26(10):1165-72. Disponível em: https://applications.emro.who.int/emhj/v26/10/1020-3397-2020-2610-1165-1172-eng.pdf.
https://applications.emro.who.int/emhj/v... ,²⁰20 Martínez J, Bolívar Y, Yanez-Peñúñuri L, et al. Tendencias de la investigación sobre síntomas de trastornos mentales durante la pandemia por COVID-19. Med UPB. 2020 [acesso em 2021 mar 22]; 39(2):24-33. Disponível em: https://revistas.upb.edu.co/index.php/medicina/article/view/5336.
https://revistas.upb.edu.co/index.php/me... ,²¹21 Pandey D, Bansal S, Goyal S, et al. Psychological impact of mass quarantine on population during pandemics-The COVID-19 Lock-Down (COLD) study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(10):e0240501-e0240501. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240501.
https://journals.plos.org/plosone/articl... ,²²22 Benke C, Autenrieth LK, Asselmann E, et al. Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113462-113462. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500345/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²³23 Pieh C, O Rourke T, Budimir S, et al. Relationship quality and mental health during COVID-19 lockdown. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0238906-e0238906. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238906.
https://journals.plos.org/plosone/articl... ,²⁴24 Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. 2020 [acesso em 2021 mar 22]; (186):31-4. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405905/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁶26 Gómez-Salgado J, Andrés-Villas M, Domínguez-Salas S, et al. Related Health Factors of Psychological Distress During the COVID-19 Pandemic in Spain. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(11). Disponível em: https://dx.doi.org/10.3390/ijerph17113947.
https://dx.doi.org/10.3390/ijerph1711394... ,²⁷27 Losada-Baltar A, Márquez-González M, Jiménez-Gonzalo L, et al. Differences in anxiety, sadness, loneliness and comorbid anxiety and sadness as a function of age and self-perceptions of aging during the lock-out period due to COVID-19. Rev Esp Geriatr Gerontol. 2020 [acesso em 2021 mar 22]; 55(5):272-8. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269939/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁹29 Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241658-e0241658. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241658.
https://journals.plos.org/plosone/articl... ,³⁰30 Ozamiz-Etxebarria N, Dosil-Santamaria M, Picaza-Gorrochategui M, et al. Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain. Cad. Saúde Publica. 2020 [acesso em 2021 mar 22]; 36(4):e00054020-e00054020. Disponível em: https://doi.org/10.1590/0102-311X00054020.
https://doi.org/10.1590/0102-311X0005402... ,³¹31 Peng M, Mo B, Liu Y, et al. Prevalence, risk factors and clinical correlates of depression in quarantined population during the COVID-19 outbreak. J Affect Disord. 2020 [acesso em 2021 mar 22]; (275):119-24. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330582/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,³²32 Glowacz F, Schmits E. Psychological distress during the COVID-19 lockdown: The young adults most at risk. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113486-113486. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518205/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,³³33 Becerra-García JA, Giménez Ballesta G, Sánchez-Gutiérrez T, et al. Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational-contextual factors. Rev esp salud publica. 2020 [acesso em 2021 mar 22]; (94). Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-32515363.
https://pesquisa.bvsalud.org/portal/reso... ; and 11 papers (38%), unemployment or financial loss¹²12 Duarte MQ, Santo MAS, Lima CP, et al. Covid-19 and the impacts on mental health: a sample from Rio Grande do Sul, Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2021 mar 22]; 25(9):3401-11. Disponível em: https://doi.org/10.1590/1413-81232020259.16472020.
https://doi.org/10.1590/1413-81232020259... ,¹⁸18 Burhamah W, AlKhayyat A, Oroszlányová M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020 [acesso em 2021 mar 22]; (277):977-85. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476447/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁰20 Martínez J, Bolívar Y, Yanez-Peñúñuri L, et al. Tendencias de la investigación sobre síntomas de trastornos mentales durante la pandemia por COVID-19. Med UPB. 2020 [acesso em 2021 mar 22]; 39(2):24-33. Disponível em: https://revistas.upb.edu.co/index.php/medicina/article/view/5336.
https://revistas.upb.edu.co/index.php/me... ,²²22 Benke C, Autenrieth LK, Asselmann E, et al. Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113462-113462. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500345/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²³23 Pieh C, O Rourke T, Budimir S, et al. Relationship quality and mental health during COVID-19 lockdown. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0238906-e0238906. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238906.
https://journals.plos.org/plosone/articl... ,²⁴24 Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. 2020 [acesso em 2021 mar 22]; (186):31-4. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405905/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁹29 Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241658-e0241658. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241658.
https://journals.plos.org/plosone/articl... ,³³33 Becerra-García JA, Giménez Ballesta G, Sánchez-Gutiérrez T, et al. Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational-contextual factors. Rev esp salud publica. 2020 [acesso em 2021 mar 22]; (94). Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-32515363.
https://pesquisa.bvsalud.org/portal/reso... ,³⁴34 Nelson BW, Pettitt A, Flannery JE, et al. Rapid assessment of psychological and epidemiological correlates of COVID-19 concern, financial strain, and health-related behavior change in a large online sample. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241990-e0241990. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241990.
https://journals.plos.org/plosone/articl... ,³⁵35 Verma S, Mishra A. Depression, anxiety, and stress and socio-demographic correlates among general Indian public during COVID-19. Int J Soc Psychiatry. 2020 [acesso em 2021 mar 22]; 66(8):756-62. Disponível em: https://doi.org/10.1177/0020764020934508.
https://doi.org/10.1177/0020764020934508... . Moreover, seven papers (24%) mention lower income as stressors¹¹11 Smith L, Jacob L, Yakkundi A, et al. Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (291):113138-113138. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258801/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹²12 Duarte MQ, Santo MAS, Lima CP, et al. Covid-19 and the impacts on mental health: a sample from Rio Grande do Sul, Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2021 mar 22]; 25(9):3401-11. Disponível em: https://doi.org/10.1590/1413-81232020259.16472020.
https://doi.org/10.1590/1413-81232020259... ,¹⁴14 Lei L, Huang X, Zhang S, et al. Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine During the COVID-19 Epidemic in Southwestern China. Med Sci Monit. 2020 [acesso em 2021 mar 22]; (26):e924609-e924609. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199435/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹⁷17 Hidalgo MD, Balluerka N, Gorostiaga A, et al. The Psychological Consequences of COVID-19 and Lockdown in the Spanish Population: An Exploratory Sequential Design. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(22). Disponível em: https://dx.doi.org/10.3390/ijerph17228578.
https://dx.doi.org/10.3390/ijerph1722857... ,¹⁹19 Massad I, Al-Taher R, Massad F, et al. The impact of the COVID-19 pandemic on mental health: early quarantine-related anxiety and its correlates among Jordanians. East Mediterr Health J. 2020 [acesso em 2021 mar 22]; 26(10):1165-72. Disponível em: https://applications.emro.who.int/emhj/v26/10/1020-3397-2020-2610-1165-1172-eng.pdf.
