Mental Health of Psychology Professionals and Students in Brazil: A Comparative AnalysisAbstract:
University students and health professionals have a higher prevalence of psychological distress compared to the general population. This study aims to investigate the prevalence of symptoms of anxiety, depression, stress, and quality of life in Brazilian psychology professionals and students and to verify whether there are differences in the intensity of symptoms between the two samples. A total of 2,324 individuals answered a sociodemographic questionnaire, the WHOQOL-Bref quality of life assessment instrument, and the Depression, Anxiety & Stress Scale. The results revealed a high prevalence of symptoms of depression (50%) and anxiety (45.8%) among psychology students, values more than two times higher than those observed in professionals, of whom 20% reported symptoms of depression and 12.7% of anxiety. Both groups reported a satisfactory level (above 80 points) of overall quality of life. The study concludes that targeted self-care interventions are essential for these groups that take care of the mental health of the population.
Keywords:
anxiety; depression; quality of life; psychologists; college students
Resumo:
Universitários e profissionais da saúde apresentam maior prevalência de sofrimento mental em comparação à população geral. Este estudo objetivou investigar a prevalência de sintomas de ansiedade, depressão, estresse e qualidade de vida em profissionais e estudantes de psicologia brasileiros e verificar se há diferenças na intensidade dos sintomas entre as duas amostras. Participaram 2.324 indivíduos, que responderam a um questionário sociodemográfico, ao instrumento de avaliação da qualidade de vida WHOQOL-Bref e à Depression, Anxiety & Stress Scale. Os resultados revelaram uma alta prevalência de sintomas de depressão (50%) e ansiedade (45,8%) entre os estudantes de psicologia, valores mais de duas vezes superiores aos observados nos profissionais, dos quais 20% relataram sintomas de depressão e 12,7% de ansiedade. Ambos os grupos relataram um nível satisfatório (acima de 80 pontos) de qualidade de vida geral. Conclui-se que intervenções direcionadas ao autocuidado são essenciais esses grupos que cuidam da saúde mental da população.
Palavras-chave:
ansiedade; depressão; qualidade de vida; psicólogos; estudantes universitários
Resumen:
Los estudiantes universitarios y los profesionales de la salud presentan una prevalencia más alta de problemas mentales en comparación con la población general. Este estudio investigó la prevalencia de los síntomas de ansiedad, depresión, estrés y calidad de vida entre profesionales y estudiantes de psicología en Brasil, además de verificar si estos síntomas presentan diferencias de intensidad en estas dos muestras. Participaron 2.324 individuos, quienes respondieron a un cuestionario sociodemográfico, al instrumento de evaluación de la calidad de vida WHOQOL-Bref y a la Escala de Depresión, Ansiedad y Estrés. Los resultados mostraron una alta prevalencia de síntomas de depresión (50%) y ansiedad (45,8%) entre los estudiantes de psicología más del doble que en los profesionales, de los cuales el 20% reportó depresión; y el 12,7%, ansiedad. Ambos grupos informaron un nivel satisfactorio (mayor de 80 puntos) de calidad de vida general. Se concluye que las intervenciones dirigidas al autocuidado son esenciales para estos grupos que cuidan de la salud mental de la población.
Palabras clave:
ansiedad; depresión; calidad de vida; psicólogos; estudiantes universitarios
Mental health problems are prevalent in the general population, with anxiety and depression disorders being the most common and disabling, generating high costs and causing absence from work (Santomauro et al., 2021 ; World Health Organization [WHO], 2022a ). According to estimates from the Global Burden of Disease study, the COVID-19 pandemic significantly impacted the psychological well-being of people worldwide, evidenced by the increase of 27.6% in cases of major depressive disorder and 25.6% in cases of anxiety disorders in 2020 (Santomauro et al., 2021 ). These data highlight the relevance of in-depth interventions and studies to understand and mitigate these symptoms in different populations.
Among the groups affected by the high global incidence of mental disorders, university students stand out as one of the most affected worldwide, especially regarding mood, anxiety, and substance use disorders (Auerbach et al., 2018 ). The World Mental Health International College Student (WMH-ICS) evaluated 1,572 students in 21 countries and found that about a fifth (20.3%) of all students reported a history of at least one psychological disorder in the past 12 months (Auerbach et al., 2016 ). In another research by the WMH-ICS, 31% of the 13,984 students evaluated in eight countries reported the presence of some common mental disorder (CMD) in the past 12 months (Auerbach et al., 2018 ). Even before the COVID-19 pandemic, university students already had higher rates of CMD symptoms compared to the general population and other specific audiences, such as motorcyclists and health professionals (Lopes et al., 2022 ).
