Closed doors: predictors of stress, anxiety, depression, and PTSD during the onset of COVID-19 pandemic in Brazil

BACKGROUND: The rise in mental health problems in the population directly or indirectly because of the coronavirus disease 2019 (COVID-19) pandemic is a major concern. The aim of this study was to investigate and compare independent predictors of symptoms of stress, anxiety, depression, and posttraumatic stress disorder (PTSD) in Brazilians one month after the implementation of measures of social distancing. METHODS: This cross-sectional study was performed using a web-based survey. The Depression, Anxiety, and Stress Scale (DASS-21) and PTSD Checklist for DSM-5 (PCL-5) were the outcomes. Data were gathered regarding demographics, social distancing, economic problems, exposure to the news of the pandemic, psychiatric history, sleep disturbances, traumatic situations, and substance use. The Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) was also administered. The predictors of the symptoms were investigated using hierarchical multiple linear regression. RESULTS: Of a sample of 3587 participants, approximately two-thirds considered that their mental health worsened after the beginning of the social restriction measures. The most important predictors of the symptoms investigated were the intensity of the distress related to the news of the pandemic, younger age, current psychiatric diagnosis, trouble sleeping, emotional abuse or violence, and economic problems. CONCLUSIONS: These results confirmed the hypothesis that the pandemic impacted the mental health of the population and indicated that the level of distress related to the news was the most important predictor of psychological suffering

Translation, cultural adaptation, and validation of the Brazilian Portuguese version of the Higher Education Stress Inventory (HESI-Br)

Objective There are no validated instruments to measure education-related stress in Brazilian university students. Thus, we aimed to translate and test internal reliability, convergent/discriminant validity, and measurement equivalence of the Higher Education Stress Inventory (HESI). Methods The translation protocol was carried out by two independent translators. The instrument was culturally adapted after a pilot version that was administered to 36 university students. The final version (HESI-Br) was administered to 1021 university students (Mean age = 28.3, SD = 9.6, 76.7% female) via an online questionnaire that extended from September 1 to October 15, 2020. Factor structure was estimated using exploratory factor analysis (EFA) in the first half of the data set. We tested the best EFA-derived model with confirmatory factor analysis (CFA) in the second half. Convergent/discriminant validity was tested using the Depression, Anxiety and Stress Scale (DASS- 21). Sex, age groups, period of study, family income and area of study were used to test measurement equivalence. Results EFA suggested five factors: career dissatisfaction; faculty shortcomings; high workload; financial concerns; and toxic learning environment. CFA supported the 5-factor model (15 items), but not a higher order factor, suggesting multidimensionality. All 5 factors presented acceptable internal reliabilities, with Cronbach’s α ≥.72 and McDonald’s ω ≥.64. CFA models indicate that HESI-Br and DASS-21 assess different but correlated underlying latent constructs, supporting discriminant validity. Equivalence was ascertained for all tested groups. Conclusions The 15-item HESI-Br is a reliable and invariant multidimensional instrument for assessing relevant stressors among university students in Brazil