https://applications.emro.who.int/emhj/v... ,²³23 Pieh C, O Rourke T, Budimir S, et al. Relationship quality and mental health during COVID-19 lockdown. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0238906-e0238906. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238906.
https://journals.plos.org/plosone/articl... ,²⁴24 Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. 2020 [acesso em 2021 mar 22]; (186):31-4. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405905/.
https://www.ncbi.nlm.nih.gov/pmc/article... , while six of them (20%) mention being in the risk group¹¹11 Smith L, Jacob L, Yakkundi A, et al. Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (291):113138-113138. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258801/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹²12 Duarte MQ, Santo MAS, Lima CP, et al. Covid-19 and the impacts on mental health: a sample from Rio Grande do Sul, Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2021 mar 22]; 25(9):3401-11. Disponível em: https://doi.org/10.1590/1413-81232020259.16472020.
https://doi.org/10.1590/1413-81232020259... ,¹³13 Mazza C, Ricci E, Biondi S, et al. A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(9). Disponível em: https://dx.doi.org/10.3390/ijerph17093165.
https://dx.doi.org/10.3390/ijerph1709316... ,²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁹29 Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241658-e0241658. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241658.
https://journals.plos.org/plosone/articl... ,³⁰30 Ozamiz-Etxebarria N, Dosil-Santamaria M, Picaza-Gorrochategui M, et al. Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain. Cad. Saúde Publica. 2020 [acesso em 2021 mar 22]; 36(4):e00054020-e00054020. Disponível em: https://doi.org/10.1590/0102-311X00054020.
https://doi.org/10.1590/0102-311X0005402... ,³⁶36 Ammar A, Mueller P, Trabelsi K, et al. Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0240204-e0240204. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240204.
https://journals.plos.org/plosone/articl... , living alone²²22 Benke C, Autenrieth LK, Asselmann E, et al. Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113462-113462. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500345/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁴24 Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. 2020 [acesso em 2021 mar 22]; (186):31-4. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405905/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁹29 Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241658-e0241658. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241658.
https://journals.plos.org/plosone/articl... ,³³33 Becerra-García JA, Giménez Ballesta G, Sánchez-Gutiérrez T, et al. Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational-contextual factors. Rev esp salud publica. 2020 [acesso em 2021 mar 22]; (94). Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-32515363.
https://pesquisa.bvsalud.org/portal/reso... ,³⁷37 López-Carral H, Grechuta K, Verschure PFMJ. Subjective ratings of emotive stimuli predict the impact of the COVID-19 quarantine on affective states. PLoS One. 2020 [acesso em 2021 mar 22]; 15(8):e0237631-e0237631. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237631.
https://journals.plos.org/plosone/articl... and having a history of mental health problems¹²12 Duarte MQ, Santo MAS, Lima CP, et al. Covid-19 and the impacts on mental health: a sample from Rio Grande do Sul, Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2021 mar 22]; 25(9):3401-11. Disponível em: https://doi.org/10.1590/1413-81232020259.16472020.
https://doi.org/10.1590/1413-81232020259... ,¹⁵15 Gopal A, Sharma AJ, Subramanyam MA. Dynamics of psychological responses to COVID-19 in India: A longitudinal study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(10):e0240650-e0240650. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553269/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹⁸18 Burhamah W, AlKhayyat A, Oroszlányová M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020 [acesso em 2021 mar 22]; (277):977-85. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476447/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²²22 Benke C, Autenrieth LK, Asselmann E, et al. Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113462-113462. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500345/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁹29 Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241658-e0241658. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241658.
https://journals.plos.org/plosone/articl... ,³⁶36 Ammar A, Mueller P, Trabelsi K, et al. Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0240204-e0240204. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240204.
https://journals.plos.org/plosone/articl... . Only 5 papers (17%) indicate low schooling¹⁴14 Lei L, Huang X, Zhang S, et al. Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine During the COVID-19 Epidemic in Southwestern China. Med Sci Monit. 2020 [acesso em 2021 mar 22]; (26):e924609-e924609. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199435/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²¹21 Pandey D, Bansal S, Goyal S, et al. Psychological impact of mass quarantine on population during pandemics-The COVID-19 Lock-Down (COLD) study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(10):e0240501-e0240501. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240501.
https://journals.plos.org/plosone/articl... ,²²22 Benke C, Autenrieth LK, Asselmann E, et al. Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113462-113462. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500345/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁴24 Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. 2020 [acesso em 2021 mar 22]; (186):31-4. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405905/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,³¹31 Peng M, Mo B, Liu Y, et al. Prevalence, risk factors and clinical correlates of depression in quarantined population during the COVID-19 outbreak. J Affect Disord. 2020 [acesso em 2021 mar 22]; (275):119-24. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330582/.
https://www.ncbi.nlm.nih.gov/pmc/article... and being single¹⁴14 Lei L, Huang X, Zhang S, et al. Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine During the COVID-19 Epidemic in Southwestern China. Med Sci Monit. 2020 [acesso em 2021 mar 22]; (26):e924609-e924609. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199435/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹⁸18 Burhamah W, AlKhayyat A, Oroszlányová M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020 [acesso em 2021 mar 22]; (277):977-85. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476447/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²¹21 Pandey D, Bansal S, Goyal S, et al. Psychological impact of mass quarantine on population during pandemics-The COVID-19 Lock-Down (COLD) study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(10):e0240501-e0240501. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240501.
https://journals.plos.org/plosone/articl... ,²²22 Benke C, Autenrieth LK, Asselmann E, et al. Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113462-113462. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500345/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,³¹31 Peng M, Mo B, Liu Y, et al. Prevalence, risk factors and clinical correlates of depression in quarantined population during the COVID-19 outbreak. J Affect Disord. 2020 [acesso em 2021 mar 22]; (275):119-24. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330582/.
https://www.ncbi.nlm.nih.gov/pmc/article... as factors associated with mental illness.

