Stressors and protective factors of the COVID-19 pandemic in the mental health of the world population: an integrative review

Meirelles, Tatiane Veríssimo da Silveira; Teixeira, Mirna Barros

doi:10.1590/0103-11042021E211i

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REVIEW • Saúde debate 45 (spe2) • Dec 2021 • https://doi.org/10.1590/0103-11042021E211i copy

Stressors and protective factors of the COVID-19 pandemic in the mental health of the world population: an integrative review

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ABSTRACT

This paper aimed to analyze the mental health protective factors and stressors of the pandemic in Brazil and internationally. We conducted an integrative literature review by searching for scientific publications indexed in the LILACS and MEDLINE databases from January to December 2020. Twentynine papers have been analyzed by author, year, country of study, methodology; mental health stressors and protective factors related. We concluded that people subjected to restrictive measures imposed by the COVID-19 pandemic are vulnerable to mental health problems. However, very few studies have evaluated the related psychosocial factors despite the global impact.

KEYWORDS
Mental health; Social isolation; COVID-19

Author Country/Region Journal	Methodology Methods Studied population	General Objective	Line 1: Mental health-related stressors	Line 2: Mental health-related protective factors
Smith et al. (2020) United Kingdom Psychiatry Res	Quantitative cross-sectional study n= 932 United Kingdom residents >18 years, both sexes	Assess the impact of COVID-19 social distancing on mental health.	Female, younger age, lower annual income, smoker, and physical multimorbidity.	Male, older age, higher annual income, non-smoker, and no physical multimorbidity.
Duarte et al. (2020) Brazil Ciênc. Saúde Colet.	Quantitative cross-sectional study n= 799 Rio Grande do sul residents 18-75 years, both sexes	To verify the factors associated with indicators of mental disorders symptoms in Rio Grande do sul residents.	Female, younger age, previous diagnosis of mental disorder, non-health worker, reduced income in the period, part of the risk group, and greater exposure to information about COVID-19.	Male, older age, not having a diagnosis of mental disorder, health professional, not having economic losses, not being from the risk group, and suffering less exposure to information about COVID-19.
Mazza et al. (2020) Italy Int. j. environ. res. public health (Online)	Quantitative cross-sectional study n=2,766 Italy residents >18 years, both sexes	To establish the prevalence of psychiatric symptoms and identify risk and protective factors for psychological distress in the general population.	Female, younger age, no children, negative affect, detachment, history of stressful situations, history of medical problems, having an acquaintance infected with cOVID-19, working outside the home.	Male, older age, with children, positive affect, not having a clinical history, not having infected acquaintances, home office work.
Lei et al. (2020) China Med Sci Monit	Quantitative cross-sectional study n=1,593 Southwest China residents >18 years, both sexes	To assess and compare the prevalence and associated factors of anxiety and depression among the public affected by quarantine and those not affected during the cOVID-19 outbreak.	Female, younger age, student, divorced, widowed or single, low household income, low schooling, poor self-perception of health, greater concern about being infected, elevated level of self-assessment of knowledge about cOVID-19, lack of psychological support.	Male, older age, not a student, married, high family income, no economic loss, high schooling level, good self-perception of health, psychological support, or counseling from the community/government agencies.
Fawaz; Samaha (2020) Lebanon Int J Soc Psychiatry	Quantitative cross-sectional study n=950 Lebanon residents >18 years, both sexes	To assess the prevalence of post-traumatic stress symptoms (pTss) during the cOVID-19 quarantine period in Lebanese citizens.	Quarantine practices.	Not applicable (NA).
Verma; Mishra (2020) India Int J Soc Psychiatry	Quantitative cross-sectional study n=354 India residents >18 years, both sexes	To identify the prevalence rates of depression, anxiety and stress and their sociodemographic correlates among the Indian population during the lockdown to contain the COVID-19 spread.	Male, unemployed, alcohol abuse.	Female, employed.
Gopal; Sharma; Subramanyam (2020) India PLoS One	Quantitative longitudinal study (2 months) n=159 > 18 years, both sexes	To investigate how levels of anxiety, stress and depressive symptoms changed during confinement among Indian adults.	Female, history of mental health problems, increased domestic responsibility.	Male, less domestic responsibility, higher resilience levels.
Lee; Cadigan; Rhew (2020) USA J Adolesc Health	Quantitative longitudinal study n=564 Young adults residing in Seattle, WA. 22-29, both sexes	To examine the increasing loneliness in a sample of young adults.	Female, concerns about the impact of COVID-19 on her social relationships.	Male, social support during the pandemic.
