Covid-19-related stressors, mental disorders, depressive and anxiety symptoms: 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, depressive and anxiety symptoms 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. A 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. Depressive and anxiety symptoms were measured by PHQ-9 and GAD-7 scales. Covid-19-related stressors (Sars-CoV-2 infection, the infection of a close relative, self-isolation and lack of protective equipment at work), as well as other stressors during the pandemic (not directly related to the risk of the infection), were measured. The associations with mental disorders, depressive and anxiety symptoms were explored through univariable and multivariable regression analyses. RESULTS: In total, 1203 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 Sars-CoV-2 infection; 43.2% had a close relative member who had Covid-19; 28.2% reported lack of appropriate protection; 27.5% had been quarantined) 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 PHQ-9 was 3.2 ± 3.8 and GAD-7 was 2.1 ± 3.1. In this study, one Covid-19 stressor, i.e. lack of protective equipment, was weakly associated with a greater frequency of anxiety disorders (p = 0.023), while the other stressors had significant associations with several groups of mental disorders and symptom levels. CONCLUSIONS: Our study did not provide any evidence that the prevalence of mental disorders exceeds the range of pre-pandemic data reported in the literature. Covid-related stressors, although frequently reported, did not dramatically influence the prevalence of mental disorders. The provision of the appropriate equipment at workplaces might lead to the reduction of anxiety disorders.

The Serbian COVID-19 Stress Scale and vaccine acceptance: is there a place for COVID-19-related distress in explaining attitudes towards vaccination?

OBJECTIVES: Previous research has shown that the COVID-19 Stress Scale (CSS), a measure assessing various dimensions of distress related to the COVID-19 pandemic, is associated with self-protective behaviours; however, it remains unknown whether this distress can be used to predict attitudes towards vaccination. The purpose of this study was to validate the Serbian CSS (Serbian-CSS) and to explore its predictive power over and above certain sociodemographic characteristics, individual difference variables (attitudes and personality) and general distress in relation to COVID-19 vaccine acceptance. STUDY DESIGN: An online cross-sectional study was conducted that targeted users of different social network groups at the beginning of the public COVID-19 vaccination programme in Serbia. METHODS: A large, online study sample (N = 3129) provided self-reported data on COVID-19-related distress, health and sociodemographic indicators, individual difference variables and attitudes towards vaccination. RESULTS: The Serbian-CSS is a valid and reliable instrument that assesses six dimensions of COVID-19 distress. The strongest predictors of vaccine acceptance were attitudes towards immigrants (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [CI] 0.31, 0.41), followed by education (AOR = 1.51, 95% CI 1.27, 1.88) and prepandemic mental health issues (AOR = 1.61, 95% CI 1.30, 2.01). CONCLUSIONS: The level of distress measured by the CSS had a non-substantial contribution to vaccine acceptance, which is probably because of the mild level of distress that was observed at the time of assessment. Public health messaging that relies on the distribution of information is not sufficient to address strongly held beliefs against vaccination. The study provides a benchmark for future cross-cultural research regarding negative affective states associated with the COVID-19 pandemic.