A study conducted in India pointed out that the time of lockdown may be associated with increased psychological distress²¹21 Pandey D, Bansal S, Goyal S, et al. Psychological impact of mass quarantine on population during pandemics-The COVID-19 Lock-Down (COLD) study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(10):e0240501-e0240501. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240501.
https://journals.plos.org/plosone/articl... . Routine change imposed by restrictive measures³⁶36 Ammar A, Mueller P, Trabelsi K, et al. Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0240204-e0240204. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240204.
https://journals.plos.org/plosone/articl... ,³⁷37 López-Carral H, Grechuta K, Verschure PFMJ. Subjective ratings of emotive stimuli predict the impact of the COVID-19 quarantine on affective states. PLoS One. 2020 [acesso em 2021 mar 22]; 15(8):e0237631-e0237631. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237631.
https://journals.plos.org/plosone/articl... , quarantine³⁰30 Ozamiz-Etxebarria N, Dosil-Santamaria M, Picaza-Gorrochategui M, et al. Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain. Cad. Saúde Publica. 2020 [acesso em 2021 mar 22]; 36(4):e00054020-e00054020. Disponível em: https://doi.org/10.1590/0102-311X00054020.
https://doi.org/10.1590/0102-311X0005402... ,³⁸38 Fawaz M, Samaha A. COVID-19 quarantine: Post-traumatic stress symptomatology among Lebanese citizens. Int J Soc Psychiatry. 2020 [acesso em 2021 mar 22]; 66(7):666-74. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270572/.
https://www.ncbi.nlm.nih.gov/pmc/article... , and greater adherence to stricter recommendations to prevent the spread of the virus³⁴34 Nelson BW, Pettitt A, Flannery JE, et al. Rapid assessment of psychological and epidemiological correlates of COVID-19 concern, financial strain, and health-related behavior change in a large online sample. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241990-e0241990. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241990.
https://journals.plos.org/plosone/articl... were also identified as stressors affecting subjects’ mental health. These findings in the review corroborate an initial study that indicated that growing psychological complaints seem to increase with prolonged isolation, in which depressive and anxious symptoms become more susceptible⁹9 Huremović D, organizador. Psychiatry of Pandemics: A Mental Health Response to Infection Outbreak. Switzerland: Springer International Publishing; 2019. [acesso em 2021 fev 20]. Disponível em: https://www.springer.com/gp/book/9783030153458.
https://www.springer.com/gp/book/9783030... .