Ammar et al. (2020) USA PLoS One	Quantitative cross-sectional study n=1,047 Multicenter study, Asia, Africa, Europe and Americas residents >18 years, both sexes	To assess the emotional and behavioral changes associated with home confinement during the COVID-19 outbreak.	Weakening of physical and social contacts with disruption of normal lifestyles risk groups, living in congregated environments, substance use problems, pre-existing psychiatric problems.	No psychiatric and chemical addiction history.
Losada-Baltar et al. (2020) Spain Rev Esp Geriatr Gerontol	Quantitative cross-sectional study n=1,501 Spain residents 18-88 years, both sexes	To analyze differences, based on age and self-perception of aging, in anxiety, sadness, loneliness and comorbidities during confinement due to COVID-19.	Younger age, negative self-perception about own aging.	Older age, especially middle age.
Guo et al. (2020) China J Med Internet Res	Quantitative cross-sectional study n=2,331 China residents >18 years, both sexes	To estimate the prevalence of anxiety and depressive symptoms and to identify associated demographic and psychosocial factors in the Chinese population during the COVID-19 pandemic quarantine period.	Younger age, living alone, having monetary loss, concerns about infection, sedentary behavior, poor sleep quality, living with cancer or other chronic illnesses, or having family members with cancer.	Older age, living with other people, physical activity, not having comorbidities, connection and social support.
Every-Palmer et al. (2020) New Zealand PLoS One	Quantitative cross-sectional study n=2,010 New Zealand residents 18-90 years, both sexes	To assess levels of psychological distress, anxiety, well-being, suicidal ideation, alcohol consumption and family relationships.	Younger age, living alone, unemployment or reduced work, health problems and previous diagnoses of mental illness.	Older age, enjoying working from home, spending more time with the family, flexibility at work, social cohesion, creating healthy habits.
Hidalgo et al. (2020) Spain Int. j. environ. res. public health	Sequential exploratory design (mixed research) Qualitative stage n=40 Quantitative stage n=6,789 Spain residents >18 years, both sexes	To analyze the psychological impact of the COVID-19 pandemic and the lockdown on the Spanish population and identify which population profiles were most affected.	Female, younger age, mother, low or medium socioeconomic status.	Male, middle-aged, higher socioeconomic status.
Pérez-Fuentes et al. (2020) Spain PLoS One	Quantitative cross-sectional study n=1,014 Spain residents 18-76, both sexes.	To analyze the effect of exceptionally stressful situations, such as current health risk, on an individual’s cognitive and emotional state.	Greater perception of threat and susceptibility to disease.	Lower perception of threat and susceptibility to disease.
Burhamah et al. (2020) Kuwait J Affect Disord	Quantitative cross-sectional study n=4,132 Kuwait residents >18 years, both sexes	To assess the impact of the COVID-19 outbreak on mental health in Kuwait and explore the influence of risk factors.	Female, younger age (<30), single, job loss, financial stress, previous psychiatric history, smokers, having family members with cOVID-19, healthcare professional, increased use of social media and information about COVID-19, fear of infection.	Male, older age, satisfaction with the government, confidence in the country's care standards, retired.
Ozamiz-Etxebarria et al. (2020) Spain Cad Saude Publica	Exploratory descriptive cross-sectional study n=976 Basque Autonomous Community residents >18 years, both sexes	To measure levels of stress, anxiety and depression in a sample of the Basque Autonomous Community.	Younger age, chronic diseases, confinement.	Older age, no chronic diseases.
Massad et al. (2020) Jordan East Mediterr Health J	Quantitative cross-sectional study n=5274 Jordan residents >18 years, both sexes	To estimate the prevalence of quarantine-related anxiety and its socioeconomic correlates.	Female, younger, more members living in the house, low social support, low income.	Older age, greater support and social network, and higher income.
Martínez et al. (2020) Colombia Med. U.P.B	Systematic review n=16	To conduct a systematic review of research trends on symptoms of mental disorders during the COVID-19 pandemic.	Female, younger age, consumption of psychoactive substances, low school performance, job loss, poor sleep quality, poor self-care and low perception of health status during the pandemic.	Male, older age, employed, satisfactory self-care.
Nelson et al. (2020) Canada PLoS One	Quantitative cross-sectional study n=2,065 United states, canada, and Europe residents >18 years, both sexes	To characterize whether current levels of individual transdiagnostic mental health symptoms (i.e., anxiety and depression) are elevated when compared to historical normative data.	Greater concern about COVID-19, greater cases of COVID-19 in the country and in the world, job loss, adherence to strict quarantine recommendations.	Employed, more flexible quarantine measures.
Pandey et al. (2020) India PLoS One	Quantitative cross-sectional study n=1,395 India residents 18-73 years, both sexes	To explore the degree of psychological distress in terms of Depression, Anxiety and Stress among the adult population of India during the mandatory 21-day lockdown.	Female, younger age, single, longer lockdown time, concerns related to disease morbidity and mortality, lower schooling level.	Male, older age, married or divorced, shorter lockdown time, higher schooling level.
