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Rev. bras. psicoter. 2022; 24(2):115-122

Comunicaçao breve

O impacto da pandemia da COVID-19 na Qualidade de Vida em residentes locais no sul do Brasil

The impact of the COVID-19 pandemic on Quality of Life among Local Residents in south of Brazil

El impacto de la pandemia COVID-19 en la Calidad de Vida de los residentes locales en el sur de Brasil

Joana Bücker, Letícia Sanguinetti Czepielewski

Resumo

Abstract

Resumen

 

 

INTRODUCTION

The COVID-19 pandemic resulted in an impact on the daily life routine in most people around the world. Despite the efforts to contain the virus, unfortunately, a significant and growing number of deaths has been reported in all continents, and Brazil is being severely affected by the COVID-19 transmission¹. Local governments everywhere adopted some type of social distancing as a way to prevent the spread of the virus. The impact of this restrictive measure, especially in the early stage of the pandemic, when feelings of uncertainty and fear of becoming infected prevailed, resulted in higher levels of psychiatric symptoms, economic crisis, and negative effects on the quality of life (QoL)².

The studies about QoL - which is the "individual's perception of their position in life in the context of the culture in which they live and in relation to their goals, expectations, standards and concerns''³ - during pandemic suggest differences between countries. Developing nations, with compromised health structures, have been greatly affected^2,4. Few studies link the current pandemic to reduced QoL in Brazil^5,6. These studies indicated that females, lower educational levels, testing positive for COVID-19, and unemployed participants showed worse QoL, as well as higher rates of QoL were associated with less depressive symptoms. However, Brazil is a continental country, with differences in culture, socioeconomic levels, and patterns of social isolation measures. Knowing that these characteristics may influence QoL, it is important to evaluate this construct in a more homogeneous population to reduce possible confounders.

Therefore, we aim to assess the impact of COVID-19 pandemic on QoL in a region in the South of Brazil called "Vale do Taquari", during the initial stage of the COVID-19 outbreak. This population has similar culture, socioeconomic status, and social distance policies adopted by the local governments, as well as high rates of contamination^7,8. More specifically, we aimed to: i) describe QoL of participants; ii) investigate the relationship between QoL and sociodemographic, pandemic related, and psychological symptoms variables; and iii) explore which variables contribute most to the likelihood that participants have better QoL. Particular attention will be given to the physical, psychological, social, and environmental domains of QoL.


METHODS

Participants comprised 325 individuals from "Vale do Taquari'' in Rio Grande do Sul, Brazil. The project was approved by the local ethics' committee (CAAE number 34754020.2.0000.5310) and all participants provided electronic informed consent. The subjects were drawn from an online questionnaire, builded in the Google Forms Platform and conducted between August and September/2020. Evaluations included clinical and sociodemographic variables, and the following instruments: Depression, Anxiety and Stress Scale-21 (DASS21)⁹, The Pittsburgh Sleep Quality Index (PSQI)¹⁰, and The World Health Organization quality of life assessment (WHOQOL-bref) with four domains (physical, psychological, social relationships, and environment)¹¹. Statistical analyses were completed in Statistical Package for the Social Sciences (SPSS v20). We first described participants' characteristics. Then, we investigated the magnitude of the relationships between QoL and sociodemographic, pandemic related, and psychological symptoms variables. Finally, we conducted linear logistic regressions with the backwards method based on the probability of the Wald statistic to explore the likelihood that participants had better QoL in each specific QoL domain. Participants were considered to have better QoL if scored 3 or 4 on each domain ("good" and "very good" according to the WHOQOL-bref guideline). Significance was set at p < 0.05, 2-tailed.


RESULTS

Sample characteristics are described in Table 1. Overall quality of life was correlated with age (r=0.232,p<0.001), years of study (r=0.189,p=0.001), depressive symptoms (r=-0.65,p=<0.001), anxiety symptoms (r=-0.49,p<0.001), stress symptoms (r=-0.51,p<0.001), and sleep quality (r=-0.54,p<0.001). Further, overall QoL was also correlated with experiencing stressful situations during the pandemic (r=0.252,p<0.001).

Similar relationships were found for QoL domains (Table 2).




In order to investigate which variables contributed most to the likelihood that participants have better QoL, we conducted four separate logistic regression models with backwards method to ascertain the effects of age, sex, education, psychological symptoms, sleep quality, experiencing stressful situations during the pandemic, and social isolation duration on the likelihood that participants had better QoL in each specific domain.

The model predicting physical QoL was statistically significant (X²(2)=7.163,p=0.028), however, there were no significant main effects of the predictors.

The model predicting psychological QoL was statistically significant (X²(3)=127.382,p<0.001) and explained 46.4% (Nagelkerke R²) of the variance, correctly classifying 79.4% of cases. In this model, better sleep quality (Odds ratio=0.841 [95%CI.769,0.919],ß=-0.174,S.E.=0.046,Wald=14.482,p<0.001) and reduced psychological symptoms (Odds ratio=0.913 [95%CI0.908,0.955],ß=-0.071,S.E.=0.013,Wald=30.444,p<0.001) were associated with increased psychological QoL.