Only one study in India pointed to males as the most affected the pandemic³⁵35 Verma S, Mishra A. Depression, anxiety, and stress and socio-demographic correlates among general Indian public during COVID-19. Int J Soc Psychiatry. 2020 [acesso em 2021 mar 22]; 66(8):756-62. Disponível em: https://doi.org/10.1177/0020764020934508.
https://doi.org/10.1177/0020764020934508... regarding mental health. The authors argue that a plausible justification for this result, inconsistent with other studies, may be due to the Indian cultural issue: men do not participate in domestic activities and, due to confinement, responsibilities are being shared between couples. As men are not used to managing their personal, professional, and family lives, the change in the setting may have caused more significant anxiety in this public.

Another stressor was the increase in domestic responsibility. The study showed that women reported a more significant increase in their responsibilities when compared to men¹⁵15 Gopal A, Sharma AJ, Subramanyam MA. Dynamics of psychological responses to COVID-19 in India: A longitudinal study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(10):e0240650-e0240650. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553269/.
https://www.ncbi.nlm.nih.gov/pmc/article... . Thus, the intergender difference may be related to societal gender roles. Women who are mothers, for example, may have evidenced higher stress levels due to the interruption of their children’s classroom classes¹⁷17 Hidalgo MD, Balluerka N, Gorostiaga A, et al. The Psychological Consequences of COVID-19 and Lockdown in the Spanish Population: An Exploratory Sequential Design. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(22). Disponível em: https://dx.doi.org/10.3390/ijerph17228578.
https://dx.doi.org/10.3390/ijerph1722857... .

