Effects of physical activity and sociodemographic aspects on the mental health of the Brazilian population at different times of the COVID-19 pandemic

  1. Milton José de Azevedo
  2. Gabriel Peinado Costa
  3. André Pereira dos Santos
  4. Marta Camacho-Cardenosa
  5. Eugenio Merellano-Navarro
  6. Javier Brazo-Sayavera
  7. Alba Camacho-Cardenosa
  8. Atila Alexandre Trapé

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Abstract

The objective of this study was to analyze the psychological responses of the Brazilian population and understand their level of anxiety, depression, and stress during different times of the COVID-19 pandemic, as well as how the PA level and sociodemographic aspects may have influenced them. This longitudinal study collected data in two periods: April/May 2020 (T1) at the beginning of the COVID-19 pandemic with restrictions and social distancing indication (during the lockdown), and October/November 2021 (T2) period with fewer restrictions and vaccines available in Brazil (after the lockdown). Data were collected online, including sociodemographic information (age, gender, education), mental health by the Depression, Anxiety, and Stress Scale (DASS-21), and estimated PA levels using the International Physical Activity Questionnaire (IPAQ) short version. Statistical analysis used generalized linear regression models to evaluate the impact of time, sociodemographic aspects, and PA on the risk of depression, anxiety, and stress between periods. Adjusted risk probabilities and Odds Ratio (OR) with 95% confidence intervals (95% CI) were calculated with a 5% significance level. Comparisons between T2 and T1 showed an increased risk for depression (OR=1.48 [95%CI=1.03;2.12]), anxiety (2.66 [1.70;4.17]), and stress (1.95 [1.36;2.79]). Low PA levels were associated with a higher risk of depression (2.08 [1.14;3.82]) and stress (2.03 [1.09;3.80]) but not anxiety in the comparison between T2 and T1. The findings highlight the increased risk for depression, anxiety, and stress in T2 and suggest PA promotion as a possibility for mental health care.

Article activity feed

  1. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/15570851.

    Summary:

    This observational study primarily examined the mental health trends of Brazilians before and after lockdown from COVID-19. Data concerning depression, anxiety, stress, and physical activity(PA) was collected in April-May 2020, called T1, and in October-November 2021, called T2. Data was collected through an online questionnaire sent in T1 to participants from Brazil, Spain, and Chile. A subsequent form was sent in T2 only to Brazilian participants. Analysis attempted to explain data trends with other studies on the social and demographic context of Brazil at the time.

    Strengths:

    • Introduction and abstract clearly demonstrate objectives and relevant context for understanding the study. Overall, the paper is well-organized. 

    • T1 and T2 sample size lend statistical power and generalizability, and the contextual definitions of both periods adds clarity to analysis. 

    Suggestions/Improvements:

    • Abstract

      • Stylistically, the phrase PA should be introduced as "physical activity (PA)" for greater clarity. 

    • Introduction

      • Occasional inclusion of information pertaining to periods such as January 2025 or the 2017 WHO study can be removed as they are not directly relevant to analysis in the COVID-19 time period of the study, However, the inclusion of this information is personal preference. 

    • Methodological procedures

      • A stronger connection is needed between the mention of Google Forms and CHERRIES, as the latter hasn't been sufficiently elaborated upon to show its relevance or application in this context. 

      • The application of STROBE and CHERRIES are not adequately explained; they are merely mentioned. 

      • Both the snowball sampling in T1 and convenience sample in T2 result in a strong sampling bias and low generalizability, despite the sample numbers. A strong justification of benefits in comparison to limitations of these methods would aid this section. This is present in the conclusion, but earlier mention would be more ideal.  

    • Results

      • Although T1 included 3386 participants, T2 only included 1006 participants. This is a significant decrease in participation, and represents a significant source of error and bias in the study.

      • The T2 sample was skewed toward women (66.8%) in comparison to men (33.2%). While this might reflect actual survey response trends, it limits the generalizability of findings to Brazilian men or gender-diverse populations. Furthermore, there might have been a response bias resulting in more women responding than men, skewing the data.

    • Discussion

      • Studies or reviews are mentioned with a citation number. It is preferable to directly name the study or authors or use an (Author Year) in text citation. Additionally, conglomerating citations in this manner increases the difficulty of verifying whether the references are truly supporting the claim. 