The model predicting social relationships' QoL was statistically significant (X²(4)=49.316,p<0.001) and explained 20.2% (Nagelkerke R²) of the variance, correctly classifying 64.0% of cases. In this model, better sleep quality (Odds ratio=0.906 [95%CI0.841,0.975],ß=-0.099,S.E.=0.038,Wald=6.839,p=0.009), reduced psychological symptoms (Odds ratio=0.968 [95%CI0.951,0.985],ß=-0.033,S.E.=0.009,Wald=13.135,p<0.001), and shorter social isolation duration (Odds ratio=0.994 [95%CI0.989,0.999],ß=-0.006,S.E.=0.002, Wald=6.603,p=0.010) were associated with increased social relationships' QoL.

The model predicting environmental QoL was statistically significant (X²(4)=51.859,p<0.001) and explained 23.2% (Nagelkerke R²) of the variance, correctly classifying 76.2% of cases. In this model, not experiencing stressful situations during the pandemic (Odds ratio=0.428 [95%CI0.224,0.817],ß=-0.849,S.E. =0.330,Wald=6.613,p=0.010), higher education (Odds ratio=1.206 [95%CI1.069,1.361], ß=-0.187,S.E.=0.062, Wald=9.243,p=0.002), better sleep quality (Odds ratio=0.882 [95%CI0.818,0.951], ß=-0.126, S.E.=0.038, Wald=10.713,p=0.001), and older age (Odds ratio=1.026 [95%CI 1.005,1.047],ß=0.025,S.E.=0.010,Wald=5.924, p=0.015) were associated with increased environmental QoL.


DISCUSSION

We assessed quality of life (QoL) domains of participants from a particular region of Brazil and investigated their relationships to sociodemographic, psychological, and pandemic related factors. The domains of physical, psychological, social relationships, and environmental QoL were differently impacted, bringing interesting perspectives regarding the possible outcomes of the pandemic to QoL.

Our results indicated an overall regular QoL of participants during the early stages of the COVID-19 pandemic, however around 40% of individuals showed reduced physical, psychological, and social relationships QoL. The environmental domain seemed to be the least impacted, with only 26.9% of participants reporting reduced QoL. These results are in line with previous studies¹². Higher age and educational level were associated with a better perception of QoL, except for the social relationships' domain, which is supported by a similar study that suggested younger adults as the most psychologically fragile subjects in the context of the pandemic⁵.

Reduced psychological symptoms and better sleep quality showed main effects for increased psychological QoL. Conversely, characteristics related to pandemic, such as social isolation duration or perceived stress during the pandemic, were not. Thus, there might not be a direct effect of the pandemic in this domain, but rather a consequence of a prior vulnerability to mental disorders, as suggested in previous studies¹³. We further found that less psychological symptoms and better sleep quality were also related to social relationships' QoL. Moreover, we found that a shorter duration of social isolation was a significant predictor of this domain. Previous studies showed that social connectedness is a direct predictor of QoL during the COVID-19 pandemic¹⁴. Therefore, those who have not been in social isolation for a long period of time may have had more social contact and increased their perception of QoL in this domain. Interestingly, increased environmental QoL was associated with not experiencing stressful situations during the pandemic, higher education, and older age. This result suggests that a lower educational level may impact well-being, hindering access to paid work and economic resources, which may lead to a reduced sense of control over one's life, resulting in perceived stress and worse sleep quality¹⁵.

Our results must be interpreted in light of limitations. We had a smaller sample size compared to previous studies⁵, which comprised mostly females (75.4%). Further, we did not measure social and family support, that might be important to QoL during pandemic times. Nonetheless, this report is noteworthy in several respects. It is the first study that investigated QoL in a specific region with similar culture and strategies to face the pandemic. The clinical relevance of these results suggests that more attention needs to be paid to vulnerable groups identified in this study, implementing psychological interventions for vulnerable individuals who cope with the long-term consequences of this pandemic. Our results also could be used as a historical reference and help assist local authorities to define future intervention strategies, since we will probably need to deal with the deleterious effects of the pandemic even after its complete control.


CONCLUSIONS

Therefore, we showed that mental health factors, as expected, were significantly related to QoL, mainly to psychological and social relationships' domains. Thus, improving overall mental health might lead to important outcomes for the individual's psychological wellness. However, there might be consequences to QoL that will only be managed once the pandemic is controlled and life returns to some type of "normality", more specifically to the subject's satisfaction with their social relationships and environment.


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^aUniversidade do Vale do Taquari, Programa de Pós-graduação em Ciências Médicas - Lajeado/RS - Brasil
^bUniversidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Psicologia - Porto Alegre/RS - Brasil

Corresponding author

Joana Bücker
joana.bucker@gmail.com

Submitted in: 04/12/2021
Accepted in: 12/09/2022

Conflicts of Interest: The authors declare no conflict of interest.

Individual contributions: Joana Bücker was responsible for the conception and design of the study; Joana Bücker and Letícia Czepielewski were responsible for participants inclusion; Letícia Czepielewski was responsible for management and statistical analysis; Letícia Czepielewski and Joana Bücker were responsible for the interpretation of data and writing of the report. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship who are not listed.

 

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