Pandemic causes more diagnoses of depression and worsening of healthy habits

The diagnoses of depression in the Brazilian adult population grew 41% in the first two years of the Covid-19 pandemic. Women were the main drivers of the increase, with more than double the prevalence recorded among men.

In the depressed population, there was a significant worsening of healthy lifestyle habits, such as a drop in the consumption of vegetables and physical activity, in addition to an increase in the rate of smoking.

The conclusion is an unprecedented analysis by Covitel, a telephone survey that portrayed the impact of the coronavirus pandemic on risk factors for chronic non-communicable diseases. Data from before Covid-19 and from the first quarter of 2022 were analyzed, a period in which the health crisis gave a little respite.

Conducted by Vital Strategies, a global public health organization, and by UFPel (Federal University of Pelotas), the survey interviewed 9,000 Brazilians, distributed in capitals and in cities in the interior of the five regions of the country.

The increase in depression was registered all over the world and the WHO (World Health Organization) has been warning governments to allocate more investments in the prevention and care of cases.

In the case of women, the prevalence of depression diagnosis went from 13.5% to 18.8%. Among men, it jumped from 5.4% to 7.8%.

There are several hypotheses to explain the higher rate of female depression, from genetic and hormonal factors to double working hours to balance career and household chores.

But for Luciana Vasconcelos Sardinha, technical advisor for epidemiology and public health at Vital Strategies, the main reason is the fact that women seek more medical help than men. Therefore, they are the most diagnosed with the disease.

“In general, men do not seek help, they do not invest in prevention and health promotion. When they arrive at the medical service, [o estado de saúde] It’s already getting worse.”

The survey also analyzed how depression influenced the population’s lifestyle, which are risk factors for several chronic diseases, such as cardiovascular disease and diabetes.

For a healthy diet, the recommendation is to consume vegetables, greens and fruits five times or more a week. In the first quarter of this year, 12% of depressed people reported having this habit. In the general population, the rate was 39% on average.

Among women with depression, this routine is just over a third (16.9%) of that reported by the total female population (42.5%).

People diagnosed with depression also reported practicing less physical activity (11.5%) and being more smokers (19.9%). In the general adult population, the rates for these habits were 30% and 12.2%, respectively.

The prevalence of smoking among depressed women is almost triple that of the female population in general: 25.4% versus 9.9%.

“It was expected, but it is the first time that we can prove what actually happened in this moment of pandemic”, says the researcher.

According to Vasconcelos, the work had a differential of listening to the same people about their habits before the pandemic and this beginning of the year, when the crisis gave a truce.

She says there was a chance that, in this period, people could have resumed their routines. “Unfortunately, everything remains the same. The level of physical activity remains as it was at the beginning of the pandemic. People have not returned.”

In addition to women, a higher prevalence of depression was observed in white people with higher education (12 years or more of schooling). But, again, the explanation is that it is these portions of the population that generally have greater access to health services.

For the researcher, it is urgent that the Brazilian government monitor this depressed population and expand assistance to it. According to Vasconcelos, at the same time that the mental health crisis is worsening in the country, existing public services, such as CAPs (Psychosocial Care Centers), are far from what is necessary.

“There are few vacancies, the number of psychiatrists is insufficient. In the North and Northeast regions, sometimes there are not even psychiatrists to hire. Tenders are open, but vacancies are not filled.”

In addition, schools also need to be trained to recognize the signs of depression and refer cases to specialist help.

A recent review with 29 surveys, released by the Ministry of Health, showed that symptoms of anxiety and depression among children and adolescents doubled after the beginning of the pandemic. Before the health crisis, 12.9% of this group reported depressive symptoms. During the coronavirus crisis, the rate jumped to 25.2%. Anxiety symptoms, in turn, increased from 11.6% to 20.5%.

One of Vital Strategies’ contributions to the fight against psychiatric illnesses is the development of a mental health index, capturing not only health data but also education and public safety, among others.

Covitel received funding from Umane and the Ibirapitanga Institute and support from Abrasco (Brazilian Association of Collective Health). The survey differs from Vigitel (Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey) because it gathers data from 27 Brazilian capitals and the interior. Vigitel, on the other hand, works with samples only from the capitals.

For the pre-pandemic period, the new survey considered data from the last quarter of 2019 and January and February 2020.

Ministry announces mental health initiatives

The Ministry of Health announced last June 13 investments in the order of R$ 45 million to expand actions in the area of ​​mental health.

Among the initiatives are the telephone service 196 (Linha Vida), teleconsultations and care lines to organize the care of patients with anxiety and depression.

A Linha Vida pilot project, according to the ministry, will begin in the Federal District, through a multichannel service system. The goal is to prevent suicide and self-harm.

The teleconsultation project is being carried out in partnership with SPDM (Paulista Association for the Development of Medicine) and is aimed at people with mild mental disorders. The proposal is to offer 12,000 monthly teleconsultations of psychologists and psychiatrists.

The visits will be scheduled by the teams of the UBSs (Basic Health Units).

The ministry also launched a line of care focused on children, adolescents and adults with anxiety and depression disorders.

According to the folder, it will work from transfers of federal resources to multidisciplinary teams in mental health, which may be linked to outpatient clinics, polyclinics or hospital units.

For epidemiologist Luciana Vasconcelos Sardinha, who has worked at the Ministry of Health, a telephone service and the provision of teleconsultations are very far from current mental health needs.