Factors associated with comorbidity for depression, anxiety, and stress screening in a sample of university’s community during the COVID-19 pandemic

Baptista, Cremildo João

doi:10.1590/1982-0275202441e220019

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Research Report - Health Psychology • Estud. psicol. (Campinas) 41 • 2024 • https://doi.org/10.1590/1982-0275202441e220019 copy

Factors associated with comorbidity for depression, anxiety, and stress screening in a sample of university’s community during the COVID-19 pandemic

Fatores associados à comorbidade para depressão, ansiedade e estresse em amostra de comunidade universitária durante a pandemia de COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

This study presents the prevalence and factors associated with comorbidity in screening for depression, anxiety, and stress during the COVID-19 pandemic.

Methods

A cross-sectional descriptive/exploratory study used self-reported DASS-21 to screen for mental health.

Results

In an online sample, 14.48% (n = 260), 12.42% (n = 223), and 31.12% (n = 559) illegible of participants were screened, respectively, positive for only one, for only two and for all the three outcomes. Being student, having children, using substances, reporting COVID-19 symptoms, reporting worsened emotional state, and previous mental disorders were associated with comorbidity for depression, anxiety, and stress.

Conclusion

Individuals from the studied university’s community experienced psychological disorders, as measured by levels of anxiety, depression, and stress and comorbidity for these outcomes, probably as Covid-19’s initial psychological impact.

Keywords:
Anxiety; Comorbidity; COVID-19 pandemic; Depression; Stress

Item	Question	Construct or Subscale
1	I found it difficult to calm myself.	Stress
2	My mouth felt dry.	Anxiety
3	I didn't experience any positive feelings.	Depression
4	I had difficulty breathing at times (such as wheezing and breathlessness without having made any physical effort).	Anxiety
5	It was hard for me to have the initiatives to do things.	Depression
6	I intended to exaggerate when I reacted to situations.	Stress
7	I felt shaky (for example, in my hands).	Anxiety
8	I felt I was always nervous.	Stress
9	I got worried about situations in which I could have panicked and looked ridiculous.	Anxiety
10	I felt I had no desire for anything.	Depression
11	I felt restless.	Stress
12	I found it difficult to relax.	Stress
13	I felt depressed and had no motivation.	Depression
14	I was intolerant of the things that kept me from continuing to do what I had been doing.	Stress
15	I felt like I was going to panic.	Anxiety
16	I didn't feel enthusiastic about anything.	Depression
17	I felt like I was worthless as a person.	Depression
18	I felt like I was being a little too emotional/sensitive.	Stress
19	I knew my heartbeat had changed even though I hadn't done anything physically rigorous (e.g. increased heart rate, irregular heartbeat).	Anxiety
20	I felt afraid for no reason.	Anxiety
21	I felt there was no meaning to life.	Depression

