Factors associated with stress, anxiety and depression in patients with chronic diseases during the period of social distancing





Mental Disorders; Coronavirus Infections; Chronic Diseases; Social isolation.


Objective: identify factors associated with stress, anxiety and severe/extreme depression in chronically ill patients. Methods: cross-sectional study conducted in 2020, using the Google Forms platform containing sociodemographic characteristics, lifestyle habits, questions on the COVID-19 and the stress, anxiety and depression scale (DASS-21). A total of 1,274 chronically ill Brazilians were included. Multivariate logistic regression model was applied with 5% significance level. Results: being ≤ 44 years old, having a history of anxiety and depression, being an undergraduate student, in social isolation, using sleeping medications, and reducing/not performing study, remote work, and leisure activities have risk of stress, anxiety, and severe/extreme depression. While having cardiovascular disease was protective for stress (OR 0.5; 95% CI 0.35-0.79; p=0.002) and depression (OR 0.3; 95% CI 0.22-0.53; p<0.0001) severe/extreme. Conclusion: despite the risk factors related to the chronically ill during social withdrawal, cardiovascular disease was associated with protection from mental disorders.


Aquino, E. M. L; Silveira, I. H.; Pescarini, J. M.; Aquino, R..; Souza-Filho, J. & Rocha, A. S., Ferreira, A.; Victor A.; Teixeira C.; Machado D. B.; Paixão E.; Alves, F. J. O.; Pilleco, F.; Menezes, G.; Gabrielli, L.; Leite, L.; de Almeida, M. C. C.; Ortelan, N.; Fernandes, Q. H. R. F.; Ortiz, R. J. F.; Palmeira, R. N.; Pinto Junior, E. P.; Aragão, E.; de Souza, L. E. P. F.; Netto, M. B.; Teixeira, M. G.; Barreto, M. L.; Ichihara, M.Y. & Lima, R. T. R. S. (2020). Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil. Ciênc. saúde coletiva, 25: 2423-2446. https://doi.org/10.1590/1413-81232020256.1.10502020.

Bogner, H. R.; Dahlberg, B.; de Vries, H. F.; Cahil, l. E. & Barg, F. K. (2008). Older patients' views on the relationship between depression and heart disease. Fam Med, 40:652-7. https://pubmed.ncbi.nlm.nih.gov/18830841/.

Booth, F. W.; Roberts, C. K. & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Compr Physiol, 2:1143-211. https://doi.org/10.1002/cphy.c110025.

Brooks, S. K.; Webster, R. K.; Smith, L. E.; Woodland, L.; Wessely, S. & Greenberg, N. (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet, 395:912–920. https://doi.org/10.1016/S0140-6736(20)30460-8.

Cacioppo, J. T.; Cacioppo, S.; Cole, S. W.; Capitanio, J. P.; Goossens, L. & Boomsma, D. I. (2015). Loneliness across phylogeny and a call for comparative studies and animal models. Perspect Psychol Sci, 10:202-212. https://doi.org/10.1177/1745691614564876.

Cao, W.; Fang, Z.; Hou, G.; Han, M.; Xu, X. & Dong, J. (2020). O impacto psicológico da epidemia COVID-19 em estudantes universitários na China. Psiquiatria Res, 287: 112934. https://doi.org/10.1016/j.psychres.2020.112934.

Cavalcante, J. R. & Abreu, A. J. L. (2020). COVID-19 no município do Rio de Janeiro: análise espacial da ocorrência dos primeiros casos e óbitos confirmados. Epidemiol. Serv. Saúde, 29: e2020204. https://doi.org/10.5123/S1679-49742020000300007.

Chatterjee, S.; Saha, I.; Mukhopadhyay, S.; Misra, R.; Chakraborty, A. & Bhattacharya, A. (2014). Depression among nursing students in a Indian government college. Br J Nurs, 23:316-20. https://doi.org/10.12968/bjon.2014.23.6.316.

