Covid-19-related stressors and mental disorders and distress: A cross-sectional, nationally-representative, face-to-face survey in Serbia

Aim. The Covid-19 pandemic may be associated with an increase in mental disorders and mental distress. However, there are no representative studies testing the impact of stressors directly related to Covid-19. We aimed to determine whether Covid-19 related stressors were associated with mental disorders and mental distress in the second year of the pandemic.Method. This cross-sectional observational epidemiological survey was conducted from June to October 2021. We interviewed a representative sample of the adult population in Serbia (18-65 years) in the second year of the pandemic, at a time when large parts of the population had been affected by the pandemic in different ways. Multistage probabilistic household sampling of the adult population in 60 municipalities was used. Mental disorders were assessed by in-person interviews using the Mini International Neuropsychiatric Interview and depression and anxiety symptoms were self-rated on the PHQ-9 and GAD-7. Covid-19 related stressors i.e., infection, self-isolation, infection of a close relative, and lack of protective equipment at work, as well as stressors during the pandemic that were not directly Covid-19 related were measured. Associations of potential predictor variables with mental disorders and mental distress were explored through univariable and multivariable regression analyses.Results. In total, 1023 individuals (mean age 43.7±13.6 years, 48.7% male) were interviewed. Most respondents (67.8%) of the sample had already experienced Covid-19 related stressors (20.1% had Covid-19 infection; 43.2% had a close relative member who had Covid-19; 28.1% had to work without appropriate protection; 27.5% had been in quarantine themselves) and about 50% had already been vaccinated. The prevalence of any mental disorder was 15.2% (95% CI 13.2–17.2): mood disorders 4.6%, anxiety disorders 4.3% and substance use disorders 8.0%. Mean levels of distress were: PHQ-9=3.2±3.8; GAD-7=2.1±3.1. A lack of protective equipment was associated with higher levels of any disorder, anxiety disorders, and anxiety symptoms. No other Covid-19 related stressor predicted mental disorders or mental distress.Conclusions. In this study, lack of personal protective equipment for Covid-19 when it would have been appropriate was associated with higher levels of anxiety and a greater frequency of anxiety disorders. Provision of the appropriate equipment at workplaces is likely to prevent lasting increased levels of anxiety. There is no evidence that the prevalence of mental disorders in the second year was elevated.