Some justifications were pointed out for the youngest being more vulnerable to mental health problems during the pandemic. Young people are less resilient to adversity and have more difficulties understanding the radical but necessary changes in this pandemic period²⁶26 Gómez-Salgado J, Andrés-Villas M, Domínguez-Salas S, et al. Related Health Factors of Psychological Distress During the COVID-19 Pandemic in Spain. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(11). Disponível em: https://dx.doi.org/10.3390/ijerph17113947.
https://dx.doi.org/10.3390/ijerph1711394... . Thus, older people are dealing with this atypical situation better than younger people²³23 Pieh C, O Rourke T, Budimir S, et al. Relationship quality and mental health during COVID-19 lockdown. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0238906-e0238906. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238906.
https://journals.plos.org/plosone/articl... , as they are less likely to have psychological problems and are more stable both financially and emotionally¹⁹19 Massad I, Al-Taher R, Massad F, et al. The impact of the COVID-19 pandemic on mental health: early quarantine-related anxiety and its correlates among Jordanians. East Mediterr Health J. 2020 [acesso em 2021 mar 22]; 26(10):1165-72. Disponível em: https://applications.emro.who.int/emhj/v26/10/1020-3397-2020-2610-1165-1172-eng.pdf.
https://applications.emro.who.int/emhj/v... . In the younger population, changes in teaching activities, with the new remote teaching format, seem to have affected emotional stability¹⁷17 Hidalgo MD, Balluerka N, Gorostiaga A, et al. The Psychological Consequences of COVID-19 and Lockdown in the Spanish Population: An Exploratory Sequential Design. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(22). Disponível em: https://dx.doi.org/10.3390/ijerph17228578.
https://dx.doi.org/10.3390/ijerph1722857... and educational perspectives³²32 Glowacz F, Schmits E. Psychological distress during the COVID-19 lockdown: The young adults most at risk. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113486-113486. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518205/.
https://www.ncbi.nlm.nih.gov/pmc/article... , in which being a student became a more significant stressor during the pandemic than in normal periods²⁴24 Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. 2020 [acesso em 2021 mar 22]; (186):31-4. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405905/.
https://www.ncbi.nlm.nih.gov/pmc/article... . A study conducted in the United Kingdom collected data showing that people already at higher risk of loneliness (young adults, low income, and living alone) experienced an even higher risk during the COVID-19 pandemic²⁴24 Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. 2020 [acesso em 2021 mar 22]; (186):31-4. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405905/.
https://www.ncbi.nlm.nih.gov/pmc/article... . It is worth noting that loneliness can be an essential factor in increasing depressive symptoms during the pandemic. Intervention strategies must address aspects that work with loneliness, especially for those who have experienced more significant disruption in their social circle¹⁶16 Lee CM, Cadigan JM, Rhew IC. Increases in Loneliness Among Young Adults During the COVID-19 Pandemic and Association With Increases in Mental Health Problems. J Adolesc Health. 2020 [acesso em 2021 mar 22]; 67(5):714-7. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576375/.
https://www.ncbi.nlm.nih.gov/pmc/article... .

Another possible explanation is that younger people may have more access to information about COVID-19 through social media, which can lead to increased stress²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... . A study in Brazil identified that subjects who are more exposed to information about the virus and its victims are at greater risk of having minor mental disorders¹²12 Duarte MQ, Santo MAS, Lima CP, et al. Covid-19 and the impacts on mental health: a sample from Rio Grande do Sul, Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2021 mar 22]; 25(9):3401-11. Disponível em: https://doi.org/10.1590/1413-81232020259.16472020.
https://doi.org/10.1590/1413-81232020259... . Another study of the review conducted in Kuwait identified comparable results, in which higher depression rates were associated with more time devoted to pandemic news¹⁸18 Burhamah W, AlKhayyat A, Oroszlányová M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020 [acesso em 2021 mar 22]; (277):977-85. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476447/.
https://www.ncbi.nlm.nih.gov/pmc/article... . However, researchers from Spain reported that younger adults who spent less time on information had higher hostility, depression, and anxiety rates. Thus, the authors emphasize that lack of and excessive information could be harmful to mental health³³33 Becerra-García JA, Giménez Ballesta G, Sánchez-Gutiérrez T, et al. Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational-contextual factors. Rev esp salud publica. 2020 [acesso em 2021 mar 22]; (94). Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-32515363.
https://pesquisa.bvsalud.org/portal/reso... . Therefore, being informed can be a stressor and a protective factor, depending on the intensity of this consumption²⁵25 Paz C, Mascialino G, Adana-Díaz L, et al. Behavioral and sociodemographic predictors of anxiety and depression in patients under epidemiological surveillance for COVID-19 in Ecuador. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0240008-e0240008. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240008.
https://journals.plos.org/plosone/articl... .

Although several factors cause stress by interfering with the mental health of adults, some papers have identified factors that protect people’s mental health. Understanding these factors facilitates the establishment of intervention strategies for the population’s public health, which caregiving health professionals can develop, and public health policies within the scope of this pandemic.