Characteristic	n (%) (Total = 1,796)	Prevalence of morbidities (depression, anxiety, and stress)
Characteristic	n (%) (Total = 1,796)	Positive for 1 outcome n = 260 (14.48%)	p-value	Positive for 2 outcomes n = 223 (12.42%)	p-value	Positive for all 3 outcomes n = 559 (31.12%)	p-value
Sex
Male	619 (34.47)	16.16	0.143	9.85	0.017	22.46	< 0.001
Female	1,177 (65.53)	13.59	0.143	13.76	0.017	35.68	< 0.001
Age group (mean: 28.3 ± 10.1 years)
18 - 29 years	1,208 (67.26)	15.73	0.007	14.07	0.003	37.25	< 0.001
30 - 49 years	495 (27.56)	13.33		9.90		20.20
50 - 68 years	93 (5.18)	4.30		4.30		9.68
Race/skin color
White	973 (54.18)	14.90	0.835	12.74	0.425	30.22	0.662
Black/Pardo	735 (40.92)	13.88		12.52		32.24
Indigenous/Yellow	88 (4.90)	14.77		7.95		31.82
Educational level
Master/PhD	230 (12.81)	11.74	0.258	9.57	0.349	16.09	< 0.001
University degree	909 (50.61)	14.08		13.09		31.35
Primary/Secondary	657 (36.58)	15.98		12.48		36.07
Relationship with the University
Professor	104 (5.79)	6.73	0.042	7.69	< 0.001	14.42	< 0.001
Staff	276 (15.37)	13.04		6.16		14.49
Student	1,416 (78.84)	15.32		13.98		35.59
Marital status
Married/With partner	515 (28.67)	12.43	0.118	10.87	0.209	20.58	< 0.001
Single	1,281 (71.33)	15.30	0.118	13.04	0.209	35.36	< 0.001
Children
No	413 (23.00)	15.62	0.012	13.52	0.009	35.21	< 0.001
Yes	1,383 (77.00)	10.65	0.012	8.72	0.009	17.43	< 0.001
Risk group for CoVID-19
No	1,354 (75.39)	15.36	0.062	13.00	0.1905	27.33	< 0.001
Yes	442 (24.61)	11.76	0.062	10.63	0.1905	42.76	< 0.001
Substance use (alcohol, tabacco, illicit drugs, etc)
No	921 (51.30)	14.01	0.561	11.29	0.138	26.93	< 0.001
Yes	875 (48.70)	14.97	0.561	13.60	0.138	35.54	< 0.001
Cohabits?
Family/Partner	1,312 (73.05)	13.80	0.391	12.58	0.544	29.34	< 0.001
Friends/Roommates	146 (8.13)	15.75		9.59		48.63
No, lives alone	338 (18.82)	16.57		13.02		30.47
Computer and household internet access
Yes	1,538 (85.63)	14.76	0.406	12.22	0.545	29.26	< 0.001
No	258 (14.37)	12.79	0.406	13.57	0.545	42.25	< 0.001
Feeling that keeping remote activities helps to lessen oneself’ sensation of social isolation/distancing (loneliness)
No	959 (53.40)	13.45	0.186	13.45	0.155	37.33	< 0.001
Yes	837 (46.60)	15.65	0.186	11.23	0.155	24.01	< 0.001
Signs/symptoms suggesting COVID-19 infection during social/physical isolation/distancing
No	1,518 (84.52)	14.43	0.889	11.86	0.093	27.54	< 0.001
Yes	278 (15.48)	14.75	0.889	15.47	0.093	50.72	< 0.001
Financial/material hardship during physical/social isolation
No	1,365 (76.00)	14.29	0.682	12.31	0.803	25.86	< 0.001
Yes	431 (24.00)	15.08	0.682	12.76	0.803	47.80	< 0.001
Fear of being infected with SARS-CoV-2
No fear	114 (6.35)	15.79	0.846	13.16	0.693	15.79	< 0.001
Little fear	918 (51.11)	14.71		11.76		24.73
Very scared	764 (42.54)	14.01		13.09		41.10
Feeling well informed about the pandemic and the reasons for social/physical isolation/distancing
No	1,587 (88.36)	14.87	0.191	12.73	0.269	28.86	< 0.001
Yes	209 (11.64)	11.48	0.191	10.05	0.269	48.33	< 0.001
Self-rated emotional state during social/physical isolation/distancing
Remained the same	548 (30.51)	13.87	0.873	6.02	< 0.001	11.31	< 0.001
Got better	124 (6.90)	15.32		13.71		25.00
Got worse	1,124 (62.58)	14.68		15.39		41.46
Previous diagnostic of mental disorders before the COVID-19 pandemic
No	1,101 (61.30)	15.71	0.061	10.54	0.002	17.26	< 0.001
Yes	695 (38.70)	12.52	0.061	15.40	0.002	53.09	< 0.001

