Over 50% of adults in the state of São Paulo have experienced anxiety frequently since the pandemic began

Online survey with 11,863 respondents also shows that feeling sad or depressed became routine for 39%, while overall health worsened for 26%.

By Karina Toledo  |  Agência FAPESP – More than half the adult population of the state of  São Paulo in Brazil has frequently experienced anxiety or stress since the start of the coronavirus pandemic, according to an online survey with 11,863 respondents conducted by scientists at the University of Campinas (UNICAMP), Federal University of Minas Gerais (UFMG) and Oswaldo Cruz Foundation (Fiocruz).

For 39% of the respondents, feeling sad or depressed became routine during coronavirus lockdown or isolation, while almost 30% had sleep disorders despite having always slept well before the pandemic.

The responses were collected between April 24 and May 24 and then calibrated against indicators from the 2019 National Household Sample Survey (PNAD) conducted by IBGE, Brazil’s national census and statistics bureau, to present the same gender, age, ethnicity and educational attainment breakdown as the total population of the state of São Paulo.

“One of the aims of the initiative was to assess people’s state of mind during social isolation. The results show that in this respect, young adults [aged 18-29] were the most affected, with 54.9% frequently experiencing sadness and 69.7% anxiety, while the proportions among older people were 25% and 31%, respectively,” Marilisa Barros, a professor in UNICAMP’s School of Medical Sciences (FCM), told Agência FAPESP. Barros was co-principal investigator for the study with Célia Landmann Szwarcwald (Fiocruz) and Deborah Carvalho Malta (UFMG).

A breakdown by gender shows that 48.4% of women frequently felt sad or depressed, while among men, the proportions were 28.5% and 40.6%, respectively.

For 26.5% of the participants, their overall health worsened after the pandemic began. Forty percent said they began suffering from backache, while 56.6% of respondents who already had chronic back pain (32.7% of the sample) said the pain increased.

The proportion considered physically active (exercising more than 150 minutes per week) fell from 30.5% to 14.2%, while the proportion who watched television three hours or more per day rose from 21% to 52%, and the proportion who used a tablet or computer more than four hours per day rose from 46.2% to 64.3%.

“The increase in sedentary behavior and screen time was expected, but the percentage with backache surprised us,” Barros said. “We believe this has to do with changes in habitual activities, such as more people spending longer doing housework, for example.”

The survey also shows that dietary habits worsened during this period. The proportion of people who ate vegetables at least five days per week fell from 42% to 35.9%, while the proportion who ate foods considered unhealthy (at least twice a week) increased: frozen foods from 8.6% to 13%; savory snacks from 8.5% to 13.7%; and chocolate from 46.5% to 52.7%.

Drinking and smoking also increased during this period. “Although the number of smokers was fortunately small [15.7% of the sample], 28% of them said they were smoking more cigarettes per day,” Barros noted. “The proportion was higher among women [31.5%] than among men [24.3%]. In addition, the percentage was twice as high among those who said they were frequently sad and three times as high among those who said they were often anxious. The same correlation with state of mind applied to the 18.4% who said they were drinking more alcohol.”

Income and employment

Although the survey focused on questions about health, the questionnaire also included items designed to enable the researchers to assess the socio-economic impact of the pandemic and stay-at-home orders on the population of the state of São Paulo.

Household income fell for 55.3% of the respondents, and 6.3% said their income had dwindled to zero. Those most affected in this regard were the poorest with income per person corresponding to less than half the minimum wage: 9.4% of this group had lost all their income, while only 26.4% said they were earning the same amount as before the pandemic. Among the better-off (earning four times the minimum wage or more), the proportions were 6.9% and 48.8%. Among the self-employed, 91% said they had lost all or part of their income.

With regard to their current work situation, 3% lost their jobs and 19.1% were furloughed (on leave of absence), while 19.5% were still working away from home and 27.4% were working from home. Asked about how their prepandemic situation had been affected, 55.7% of the self-employed said they were without work, as did 26% of business owners and workers in the informal economy.

“We knew the pandemic was affecting employment and income, but it wasn’t entirely clear how much. The percentages were higher than I expected,” Barros said.

The proportion who said they only left home to buy provisions and medications was 60%, while 15.7% said they went out only to see a doctor or dentist. Barros was also surprised by this level of obedience to social isolation orders.

“In the older age group, 32% left home only to see a doctor or dentist, although 10% of those aged 60 or more said their lives were almost normal and they were still working away from home,” she said.

Almost 27% of respondents said they had flu symptoms during the period, while only 3.6% had been tested for COVID-19, with 41.5% of this group testing positive.

Adolescents

The researchers have now launched an online survey designed specifically to evaluate the effects of the pandemic and social isolation on the 12-17 age group (ConVid Adolescentes – Pesquisa de Comportamentos). All responses to the questionnaire are anonymous. However, “adolescents must ask a parent or guardian to sign a consent form before they’re allowed to take the survey,” Barros noted.

Both surveys will offer information of value for policymakers to plan measures that minimize the negative impact of the pandemic and social isolation on the mental health of the population, Barros said.