Especially regarding the COVID-19 pandemic period, the systematic review with meta-analysis by Robinson et al. ( 2022 ) analyzed longitudinal studies that compared symptoms of anxiety, depression, stress, functioning, and well-being before and during the pandemic, in the general population and in specific audiences, such as university students and people with some mental and physical health conditions. The results showed a worsening of mental health symptoms — mainly depression and anxiety — in the general population (with small effect sizes), but this worsening was not found among university students (Robinson et al., 2022 ; WHO, 2022a ).
The high prevalence of psychological disorders not only affects students, but also health professionals, including physicians, nurses, psychologists, social workers, among others. A study involving 258 health professionals showed that 25.2% of employees of Psychosocial Community Health Centers (CAPS) and 48.6% of Community Health Workers had symptoms of CMD (Knuth et al., 2015 ). This incidence can be explained by the work environment of these professionals, in which they deal with stressful demands, extensive workloads, emotional mobilization, low wages, precarious infrastructure, among other issues (Pimenta & Rodriguez, 2021 ). One likely hypothesis was that these problems would have worsened during the COVID-19 pandemic. However, at the international level, a meta-analysis of cross-sectional studies on the prevalence of anxiety and depression symptoms among health professionals during the pandemic compared the outcomes with pre-pandemic studies and found no differences in the reported rates (Kunzler et al., 2021 ; WHO, 2022a ).
Although there is still no consensus in the literature on the increase in mental health symptoms in specific populations due to the pandemic, it is undeniable that health professionals have been impacted in some way (Schmidt et al., 2020 ). Among the main triggers of psychological distress, studies have pointed to the increased risk of being infected, getting sick, and dying; overload and fatigue; exposure to large-scale deaths; and distancing from family and friends (Bao et al., 2020 ; Zhang et al., 2020 ). Most of these professionals were not prepared to deal with such an unusual situation and with such catastrophic outcomes as a pandemic, which increased their technical, emotional, and psychological vulnerabilities, generating symptoms such as sleep disorders, anxiety, depression, substance abuse, post-traumatic stress disorder, burnout, and suicidal ideation (Bao et al., 2020 ; Zwielewski et al., 2021 ).
Within the field of Health, psychologists address several specific factors in their work, such as patients’ suicide ideations and attempts, relapses and aggressive behaviors (Alves et al., 2015 ). Issues inherent to work, such as bureaucracy, ethical practice, regulation, and professional isolation, can also act as important stressors. These factors affect the physical, social, and emotional dimensions, and can lead to psychological distress and burnout (Alves et al., 2015 ; Lai et al., 2020 ). Despite dealing with psychological demands on a daily basis, these professionals often neglect their own mental health and do not seek help due to fear of the negative impact on their image and due to shame. A study conducted in the United Kingdom including 678 clinical psychologists identified that 425 of these professionals reported having already had some type of psychological problem. Of these, 84% (357) did not seek psychological help due to social stigmas (Tay et al., 2018 ).
According to Alves et al. ( 2015 ), the subjective nature of CMDs can lead to underdiagnosis and, consequently, to the lack of proper treatment. To reduce job burnout and prevent emotional problems in those who care for the mental health of others, self-care is recommended as a priority among psychologists. Self-care comprises a set of actions aimed at maintaining life, health, and well-being, such as the regular practice of physical activity, a healthy diet, and balance between work and leisure. By taking care of themselves, individuals contribute to their own well-being and to the promotion of their physical and mental health, with or without professional help (World Health Organization [WHO], 2022b ), being more able to take care of the mental health of others.
However, despite self-care being an essential factor for the quality of life of those who take care of the mental health of the population and for ensuring the delivery of more competent and higher quality care, the mental health of psychologists has been little explored (Pimenta & Rodrigues, 2021 ). Therefore, this study aims to investigate the prevalence of symptoms of anxiety, depression, stress, and quality of life in Brazilian psychology professionals and students and to verify whether there are differences in the intensity of symptoms between the two samples.
