新冠大流行前后的精神症状和诊断的流行率和风险因素：来自 ELSA-Brasil COVID-19 精神健康队列的研究结果。
Prevalence and risk factors of psychiatric symptoms and diagnoses before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 mental health cohort.
机构信息
Centro de Pesquisas Clínicas e Epidemiológicas, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
出版信息
Psychol Med. 2023 Jan;53(2):446-457. doi: 10.1017/S0033291721001719. Epub 2021 Apr 21.
BACKGROUND
There is mixed evidence on increasing rates of psychiatric disorders and symptoms during the coronavirus disease 2019 (COVID-19) pandemic in 2020. We evaluated pandemic-related psychopathology and psychiatry diagnoses and their determinants in the Brazilian Longitudinal Study of Health (ELSA-Brasil) São Paulo Research Center.
METHODS
Between pre-pandemic ELSA-Brasil assessments in 2008-2010 (wave-1), 2012-2014 (wave-2), 2016-2018 (wave-3) and three pandemic assessments in 2020 (COVID-19 waves in May-July, July-September, and October-December), rates of common psychiatric symptoms, and depressive, anxiety, and common mental disorders (CMDs) were compared using the Clinical Interview Scheduled-Revised (CIS-R) and the Depression Anxiety Stress Scale-21 (DASS-21). Multivariable generalized linear models, adjusted by age, gender, educational level, and ethnicity identified variables associated with an elevated risk for mental disorders.
RESULTS
In 2117 participants (mean age 62.3 years, 58.2% females), rates of CMDs and depressive disorders did not significantly change over time, oscillating from 23.5% to 21.1%, and 3.3% to 2.8%, respectively; whereas rate of anxiety disorders significantly decreased (2008-2010: 13.8%; 2016-2018: 9.8%; 2020: 8%). There was a decrease along three wave-COVID assessments for depression [ = -0.37, 99.5% confidence interval (CI) -0.50 to -0.23], anxiety ( = -0.37, 99.5% CI -0.48 to -0.26), and stress ( = -0.48, 99.5% CI -0.64 to -0.33) symptoms (all s < 0.001). Younger age, female sex, lower educational level, non-white ethnicity, and previous psychiatric disorders were associated with increased odds for psychiatric disorders, whereas self-evaluated good health and good quality of relationships with decreased risk.
CONCLUSION
No consistent evidence of pandemic-related worsening psychopathology in our cohort was found. Indeed, psychiatric symptoms slightly decreased along 2020. Risk factors representing socioeconomic disadvantages were associated with increased odds of psychiatric disorders.
背景
在 2020 年的冠状病毒病 2019（COVID-19）大流行期间，精神障碍和症状的发生率存在混合证据。我们评估了巴西纵向健康研究（ELSA-Brasil）圣保罗研究中心与大流行相关的精神病理学和精神病诊断及其决定因素。
方法
在 2008-2010 年（波 1）、2012-2014 年（波 2）、2016-2018 年（波 3）进行 ELSA-Brasil 预流行评估和 2020 年的三次大流行评估（COVID-19 波在 5 月至 7 月、7 月至 9 月和 10 月至 12 月）期间，使用临床访谈时间表修订版（CIS-R）和抑郁焦虑压力量表-21（DASS-21）比较常见精神症状以及抑郁、焦虑和常见精神障碍（CMD）的发生率。多变量广义线性模型，通过年龄、性别、教育水平和种族进行调整，确定与精神障碍风险增加相关的变量。
结果
在 2117 名参与者（平均年龄 62.3 岁，58.2%为女性）中，CMD 和抑郁障碍的发生率并未随时间显著变化，分别在 23.5%至 21.1%和 3.3%至 2.8%之间波动；而焦虑障碍的发生率显著下降（2008-2010 年：13.8%；2016-2018 年：9.8%；2020 年：8%）。在三次 COVID 波评估中，抑郁症状均呈下降趋势[ = -0.37，99.5%置信区间（CI）-0.50 至 -0.23]、焦虑症状（ = -0.37，99.5%CI -0.48 至 -0.26）和压力症状（ = -0.48，99.5%CI -0.64 至 -0.33）（所有 s < 0.001）。年龄较小、女性、较低的教育水平、非白色种族和以前的精神障碍与精神障碍的发生几率增加有关，而自我评估的良好健康和良好的人际关系则降低了风险。
结论
我们的队列中没有发现与大流行相关的精神病理学恶化的一致证据。事实上，2020 年期间，精神症状略有下降。代表社会经济劣势的危险因素与精神障碍的发生几率增加有关。
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