Study will monitor the impact of the pandemic and social isolation on the mental health of 4,000 people

Participants are members of the São Paulo arm of a study conducted in six Brazilian states beginning in 2008. The goal is to compare mental health before the pandemic to that during the pandemic in both healthy individuals and subjects suffering from anxiety and depression.

By Maria Fernanda Ziegler  |  Agência FAPESP – In Brazil, researchers will monitor the impact of social distancing and the novel coronavirus pandemic on the mental health of 4,000 people in the state of São Paulo. The purpose of the study is to evaluate the effects of increased stress due to changed habits, mourning, economic uncertainty and fear of contagion, among other factors, on both healthy people and people with disorders such as depression and anxiety.

“It’s early to say as we’re just beginning the study, but we’ve noticed that the pandemic and social isolation have acted as a sort of catalyst, especially with regard to mental health. Basically, what wasn’t too good before tends to get worse. On the other hand, factors considered positive can also be reinforced,” said André Brunoni, a professor at the University of São Paulo’s Medical School (FM-USP) and the principal investigator of the project.

The survey of mental health during the pandemic is conducted as part of the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil), which has been monitoring the overall health of 15,000 civil servants at six public universities and research centers in Northeast, South and Southeast Brazil since 2008. The multicentric cohort survey, which aims to investigate incidence and risk factors for chronic conditions such as diabetes and cardiovascular disease, is funded by the Health Ministry. The University Hospital’s Clinical and Epidemiological Research Center is in charge of the survey in São Paulo and is responsible for monitoring approximately one-third of the participants.

The study of mental health during the pandemic will be supported by FAPESP. It will involve only the ELSA-Brazil participants in the state of São Paulo, all of whom were active or retired university employees when the survey began. The age of participants in the cohort ranges from 35-74 years. The period for collecting information will extend until December, and analysis is expected to take two years.

Mental health aspects of the pandemic have been investigated in Wuhan, China, but according to Brunoni, the Brazilian study will be different because the participants have already been monitored for several years. “It’s a longitudinal cohort study, considered more robust than prevalence studies, which analyze data for a specific point in time without taking into account the psychiatric history of the participants,” Brunoni told Agência FAPESP.

The fourth wave of the survey is about to begin. With each wave, the participants are examined and interviewed to evaluate aspects such as living conditions, social differences, employment, gender and diet.

“As a result, it’s possible to know whether participants feel more or less stressed, depressed or anxious,” Brunoni said. “It’s also possible to compare these findings with the waves conducted before the pandemic in order to see how much has changed. We can go beyond an analysis of people’s acute state under social isolation to assess the magnitude of the impact.”

Surprises of social isolation

While the main hypothesis is that people have suffered extra stress because of the pandemic and social isolation, Brunoni also entertains the possibility that the study will detect less obvious responses.

“It’s only to be expected that social distancing, isolation at home and heightened risk will have had countless psychiatric and psychological repercussions, but it’s important to bear in mind that life in the city of São Paulo was already highly stressful because of traffic jams, noise and long working hours,” he said. “Several studies have evidenced a very high prevalence of anxiety, in the range of 20-30%, and depression, ranging from 5-10%. So it wouldn’t be entirely surprising to find that these levels stabilized or even improved in individuals who adapted to quarantine measures.”

In addition to the new study on mental health during the pandemic, ELSA-Brazil will enable researchers to look for correlations between physical and mental health problems and COVID-19. “We know everything about the participants’ health. We’re fortunate that the participants have responded consistently throughout this period of over a decade, and in addition to the mental health study supported by FAPESP, in the future we’ll also be able to see connections between coronavirus and comorbidities such as diabetes and cardiovascular disease. Another item that interests us is the existence of cases without mental symptoms. We want to understand why some people’s mental health is more affected than others,” said Isabela Benseñor, a professor in FM-USP and lead investigator for ELSA-Brazil.

Remote psychotherapy and emotional education

The mental health survey linked to ELSA-Brazil will be divided into two parts. The first will involve online and telephone questionnaires about the impact of the pandemic and social isolation on the participants’ mental health.

“The questionnaire is normally applied in face-to-face interviews, but owing to the need for social isolation, we’ve had to innovate. The online questionnaire will include some adaptations and alterations,” Brunoni said.

In four virtual evaluations during the pandemic, the researchers plan to elicit responses on symptoms of depression and anxiety, suicidal ideas, heightened stress, and protective and risk factors.

“The questionnaire will include items referring to lockdown and the pandemic. We want to try to understand better what’s happening,” Brunoni said. “Although as public servants on the permanent staff of the university, the participants theoretically enjoy a measure of financial stability, we’ve also included questions about economic uncertainty as well as questions about spouses or partners, for example.”

The second part will be dedicated to measuring the effectiveness of remote psychotherapy. Participants who say they need psychiatric treatment, counseling or therapy will be referred to a team of psychologists and psychiatrists with the wherewithal to provide remote therapy, which was authorized by the respective federal professional bodies in March 2020.

“This part of the survey will be designed to evaluate remote therapy and also what’s known as psychoeducation for dealing with anxiety and stress,” Brunoni said.

In Brazil, the participants will undergo serological testing to detect antibodies against coronavirus at a time to be determined, likely early next year. “This stage will be conducted after the pandemic, as the participants will have to be physically present at the research center located in USP’s University Hospital,” Benseñor said.