Prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence and hazardous alcohol drinking: a population-based study in the Brazilian Amazon

Abstract

The burden of mental health disorders is high and may be particularly alarming in developing countries. We assessed the prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence, and hazardous alcohol drinking in the Brazilian Amazon. Cross-sectional population-based study conducted in Manaus in 2019 with adults selected by probabilistic sampling. Depressive symptoms were measured by the PHQ-9 instrument (cut-off ≥9) and anxiety symptoms by the GAD-7 scale (cut-off ≥10). Prevalence ratios (PRs) of depressive and anxiety symptoms were calculated by Poisson regression with robust variance with 95% confidence intervals (CI) following a hierarchical model. Partial least squares structural equation modeling was used to investigate the relationship between the outcomes and risk behaviors. Out of the 2,321 participants, 24.3% (95%CI 22.2-26.5%) had depressive and 21.6% (95%CI 19.6-23.7%) had anxiety symptoms. Depressive symptoms were more frequent in women (PR=1.32; 95%CI 1.08-1.61), lower social class (PR=1.59; 95%CI 1.11-2.27), life-threatening events (PR=2.66; 95%CI 2.00-3.54), tobacco dependence (PR=1.84; 95%CI 1.37-2.47), worse health statuses (p<0.001), and chronic diseases (PR=1.63; 95%CI 1.33-2.00), but were lower in older adults (p=0.014). Anxiety symptoms were higher in women (PR=1.74; 95%CI 1.42-2.14), lower educational levels (PR=2.19; 95%CI 1.38-3.47), evangelical individuals (PR=1.28; 95%CI 1.05-1.57), having no religion (PR=1.72; 95%CI 1.24-2.38), life-threatening events (PR=3.26; 95%CI 2.41-4.41), tobacco dependence (PR=1.53; 95%CI 1.09-2.16), worse health statuses (p<0.001), and chronic diseases (PR=1.77; 95%CI 1.40-2.25). Depressive symptoms, anxiety symptoms, and life-threatening events were directly correlated with one another, while tobacco dependence and hazardous alcohol drinking were significantly intercorrelated (p<0.05). Cross-sectional design limits the assessment of causality. Recall bias was possible as responses were self-reported. GAD-7 scale was not validated in the Brazilian population. Nearly a quarter of the population had depressive symptoms and one-fifth presented anxiety symptoms, which were associated with socioeconomic, behavioral, and health-related factors. Implementation of social well-being policies is required to minimize the burden of mental health disorders in the Amazonian population.