      • The study mentions limitations of the convenience sampling method, but does not explain how this was factored into the analysis of research data. 

      • There is mention of "response bias" but more specific examples may enhance detail.

    Competing interests

    The authors declare that they have no competing interests.

  2. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/15571186.

    Does the introduction explain the objective of the research presented in the preprint? Yes
    Are the methods well-suited for this research? Highly appropriate
    Are the conclusions supported by the data? Highly supported
    Are the data presentations, including visualizations, well-suited to represent the data? Highly appropriate and clear
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Very clearly
    Is the preprint likely to advance academic knowledge? Highly likely
    Would it benefit from language editing? No
    Would you recommend this preprint to others? Yes, it's of high quality
    Is it ready for attention from an editor, publisher or broader audience? Yes, as it is

    Competing interests

    The authors declare that they have no competing interests.

  3. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/15359331.

    This review is the result of a virtual, collaborative live review discussion organized and hosted by PREreview as part of the PREreview Champions Program 2025 on April 9, 2025. The discussion was joined by 6 people: 3 facilitators and 3 members of the PREreview 2025 Champions Program cohort. We thank all participants who contributed to the discussion and made it possible for us to provide feedback on this preprint. The authors of this review have dedicated additional asynchronous time over the course of three weeks to help compose this final report using the notes from the Live Review. 

    Summary

    The study aimed to investigate the effectiveness of physical activity (PA) in mitigating depression and stress in the Brazilian population during different phases of COVID-19 pandemic, while also examining sociodemographic influences. Using a longitudinal approach, the researchers administered online questionnaires to the same cohort at two time points during the peak of lockdown and post-lockdown. Generalized linear model of regression and odds ratio were employed to assess changes in mental health risks. The findings revealed that depression and anxiety risks were higher during the peak of the pandemic period compared to post-lockdown, with individuals engaging in lower physical activity showing the greatest increase in mental health risks over time. Women exhibited higher baseline risks for all three conditions, though odds ratios did not significantly differ for men. A key strength of the study was its repeated measures design, allowing for direct comparison across pandemic phases. However, the limitations include potential sampling bias due to participant attrition between surveys and reliance on self-reported online data, which may introduce recency and trust biases. This study underscores the potential of PA as a mental health intervention while highlighting the need for further research on sociodemographic disparities.

    List of major concerns and feedback

    The manuscript presents several methodological and analytical areas for improvement that require attention. 

    • The absence of p-values for significant determinants limits the interpretation of results, although confidence intervals (CIs) may be sufficient.

    • The reviewers recommend applying tests such as the Student's t-test to compare mean differences in anxiety, depression, and stress between periods, after verifying normality.

    • The sample overrepresents university- educated individuals, women, and the younger population, limiting generalizability to the broader brazilian population.

    • The reliance on online questionnaires excludes those without internet access, introducing selection bias.

    • Although the code is available, the language of the survey is not specified, nor is the questionnaire attached in the appendix, both of which are crucial for replicating the study

    • The study does not formally test PA as a mediator between pandemic phases and mental health outcomes.

    • Including graphs and figures illustrating PA as a mediating factor could be useful in summarizing the effect of physical activity overall.

    List of minor concerns and feedback

    • No graphs illustrate key relationships (e.g., to illustrate the mediating role of physical activity in depression) making the results harder to interpret. 

    • Although the limitations of online sampling in the context of COVID-19 are mentioned, it would be valuable to attach the consent form and clarify in the abstract that "PA" refers to physical activity

    • The title implies the findings apply to all Brazilians, but the sample is non-representative 

    • No summary statistics (mean, SD) for mental health score for T1 and T2 groups 

    • It is recommended to include comparative figures between T1 and T2, as well as data distributions. 

    • Finally, it is suggested to moderate statements regarding external factors (e.g., government management) with stronger bibliographic support.

    We thank the authors of the preprint for posting their work openly for feedback. We also thank all participants of the Live Review call for their time and for engaging in the lively discussion that generated this review.

    Competing interests

    The authors declare that they have no competing interests.

  4. Version published to 10.1590/scielopreprints.11373 on SciELO Preprints