Mental health protective factors in the COVID-19 pandemic

The following mental health protective factors stand out during the pandemic: obtaining psychological¹⁴14 Lei L, Huang X, Zhang S, et al. Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine During the COVID-19 Epidemic in Southwestern China. Med Sci Monit. 2020 [acesso em 2021 mar 22]; (26):e924609-e924609. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199435/.
https://www.ncbi.nlm.nih.gov/pmc/article... and social support¹⁶16 Lee CM, Cadigan JM, Rhew IC. Increases in Loneliness Among Young Adults During the COVID-19 Pandemic and Association With Increases in Mental Health Problems. J Adolesc Health. 2020 [acesso em 2021 mar 22]; 67(5):714-7. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576375/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁹29 Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241658-e0241658. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241658.
https://journals.plos.org/plosone/articl... , high resilience levels¹⁵15 Gopal A, Sharma AJ, Subramanyam MA. Dynamics of psychological responses to COVID-19 in India: A longitudinal study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(10):e0240650-e0240650. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553269/.
https://www.ncbi.nlm.nih.gov/pmc/article... , greater support and social network¹⁹19 Massad I, Al-Taher R, Massad F, et al. The impact of the COVID-19 pandemic on mental health: early quarantine-related anxiety and its correlates among Jordanians. East Mediterr Health J. 2020 [acesso em 2021 mar 22]; 26(10):1165-72. Disponível em: https://applications.emro.who.int/emhj/v26/10/1020-3397-2020-2610-1165-1172-eng.pdf.
https://applications.emro.who.int/emhj/v... , tolerance for uncertainty³²32 Glowacz F, Schmits E. Psychological distress during the COVID-19 lockdown: The young adults most at risk. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113486-113486. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518205/.
https://www.ncbi.nlm.nih.gov/pmc/article... , physical activity²³23 Pieh C, O Rourke T, Budimir S, et al. Relationship quality and mental health during COVID-19 lockdown. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0238906-e0238906. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238906.
https://journals.plos.org/plosone/articl... ,²⁵25 Paz C, Mascialino G, Adana-Díaz L, et al. Behavioral and sociodemographic predictors of anxiety and depression in patients under epidemiological surveillance for COVID-19 in Ecuador. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0240008-e0240008. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240008.
https://journals.plos.org/plosone/articl... ,³³33 Becerra-García JA, Giménez Ballesta G, Sánchez-Gutiérrez T, et al. Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational-contextual factors. Rev esp salud publica. 2020 [acesso em 2021 mar 22]; (94). Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-32515363.
https://pesquisa.bvsalud.org/portal/reso... and being employed/being economically stable¹²12 Duarte MQ, Santo MAS, Lima CP, et al. Covid-19 and the impacts on mental health: a sample from Rio Grande do Sul, Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2021 mar 22]; 25(9):3401-11. Disponível em: https://doi.org/10.1590/1413-81232020259.16472020.
https://doi.org/10.1590/1413-81232020259... ,¹⁴14 Lei L, Huang X, Zhang S, et al. Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine During the COVID-19 Epidemic in Southwestern China. Med Sci Monit. 2020 [acesso em 2021 mar 22]; (26):e924609-e924609. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199435/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,¹⁸18 Burhamah W, AlKhayyat A, Oroszlányová M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020 [acesso em 2021 mar 22]; (277):977-85. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476447/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁰20 Martínez J, Bolívar Y, Yanez-Peñúñuri L, et al. Tendencias de la investigación sobre síntomas de trastornos mentales durante la pandemia por COVID-19. Med UPB. 2020 [acesso em 2021 mar 22]; 39(2):24-33. Disponível em: https://revistas.upb.edu.co/index.php/medicina/article/view/5336.
https://revistas.upb.edu.co/index.php/me... ,²²22 Benke C, Autenrieth LK, Asselmann E, et al. Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res. 2020 [acesso em 2021 mar 22]; (293):113462-113462. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500345/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²³23 Pieh C, O Rourke T, Budimir S, et al. Relationship quality and mental health during COVID-19 lockdown. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0238906-e0238906. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238906.
https://journals.plos.org/plosone/articl... ,²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁹29 Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241658-e0241658. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241658.
https://journals.plos.org/plosone/articl... ,³³33 Becerra-García JA, Giménez Ballesta G, Sánchez-Gutiérrez T, et al. Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational-contextual factors. Rev esp salud publica. 2020 [acesso em 2021 mar 22]; (94). Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-32515363.
https://pesquisa.bvsalud.org/portal/reso... ,³⁴34 Nelson BW, Pettitt A, Flannery JE, et al. Rapid assessment of psychological and epidemiological correlates of COVID-19 concern, financial strain, and health-related behavior change in a large online sample. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241990-e0241990. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241990.
https://journals.plos.org/plosone/articl... ,³⁵35 Verma S, Mishra A. Depression, anxiety, and stress and socio-demographic correlates among general Indian public during COVID-19. Int J Soc Psychiatry. 2020 [acesso em 2021 mar 22]; 66(8):756-62. Disponível em: https://doi.org/10.1177/0020764020934508.
https://doi.org/10.1177/0020764020934508... .