Daré, L. O.; Bruand, P. E.; Gérard, D.; Marin, B.; Lameyre, V.; Boumédiène, F. & Preux, P. M. (2019). Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: a meta-analysis. BMC public health, 19: 304. https://doi.org/10.1186/s12889-019-6623-6.

DeJean, D.; Giacomini, M.; Vanstone, M. & Brundisini, F. (2013). Patient experiences of depression and anxiety with chronic disease: a systematic review and qualitative meta-synthesis. Ont Health Technol Assess Ser, 1:1-33. https://pubmed.ncbi.nlm.nih.gov/24228079/.

Donner, N. C. & Lowry, C. A. (2013). Sex differences in anxiety and emotional behavior. Pflugers Arch, 465:601-626. https://doi.org/10.1007/s00424-013-1271-7.

Eurosurveillance Editorial Team. (2020). Updated rapid risk assessment from ECDC on coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK. Euro Surveill, 25:2003121. https://doi.org/10.2807/1560-7917.ES.2020.25.12.2003261.

Fittipaldi, E. O. S.; Andrade, A. D.; Santos, A. C. O.; Campos, S.; Fernandes, J. & Catanho, M. T. J. (2020). Sintomas depressivos estão Associados a Níveis Séricos Elevados de Colesterol de Lipoproteína de Baixa Densidade em Idosos com Diabetes Mellitus Tipo 2. Arq. Bras. Cardiol, In Epub July 15. https://doi.org/10.36660/abc.20190404.

González-Sanguino, C.; Ausín, B.; Castellanos, M. Á.; Saiz, J.; López-Gómez, A. & Ugidos, C. (2020). Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain Behav Immun, 87:172-176. https://doi.org/10.1016/j.bbi.2020.05.040.

Hedlund, M.; Zetterling, M.; Ronne-Engstrom, E.; Ekselius, L. & Carlsson, M. (2010). Perceived recovery after aneurysmal subarachnoid haemorrhage in individuals with or without depression. J Clin Nurs, 19:1578–87. https://doi.org/10.1111/j.1365-2702.2009.02940.x.

Holt-Lunstad, J. & Smith, T. B. (2016). Loneliness and social isolation as risk factors for CVD: implications for evidence-based patient care and scientific inquiry. Heart, 102:987-9. https://doi.org/10.1136/heartjnl-2015-309242.

Kawohl, W. & Nordt, C. (2020). COVID-19, unemployment, and suicide. The lancet. Psychiatry, 7: 389–390. https://doi.org/10.1016/S2215-0366(20)30141-3

Malta, D. C.; Andrade, S. S. C.; Oliveira, T. P.; Moura, L.; Prado, R. R. & Souza, M. F. M. (2019). Probability of premature death for chronic non-communicable diseases, Brazil and Regions, projections to 2025. Rev. bras. Epidemiol, 22: e190030. https://doi.org/10.1590/1980-549720190030

Maruyama, M. E. B. & Ferreira, H. G. (2020). Saúde mental e doenças crônicas em idosos de um grupo hiperdia. REFACS, 8: 600-611. https://doi.org/10.18554/refacs.v8i0.4696.

Pakpour, A. H. & Griffiths, M. D. (2020). The fear of COVID-19 and its role in preventive behaviors. Journal of Concurrent Disorders, 2020; TBD: TBD. http://irep.ntu.ac.uk/id/eprint/39561.

Pereira, M. D.; Oliveira, L. C.; Costa, C. F. T.; Bezerra, C. M. O.; Pereira, M. D. & Santos, C. K. A. (2020). The COVID-19 pandemic, social isolation, consequences on mental health and coping strategies: an integrative review. Research, Society and Development, 9: 1-35, e652974548. https://doi.org/10.33448/rsd-v9i7.4548.