Characteristic	Number of morbidities (depression, anxiety, and stress)
Characteristic	Positive for 1 outcome OR [95% CI]	p-value	Positive for 2 outcomes OR [95% CI]	p-value	Positive for all 3 outcomes OR [95% CI]	p-value
Sex
Male	-		-		-
Female	1.02 [0.74-1.38]	0.943	1.54 [1.07-2.21]	0.019	1.58 [1.17-2.15]	0.003
Age group
18 - 29 years	3.59 [1.13-11.38]	0.030	2.16 [0.64-7.36]	0.218	2.16 [0.81-5.79]	0.123
30 - 49 years	2.93 [0.99-8.71]	0.030	1.80 [0.58-5.64]	0.218	1.71 [0.69-4.22]	0.123
50 - 68 years	-		-		-
Educational level
Master/PhD	-		-		-
University degree	0.73 [0.39-1.37]	0.328	0.53 [0.24-1.13]	0.098	0.73 [0.38-1.41]	0.343
Primary/Secondary	0.73 [0.37-1.44]	0.358	0.40 [0.17-0.89]	0.026	0.63 [0.31-1.28]	0.201
Relationship with the University
Professor	-		-		-
Staff	2.25 [0.88-5.77]	0.012	1.14 [0.42-3.10]	0.003	1.18 [0.50-2.78]	0.014
Student	3.71 [1.33-10.35]	0.012	5.21 [1.74-15.59]	0.003	3.30 [1.28-8.55]	0.014
Marital state
Married/With partner	-		-		-
Single	0.97 [0.64-1.48]	0.903	0.87 [0.55-1.38]	0.547	1.75 [0.79-1.76]	0.431
Children
No	-		-		-
Yes	0.60 [0.37-0.96]	0.034	0.56 [0.33-0.96]	0.036	0.44 [0.28-0.70]	< 0.001
Risk group for COVID-19
No	-		-		-
Yes	1.19 [0.80-1.76]	0.385	1.20 [0.78-1.83]	0.409	2.05 [1.46-2.90]	< 0.001
Substance use (alcohol, tabacco, illicit drugs, etc)
No	-		-		-
Yes	1.44 [1.06-1.95]	0.019	1.70 [1.22-2.38]	0.002	1.67 [1.26-2.23]	< 0.001
Cohabits
Family/Partner	-		-		-
Friends/Roommates	1.14 [0.64-2.03]	0.656	0.72 [0.37-1.43]	0.351	1.44 [0.86-2.40]	0.022
No, lives alone	1.05 [0.70-1.55]	0.656	0.82 [0.53-1.27]	0.351	0.64 [0.44-0.94]	0.022
Computer and household internet access
Yes	-		-		-
No	0.86 [0.54-1.39]	0.541	0.61 [0.37-0.99]	0.048	0.51 [0.34-0.77]	0.002
Feeling that keeping remote activities helps to lessen oneself’ sensation of social isolation/distancing (loneliness)
No	-		-		-
Yes	1.08 [0.80-1.47]	0.600	0.86 [0.62-1.20]	0.380	0.71 [0.53-0.94]	0.017
Signs/symptoms suggesting COVID-19 infection during social/physical isolation/distancing
No	-		-		-
Yes	1.69 [1.07-2.69]	0.025	2.03 [1.26-3.28]	0.004	2.24 [1.49-3.37]	< 0.001
Financial/material hardship during social/physical isolation/distancing
No	-		-		-
Yes	1.66 [1.13-2.43]	0.010	1.38 [0.91-2.10]	0.134	2.06 [1.45-2.92]	< 0.001
Luck of medical assistance during social/physical isolation/distancing
No	-		-		-
Yes	1.05 [0.69-1.59]	0.836	0.88 [0.56-1.39]	0.595	1.42 [0.99-2.04]	0.059
Fear of being infected with SARS-CoV-2
No fear	-		-		-
Little fear	0.98 [0.55-1.78]	0.959	0.98 [0.50-1.90]	0.946	1.67 [0.86-3.24]	0.002
Very scared	1.27 [0.69-2.33]	0.959	1.34 [0.68-2. 64]	0.946	2.85 [1.46-5.55]	0.002
Feeling well informed about the pandemic and the reasons for social/physical isolation/distancing
No	-		-		-
Yes	0.87 [0.52-1.46]	0.604	0.86 [0.49-1.50]	0.593	1.62 [1.05-2.49]	0.028
Self-rated emotional state during social/physical isolation/distancing
Remained the same	-		-		-
Got better	1.40 [0.77-2.55]	< 0.001	2.84 [1.43-5.66]	0.003	2.27 [1.24-4.15]	0.008
Got worse	1.91 [1.37-2.66]	< 0.001	4.01 [2.62-6.15]	0.003	4.22 [2.96-6.02]	0.008
Previous diagnostic of mental disorders before the COVID-19 pandemic
No	-		-		-
Yes	2.25 [1.59-3.18]	< 0.001	4.01 [2.80-5.76]	< 0.001	7.82 [5.74-10.66]	< 0.001

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