A Chinese paper identified that obtaining psychological and social support is an important strategy to reduce the probability of mental illness generated by loneliness and helplessness that can be exacerbated during quarantine¹⁴14 Lei L, Huang X, Zhang S, et al. Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine During the COVID-19 Epidemic in Southwestern China. Med Sci Monit. 2020 [acesso em 2021 mar 22]; (26):e924609-e924609. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199435/.
https://www.ncbi.nlm.nih.gov/pmc/article... . Connection and social support are protective factors, especially for those who live alone, due to the tendency of loneliness²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... . However, a study conducted in India reported that females’ higher stress and anxiety levels than males persisted even after accounting for social support and resilience factors. This finding suggests that gender patterns persist as stressors even after the protective effects have been exercised¹⁵15 Gopal A, Sharma AJ, Subramanyam MA. Dynamics of psychological responses to COVID-19 in India: A longitudinal study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(10):e0240650-e0240650. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553269/.
https://www.ncbi.nlm.nih.gov/pmc/article... .

Besides psychological and social resources, physical activity was a strong ally in promoting mental health²³23 Pieh C, O Rourke T, Budimir S, et al. Relationship quality and mental health during COVID-19 lockdown. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0238906-e0238906. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238906.
https://journals.plos.org/plosone/articl... ,²⁵25 Paz C, Mascialino G, Adana-Díaz L, et al. Behavioral and sociodemographic predictors of anxiety and depression in patients under epidemiological surveillance for COVID-19 in Ecuador. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0240008-e0240008. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240008.
https://journals.plos.org/plosone/articl... ,²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... , in which exercising more than five times a week helped avoid depression and anxiety¹⁸18 Burhamah W, AlKhayyat A, Oroszlányová M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020 [acesso em 2021 mar 22]; (277):977-85. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476447/.
https://www.ncbi.nlm.nih.gov/pmc/article... . Good sleep quality was also a protective factor in the literature²⁰20 Martínez J, Bolívar Y, Yanez-Peñúñuri L, et al. Tendencias de la investigación sobre síntomas de trastornos mentales durante la pandemia por COVID-19. Med UPB. 2020 [acesso em 2021 mar 22]; 39(2):24-33. Disponível em: https://revistas.upb.edu.co/index.php/medicina/article/view/5336.
https://revistas.upb.edu.co/index.php/me... ,²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,³¹31 Peng M, Mo B, Liu Y, et al. Prevalence, risk factors and clinical correlates of depression in quarantined population during the COVID-19 outbreak. J Affect Disord. 2020 [acesso em 2021 mar 22]; (275):119-24. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330582/.
https://www.ncbi.nlm.nih.gov/pmc/article... .

Enjoying working remotely and having greater flexibility at work were also protective factors²⁹29 Every-Palmer S, Jenkins M, Gendall P, et al. Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study. PLoS One. 2020 [acesso em 2021 mar 22]; 15(11):e0241658-e0241658. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241658.
https://journals.plos.org/plosone/articl... ,³⁷37 López-Carral H, Grechuta K, Verschure PFMJ. Subjective ratings of emotive stimuli predict the impact of the COVID-19 quarantine on affective states. PLoS One. 2020 [acesso em 2021 mar 22]; 15(8):e0237631-e0237631. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237631.
https://journals.plos.org/plosone/articl... . A study conducted in Italy pointed out that working outside the home is associated with greater mental distress levels¹³13 Mazza C, Ricci E, Biondi S, et al. A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(9). Disponível em: https://dx.doi.org/10.3390/ijerph17093165.
https://dx.doi.org/10.3390/ijerph1709316... . This issue may be associated with a higher perception of threat and susceptibility to disease when work is conducted in person, while lower threat levels become a protective factor during the pandemic period³⁹39 Pérez-Fuentes MDC, Molero Jurado MDM, Martos Martínez Á, et al. Threat of COVID-19 and emotional state during quarantine: Positive and negative affect as mediators in a cross-sectional study of the Spanish population. PLoS One. 2020 [acesso em 2021 mar 22]; 15(6):e0235305-e0235305. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316299/.
https://www.ncbi.nlm.nih.gov/pmc/article... . Furthermore, studies have shown that the prevalence of anxiety and depression in the COVID-19 positive group is higher than in the group unaffected by the virus¹⁴14 Lei L, Huang X, Zhang S, et al. Comparison of Prevalence and Associated Factors of Anxiety and Depression Among People Affected by versus People Unaffected by Quarantine During the COVID-19 Epidemic in Southwestern China. Med Sci Monit. 2020 [acesso em 2021 mar 22]; (26):e924609-e924609. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199435/.
https://www.ncbi.nlm.nih.gov/pmc/article... . Having people with COVID-19 close was also pointed out as a stressor by the literature¹⁸18 Burhamah W, AlKhayyat A, Oroszlányová M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020 [acesso em 2021 mar 22]; (277):977-85. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476447/.
https://www.ncbi.nlm.nih.gov/pmc/article... ,²⁶26 Gómez-Salgado J, Andrés-Villas M, Domínguez-Salas S, et al. Related Health Factors of Psychological Distress During the COVID-19 Pandemic in Spain. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(11). Disponível em: https://dx.doi.org/10.3390/ijerph17113947.
https://dx.doi.org/10.3390/ijerph1711394... ,³³33 Becerra-García JA, Giménez Ballesta G, Sánchez-Gutiérrez T, et al. Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational-contextual factors. Rev esp salud publica. 2020 [acesso em 2021 mar 22]; (94). Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/mdl-32515363.
https://pesquisa.bvsalud.org/portal/reso... .

