Salud Mental

Meta-worry, anxiety, and depression in the coronavirus 2019 (COVID-19) pandemic: Brazil, June 2020


Luana Cristina Silva-Santos
Maísa Carvalho Silva
André Faro


Introduction. Threats to mental health and psychological well-being have been considered among the most challenging dimensions to deal with the COVID-19 pandemic.

Objective. To track the occurrence of significant anxiety and depression symptoms and the level of worry among residents in Brazil in June 2020.

Method. The final sample totaled 4,805 participants from all Brazilian states. A sociodemographic and health questionnaire (with questions related to COVID-19), the translated versions of the Meta-Worry Questionnaire, and the 4-item Patient Health Questionnaire (PHQ-4) were used. Inferential analyses were computed using the Multinomial Logistic Regression (backward stepwise) in which the PHQ-4 findings were stratified into four categories: no symptoms, only anxiety symptoms, only depression symptoms, and both symptoms.

Results. Research findings have shown that there are characteristics that predict greater exposure to significant symptoms of anxiety and depression (gender, age, and level of worry), with level of worry being the variable with the greatest impact on the model.

Discussion and conclusion. These data found during the COVID-19 pandemic intra-crisis period allow for early prediction of the negative outcomes associated with the pandemic, such as common mental disorders, and allocating interventions to help people to rationally deal with the stress related to this moment, regulating their emotions, and improving their overall mental health.
Meta-worry, common mental disorders, COVID-19, pandemics, mental health


Download data is not yet available.


Adams, S. H., Park, M. J., Schaub, J. P., Brindis, C. D., & Irwin Jr., C. E. (2020). Medical vulnerability of young adults to severe COVID-19 illness—Data from the National Health Interview Survey. Journal of Adolescent Health, 67(3), 362-368. doi: 10.1016/j.jadohealth.2020.06.025

Barrucho, L. (2020). Brasil: O novo epicentro da pandemia de coronavírus? BBC News. Retrieved from

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, 395(10227), 912-920. doi: 10.1016/S0140-6736(20)30460-8

Caetano, R., Silva, A. B., Guedes, A. C. C. M., Paiva, C. C. N. de, Ribeiro, G. da R., Santos, D. L., & Silva, R. M. da. (2020). Desafios e oportunidades para telessaúde em tempos da pandemia pela COVID-19: uma reflexão sobre os espaços e iniciativas no contexto brasileiro. Cadernos de Saúde Pública, 36(5), e00088920. doi: 10.1590/0102-311X00088920

Choi, E. P. H., Hui, B. P. H., & Wan, E. Y. F. (2020). Depression and anxiety in Hong Kong during COVID-19. International Journal of Environmental Research and Public Health, 17(10), 3740. doi: 10.3390/ijerph17103740

Conselho Nacional de Saúde. (2020). Recomendação Nº 36, de 11 de maio de 2020. Conselho Nacional de Saúde. Retrieved from

Dinis, A., & Gouveia, J. P. (2011). Estudo das características psicométricas da versão portuguesa do Questionário de Metacognições - versão reduzida do Questionário de Meta-preocupação. Psychologica, 54, 281-307. doi: 10.14195/1647-8606_54_11

Ettman, C. K., Abdalla, S. M., Cohen, G. H., Sampson, L., Vivier, P. M., & Galea, S. (2020). Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Network Open, 3(9), e2019686. doi: 10.1001/jamanetworkopen.2020.19686

Faro, A., Bahiano, M. de A., Nakano, T. de C., Reis, C., Silva, B. F. P. da, & Vitti, L. S. (2020). COVID-19 e saúde mental: a emergência do cuidado. Estudos de Psicologia (Campinas), 37, e200074. doi: 10.1590/1982-0275202037e200074

Faro, A., Silva-Santos, L. C., Silva, M. C., & Vasconcelos, M. M. (2021). Metapreocupação, ansiedade e depressão na pandemia da COVID-19. Scielo Preprints. doi: 10.1590/SciELOPreprints.2436