Peng et al. (2020) China J Affect Disord	Quantitative cross-sectional study n=2,237 Residents of de Shenzhen, China, with unconfirmed COVID-19 infection 18-70 years, both sexes	To assess the prevalence and clinical correlates of depressive symptoms in the general population quarantined during the COVID-19 outbreak.	Younger age, single, lower schooling level, poor sleep quality.	Older age, married, higher schooling level, good sleep quality.
Becerra-García et al. (2020) Spain Rev. esp. salud publica	Quantitative cross-sectional study n=151 Spain residents 18-76 years, both sexes	To analyze the differences in the psychopathological symptoms of the Spanish population during the COVID-19 quarantine based on sociodemographic, environmental and occupational variables.	Younger age (<35), unemployed, acquaintances and relatives with cOVID-19, not practicing sports, living alone, devoting little time to pandemic information (<30 minutes).	Older age, employed, not having acquaintances and relatives with cOVID-19, practicing sports daily, living with more than two people, dedicating more time to information about the pandemic.
Benke et al. (2020) Germany Psychiatry Res	Quantitative cross-sectional study n=4,335 Germany residents 18-95 years, both sexes	To identify potential predictors for the immediate mental health consequences of the COVID-19 pandemic.	Female, younger age, lower schooling level, unemployed, single, living alone, living without children, current or past psychiatric and psychological treatments, being in self-quarantine, belonging to a COVID-19 risk group, more restrictive public health measures.	Female, advanced age, higher schooling level, formal employment, living with a partner, living with children, not having a history of psychotherapeutic or psychiatric treatment.
Glowacz; Schmits (2020) Belgium Psychiatry Res	Quantitative cross-sectional study n=2,871 Unspecified sample 18-85 years, both sexes	To measure psychological distress related to the cOVID-19 crisis, public health measures for containment and provide health intervention policies.	Younger age, proximity to contamination in young people, social media use overload, intolerance of uncertainty, higher levels of occupational activities in older people.	Older age, tolerance of uncertainty, lower occupational activities in older people.
Pieh et al. (2020) Austria PLoS One	Quantitative cross-sectional study n=1,005 Austria residents >18 years, both sexes	To assess mental health during the COVID-19 lockdown in Austria and the effect of age, gender, income, work, and physical activity.	Female, younger age (adults under 35 years old), people without work, and low income.	Male, older age, economically active, physical activity.
Bu; Steptoe; Fancourt (2020) United Kingdom Public Health	Quantitative cross-sectional study with paired samples before (n=31,064) and during (n=60,341) United Kingdom residents > 18 years, both sexes	To compare sociodemographic predictors of loneliness before and during the COVID-19 pandemic.	Female, young adults, student, people with less education or income, economically inactive, people living alone and residing in urban areas, minority ethnic groups.	Male gender, older age, more educated and economically active people, people who do not live alone, living in rural areas, majority ethnic groups (white).
Paz et al. (2020) Ecuador PLoS One	Quantitative cross-sectional study n=759 Subjects who were part of the epidemiological surveillance program in Ecuador >18 years, both sexes	To identify behaviors during confinement and sociodemographic variables associated with the mental health status of confirmed or suspected COVID-19 patients.	Female, being from the coast of Ecuador.	Engaging in physical activity, having a daily routine, and spending an hour or less daily searching for information.
López-Carral; Grechuta; Verschure (2020) Spain PLoS One	Online experiment and quantitative cross-sectional study n=112 Residents of 17 countries (53.57% in Spain)	To assess the effects of quarantine-induced mood changes, implicitly measured through subjective ratings of emotional stimuli.	Change of routine, negative perception of the current situation, living alone.	Enjoying working from home, living with other people.
Gómez-Salgado et al. (2020) Spain Int. j. environ. res. public health (Online)	Cross-sectional observational study n=4,180 Spain residents >18 years, both sexes	To analyze psychological distress during the cOVID-19 pandemic.	Female, younger age, working outside the home in essential activities during the pandemic, being in quarantine, low health perception, presence of symptoms of cOVID-19, having close contact with someone infected or suspected of being infected.	Female, older age, better health perception, living with children or children under 16 years of age.

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[1] Collaborators

Meirelles TVS (0000-0003-0341-8309)^* * Orcid (Open Researcher and Contributor ID). and Teixeira MB (0000-0003-0088-9420)^* * Orcid (Open Researcher and Contributor ID). equally contributed to the elaboration of the manuscript.