Santos, A. C.; Tenorio, P. J.; Barbosa, E. A. S.; Souza, G. F. A.; Souza G. A.; Praciano, G. A. F.; Maranhão, L. B. B.; Costa, G. O. L. P. & Souza, A. S. R. (2021). The testing for COVID-19 in symptomatic patients as a protective factor against stress, anxiety, and depression. Revista Brasileira de Saúde Materno Infantil. 21(Suppl1):133-143. https://doi.org/10.1590/1806-9304202100S100007>.

Shigemura, J.; Ursano, R. J.; Morganstein, J. C.; Kurosawa, M. & Benedek, D. M. (2020). Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: mental health consequences and target populations. Psychiatry Clin Neurosci, 74:281-2. https://doi.org/10.1111/pcn.12988.

Souza, A. S. R; Souza, G. F. A.; Souza G. A.; Cordeiro, A. L. N.; Praciano, G. A. F.; Alves, A. C. S.; Santos, A. C.; Silva Júnior, J. R. & Souza, M. B. R. (2021). Factors associated with stress, anxiety, and depression during social distancing in Brazil. Rev Saude Publica, 55:5. https://doi.org/10.11606/s1518-


Souza, A. S. R; Souza, G. F. A. & Praciano, G. A. F. (2020). A saúde mental das mulheres em tempos da covid-19. Rev. Bras. Saude Mater. Infant, 20(3). https://doi.org/10.1590/1806-93042020000300001.

Souza, G. F. A.; Praciano, G. A. F.; Ferreira Neto, O. C.; Paiva, M. C.; Jesus, R. P. F. S.; Cordeiro, A. L. N.; Souza, G. A.; Silva Junior, J. R. & Souza, A. S. R. (2021). Factors associated with psychic symptomatology in diabetics during the COVID-19 pandemic. Revista Brasileira de Saúde Materno Infantil, 21(Suppl1):177-186. https://doi.org/10.1590/1806-04202100S100009>.

Tomei, G.; Cangemi, C.; Giubilati, R. & Fioravanti, M. (2007). Salute mentale ed alterazione delle abitudini di vita dei lavoratori giovani [Mental health and life style changes in young workers]. G Ital Med Lav Ergon, 29:903-921. https://gimle.fsm.it.

Vignola, R. C. & Tucci, A. M. (2014). Adaptation and validation of the depression, anxiety and stress scale (DASS) to Brazilian Portuguese. J Affect Disord, 155: 104-109. https://doi.org/ 10.1016/j.jad.2013.10.031.

Votaw, V. R.; Geyer, R.; Rieselbach, M. M. & McHugh, R. K. (2019). The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend, 200:95-114. https://doi.org/10.1016/j.drugalcdep.2019.02.033

Wang, B.; Li, R.; Lu, Z. & Huang, Y. (2020). Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY), 12:6049-6057. https://doi.org/10.18632/aging.103000

Willgoss, T.; Yohannes, A.; Goldbart, J. & Fatoye, F. (2011). COPD and anxiety: its impact on patients' lives. Nurs Times. 107:16-9. https://pubmed.ncbi.nlm.nih.gov/21661487/.

World Health Organization. (2017). Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization. https://apps.who.int/iris/handle/10665/254610.

Zhang, A. Z.; Wang, Q. C.; Huang, K. M.; Huang, J. G.; Zhou, C. H. & Sun, F. Q. (2016). Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study. World journal of gastroenterology, 22: 9437–9444. https://doi.org/10.3748/wjg.v22.i42.9437.



How to Cite

SOUZA, G. F. de A. .; PRACIANO, G. de A. F.; REVORÊDO, L. M. Y. .; RAMOS, I. T. de F. .; FERREIRA NETO, O. da C. .; REGO, J. S. de O. .; COSTA, G. V. da .; MEDEIROS, L. de A. .; SOUZA, A. S. R. . Factors associated with stress, anxiety and depression in patients with chronic diseases during the period of social distancing. Research, Society and Development, [S. l.], v. 10, n. 14, p. e339101422211, 2021. DOI: 10.33448/rsd-v10i14.22211. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/22211. Acesso em: 14 jun. 2024.



Health Sciences