Galhardi, C. P., Freire, N. P., Minayo, M. C. de S., & Fagundes, M. C. M. (2020). Fato ou Fake? Uma análise da desinformação frente à pandemia da Covid-19 no Brasil. Ciência & Saúde Coletiva, 25(Sup. 2), 4201-4210. doi: 10.1590/1413-812320202510.2.28922020

Garcia, L. P., & Duarte, E. (2020). Infodemia: Excesso de quantidade em detrimento da qualidade das informações sobre a COVID-19. Epidemiologia e Serviços de Saúde, 29(4), e2020186. doi: 10.1590/s1679-49742020000400019

Hou, W. K., Lee, T. M.-C, Liang, L., Li, T. W., Liu, H., Ettman, C. K., & Galea, S. (2021). Civil unrest, COVID-19 stressors, anxiety, and depression in the acute phase of the pandemic: a population-based study in Hong Kong. Social Psychiatry and Psychiatric Epidemiology, 56(8), 1499-1508. doi: 10.1007/s00127-021-02037-5

International Labour Organization. (2020). ILO Monitor: COVID-19 and the world of work, Sixth Edition. Retrieved from

Jia, R., Ayling, K., Chalder, T., Massey, A., Broadbent, E., Coupland, C., & Vedhara, K. (2020b). Mental health in the UK during the COVID-19 pandemic: cross-sectional analyses from a community cohort study. BMJ Open, 10(9), e040620. doi: 10.1136/bmjopen-2020-040620

Jia, R., Ayling, K., Chalder, T., Massey, A., Broadbent, E., Morling, J. R., … Vedhara, K. (2020a). Young people, mental health and COVID-19 infection: the canaries we put in the coal mine. Public Health, 189, 158-161. doi: 10.1016/j.puhe.2020.10.018

Jiloha, R. C. (2020). COVID-19 and Mental Health. Epidemiology International, 5(1), 7-9. doi: 10.24321/2455.7048.202002

Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: The PHQ–4. Psychosomatics, 50(6), 613-621. doi: 10.1016/S0033-3182(09)70864-3

Lam, M. H.-B., Wing, Y.-K., Yu, M. W.-M., Leung, C.-M., Ma, R. C., Kong, A. P., … Lam, S.-P. (2009). Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: Long-term follow-up. Archives of Internal Medicine, 169(22), 2142-2147. doi: 10.1001/archinternmed.2009.384

Li, J., Yang, Z., Qiu, H., Wang, Y., Jian, L., Ji, J., & Li, K. (2020). Anxiety and depression among general population in China at the peak of the COVID-19 epidemic. World Psychiatry, 19(2), 249-250. doi: 10.1002/wps.20758

Ministério da Saúde. (2020a). Boletim Epidemiológico 16: Doença pelo Coronavírus COVID-19. Secretaria de Vigilância em Saúde. Retrieved from

Ministério da Saúde. (2020b). Boletim Epidemiológico 20: Doença pelo Coronavírus COVID-19. Secretaria de Vigilância em Saúde. Retrieved from

Ministério da Saúde. (2020c). Boletim Epidemiológico 24: Doença pelo Coronavírus COVID-19. Secretaria de Vigilância em Saúde. Retrieved from

Ministério da Saúde. (2020d). Boletim Epidemiológico 43: Doença pelo Coronavírus COVID-19. Secretaria de Vigilância em Saúde. Retrieved from

Ministério da Saúde. (2021). Boletim Epidemiológico 48: Doença pelo Coronavírus COVID-19. Secretaria de Vigilância em Saúde. Retrieved from

Pan American Health Organization [PAHO]. (2020). Entenda a infodemia e a desinformação na luta contra a COVID-19. Retrieved from

Pan, K.-Y., Kok, A. A. L., Eikelenboom, M., Horsfall, M., Jörg, F., Luteijn, R. A., Rhebergen, D., … Penninx, B. W. J. H. (2021). The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts. The Lancet Psychiatry, 8(2), 121-129. doi: 10.1016/S2215-0366(20)30491-0

