Multimorbidity worsened anxiety and depression symptoms during the COVID-19 pandemic in Brazil

Abstract

Multimorbidity is a global health issue impacting the quality of life of all ages. Multimorbidity with a mental disorder is little studied and is likely to have been affected by the COVID-19 pandemic. We used a survey of 14,007 respondents living in Brazil to investigate whether people who already had at least one chronic medical condition had more depression and anxiety symptoms during social distancing in 2020. Generalized linear models and structural equation modelling were used to estimate the effects. A 19 % and 15 % increase in depressive symptoms were found in females and males, respectively, for each unit of increase in the observed value of reported chronic disease. Older subjects presented fewer symptoms of depression and anxiety. There was a 16 % increase in anxiety symptoms in females for each unit increase in the reported chronic disease variable and a 14 % increase in males. Younger subjects were more affected by anxiety symptoms in a dose-response fashion. High income was significantly related to fewer depressive and anxiety symptoms in both males and females. Physical activity was significantly associated with fewer anxiety and depression symptoms. Structural equation modelling confirmed these results and provided further insight into the hypothesised paths.

Keywords: Anxiety; Chronic diseases; Covid-19; Depression; Epidemiology; Mental disorders; Pandemic; Physical exercises.

Fig. 1

Results of glm models using Average Marginal Effect (AME). AME is the mean change in probability in the dependent variable for 1 unit increase in the explanatory variable. *, p < 0.05.

Fig. 2

Results of glm models using Average Marginal Effect (AME). AME is the mean change in probability in the dependent variable for 1 unit increase in the explanatory variable. *, p < 0.05.

Fig. 3

Structural equation model for depressive symptoms. Circles represent latent variables and boxes the measured variables. Straight arrows represent the direction of the relationship. Standardized estimated coefficients. Negative coefficients are in red, representing reduction of the value at the tip of the arrow. Residuals and variances were omitted. RMSEA = 0.044 (CI 0.043–0.046); SRMR = 0.045; TLI = 0.95. *, p < 0.05. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Fig. 4

Structural equation model for anxiety symptoms. Circles represent latent variables and boxes the measured variables. Straight arrows represent the direction of the relationship. Standardized estimated coefficients. Negative coefficients are in red, representing reduction of the value at the tip of the arrow. Residuals and variances were omitted. RMSEA = 0.034 (CI 0.032–0.035); SRMR = 0.029; TLI = 0.87. *, p < 0.05. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)