A study conducted in Brazil identified that being a health professional is 40% less likely to have minor mental disorders. A plausible justification would be greater access to health services and a better understanding of COVID-19¹²12 Duarte MQ, Santo MAS, Lima CP, et al. Covid-19 and the impacts on mental health: a sample from Rio Grande do Sul, Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2021 mar 22]; 25(9):3401-11. Disponível em: https://doi.org/10.1590/1413-81232020259.16472020.
https://doi.org/10.1590/1413-81232020259... . However, another study identified that health professionals are more likely to develop psychological problems due to increased working hours and the need to isolate themselves from family members to avoid contagion¹⁸18 Burhamah W, AlKhayyat A, Oroszlányová M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020 [acesso em 2021 mar 22]; (277):977-85. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476447/.
https://www.ncbi.nlm.nih.gov/pmc/article... . A survey conducted in Spain corroborates this result, as it identified that working outside the home in essential activities during the pandemic is a stressor²⁶26 Gómez-Salgado J, Andrés-Villas M, Domínguez-Salas S, et al. Related Health Factors of Psychological Distress During the COVID-19 Pandemic in Spain. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(11). Disponível em: https://dx.doi.org/10.3390/ijerph17113947.
https://dx.doi.org/10.3390/ijerph1711394... .

Again, regarding work, people with mild and moderate mental illness are twice as likely to lose their jobs, and unemployment rates for subjects with severe mental disorders are five times higher than people without the disorder; important data mentioned in an Austrian paper²³23 Pieh C, O Rourke T, Budimir S, et al. Relationship quality and mental health during COVID-19 lockdown. PLoS One. 2020 [acesso em 2021 mar 22]; 15(9):e0238906-e0238906. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238906.
https://journals.plos.org/plosone/articl... . Considering the impact of the pandemic on mental health¹³13 Mazza C, Ricci E, Biondi S, et al. A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int j environ res public health. 2020 [acesso em 2021 mar 22]; 17(9). Disponível em: https://dx.doi.org/10.3390/ijerph17093165.
https://dx.doi.org/10.3390/ijerph1709316... , interventions aimed at promoting psychological well-being are increasingly necessary.

Final considerations

People subjected to the restrictive measures imposed by the COVID-19 pandemic are vulnerable to mental health problems. However, few studies have evaluated the related psychosocial factors²⁸28 Guo Y, Cheng C, Zeng Y , et al. Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study. J Med Internet Res. 2020 [acesso em 2021 mar 22]; 22(8):e20328-e20328. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419152/.
https://www.ncbi.nlm.nih.gov/pmc/article... . Despite a topic of strong relevance and global impact, there is still a knowledge gap on the topic. Research on mental disorders during the pandemic is incipient and scarce, especially considering the scientific productions developed in Latin America²⁰20 Martínez J, Bolívar Y, Yanez-Peñúñuri L, et al. Tendencias de la investigación sobre síntomas de trastornos mentales durante la pandemia por COVID-19. Med UPB. 2020 [acesso em 2021 mar 22]; 39(2):24-33. Disponível em: https://revistas.upb.edu.co/index.php/medicina/article/view/5336.
https://revistas.upb.edu.co/index.php/me... .

We should assess the diverse groups and their needs to elaborate intervention strategies and public policies in pandemics. For example, young people were considered the most vulnerable in surveys conducted by different countries, and they require attention. Moreover, with a better understanding of risk and protective factors, we recommend that further studies investigate possible coping strategies and self-care practices that can reduce the effects of the pandemic on mental health.

References

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