Paz, C., Mascialino, G., Adana-Díaz, L., Rodríguez-Lorenzana, A., Simbaña-Rivera, K., Gómez-Barreno, L., … Ortiz-Prado, E. (2020). Anxiety and depression in patients with confirmed and suspected COVID-19 in Ecuador. Psychiatry and Clinical Neurosciences, 74(10), 554-555. doi: 10.1111/pcn.13106

Pereira, M. D., Oliveira, L. C. de, Costa, C. F. T., Bezerra, C. M. de O., Pereira, M. D., Santos, C. K. A. dos, & Dantas, E. H. M. (2020). A pandemia de COVID-19, o isolamento social, consequências na saúde mental e estratégias de enfrentamento: uma revisão integrativa. Research, Society and Development, 9(7), e652974548. doi: 10.33448/rsd-v9i7.4548

Riecher-Rössler, A. (2017). Sexand gender differences in mental disorders. The Lancet Psychiatry, 4(1), 8-9. doi: 10.1016/S2215-0366(16)30348-0

Rodríguez-Rey, R., Garrido-Hernansaiz, H., & Collado, S. (2020). Psychological impact and associated factors during the initial stage of the coronavirus (COVID-19) pandemic among the general population in Spain. Frontiers in Psychology, 11, 1540. doi: 10.3389/fpsyg.2020.01540

Salari, N., Hosseinian-Far, A., Jalali, R., Vaisi-Raygani, A., Rasoulpoor, S., Mohammadi, M., … Khaledi-Paveh, B. (2020). Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Globalization and Health, 16, 57. doi: 10.1186/s12992-020-00589-w

Seco Ferreira, D. C., Oliveira, W. L., Delabrida, Z. N. C., Faro, A., & Cerqueira-Santos, E. (2020). Intolerance of uncertainty and mental health in Brazil during the Covid-19 pandemic. Suma Psicológica, 27(1), 62-69. doi: 10.14349/sumapsi.2020.v27.n1.8

Shah, S. M. A., Mohammad, D., Qureshi, M. F. H., Abbas, M. Z., & Aleem, S. (2021). Prevalence, psychological responses and associated correlates of depression, anxiety and stress in a global population, during the Coronavirus Disease (COVID-19) pandemic. Community Mental Health Journal, 57, 101-110. doi: 10.1007/s10597-020-00728-y

Wang, P.-W., Ko, N.-Y., Chang, Y.-P., Wu, C.-F., Lu, W.-H., & Yen, C.-F. (2020). Subjective deterioration of physical and psychological health during the COVID-19 pandemic in Taiwan: Their association with the adoption of protective behaviors and mental health problems. International Journal of Environmental Research and Public Health, 17(18), 6827. doi: 10.3390/ijerph17186827

Wells, A. (2005). The metacognitive model of GAD: Assessment of meta-worry and relationship with DSM-IV generalized anxiety disorder. Cognitive Therapy and Research, 29, 107-121. doi: 10.1007/s10608-005-1652-0

Wells, A. (2010). Metacognitive theory and therapy for worry and generalized anxiety disorder: Review and status. Journal of Experimental Psychopathology, 1(1), 133-145. doi: 10.5127/jep.007910

Wilson, J. M., Lee, J., Fitzgerald, H. N., Oosterhoff, B., Sevi, B., & Shook, N. J. (2020). Job insecurity and financial concern during the COVID-19 pandemic are associated with worse mental health. Journal of Occupational and Environmental Medicine, 62(9), 686-691. doi: 10.1097/JOM.0000000000001962

Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M. W., Gill, H., Phan, L., Chen-Li, D., … McIntyre, R. S. (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of Affective Disorders, 277, 55-64. doi: 10.1016/j.jad.2020.08.001

Zhao, N., & Zhou, G. (2020). Social media use and mental health during the COVID‐19 pandemic: Moderator role of disaster stressor and mediator role of negative affect. Applied Psychology: Health and Well‐Being, 12(4), 1019-1038. doi: 10.1111/aphw.12226