Method
Participants
This is a descriptive and cross-sectional study, conducted with non-probabilistic convenience sampling. A total of 2,324 participants were included, of whom 1,560 were psychologists and 764 were psychology students regularly enrolled in Brazilian universities. To include psychologists in the research, the following criteria were adopted: (i) having a registration number in the Brazilian Federal Council of Psychology; (ii) living in Brazil. For the inclusion of students, the criteria considered were: (i) being enrolled in a psychology course at a Brazilian university; (ii) attending at least the fifth semester (third year); (iii) attending/completing an internship (mandatory or voluntary) or supervised clinical care. Participants who did not answer all the items of the form were excluded.
Instruments
Sociodemographic questionnaire.
All participants answered a questionnaire that included questions about age, sex, region, marital status, type of educational institution (public or private, in the case of students), and emotional aspects, such as frequency of therapy, diagnose of mental disorder, and current use of psychotropic drugs. In the case of students, they were also asked to indicate the semester in which they were enrolled (from the fifth semester on). Concerning professionals, they were asked whether or not they were working on the forefront during the COVID-19 period, in places such as basic health units, hospitals, or specific clinics. Moreover, they were asked about their higher education level, experience of COVID-19 infection, loss of family members due to COVID-19, and whether they had patients infected or deceased by COVID-19.
Abbreviated instrument for quality of life assessment (WHOQOL-Bref)
WHOQOL-Bref is a questionnaire developed by the World Health Organization (WHO) to assess quality of life. It consists of 26 questions, two of which are general questions of quality of life (satisfaction with health and perception of quality of life), and the other 24 evaluate four main domains: physical, psychological, social relationships, and environment. The answers to the statements are given from a five-point Likert-type scale, in which 1 means “very poor”; 2, “poor”; 3, “neither poor nor good”; 4, “good”; and 5, “very good”. For interpretation, higher scores indicate better quality of life (Fleck et al., 2000 ).
Depression, Anxiety & Stress Scale (DASS-21)
DASS-21 is an instrument for tracking symptoms of anxiety, depression, and stress, each group consisting of seven items, totaling 21 items. It was adapted and validated for the Brazilian population (Vignola & Tucci, 2014 ). Responses to scale statements are provided from a four-point Likert-type scale, in which zero means “did not apply to me at all”; 1 means “applied to me to some degree, or some of the time”; 2 means “applied to me to a considerable degree, or a good part of the time”; and 3 means “applied to me very much, or most of the time,” considering the past week. The results can be categorized according to different criteria, from normal symptoms (anxiety: 0–7 points; depression: 0–9 points; stress: 0–14 points), mild symptoms (anxiety: 8–9 points; depression: 10–13 points; stress: 15–18 points), moderate symptoms (anxiety: 10–14 points; depression: 14–20 points; stress: 19–25 points), severe symptoms (anxiety: 15–19 points; depression: 21–27 points; stress: 26–33 points), to extremely severe symptoms (anxiety: 20+ points; depression: 28+ points; stress: 34+ points). In this study, the average of the total sum of the score for each of the three groups of symptoms evaluated was used.
Procedures
Data collection. The process of dissemination and invitation to participate in the research was carried out via social media. The instruments were made available on an online survey platform (Survey Monkey®) for 30 days. Participants only had access to the instrument link after signing an informed consent form.
Data analysis. For statistical analyses, data were imported into the JASP ® program. Descriptive analyses were used to calculate the frequency, percentage, mean, and standard deviation of the data collected. Inferential analyses used the Chi-squared test to evaluate possible associations between nominal or categorical variables. The effect size was calculated using Cramér’s V, considering the magnitude of the effect based on the number of degrees of freedom. For continuous or discrete variables, the one-way analysis of variance (ANOVA) was applied, with the effect size calculated from the partial Eta squared. A 5% significance level was considered in all analyses.
Ethical Considerations
This study was approved by the Human Research Ethics Committee (HREC) of the university to which the researchers were affiliated (CAAE No. 44621821.6.0000.0121; approval opinion No. 4,619,637).
Results
Based on the data presented in Table 1 , it was possible to trace the sociodemographic profile of the sample. Regarding sex, a predominance of women was observed in both groups, with no significant differences between them. In the geographical context, most participants lived in the Southeast region of Brazil, and significant differences were also not found concerning this variable between the groups. Considering marital status and the number of children, a significant disparity between the groups stands out, with a considerably higher proportion of professionals married and with children compared to students.
When analyzing the prevalence of emotional problems among psychology students, it is observed that almost half of them presented symptoms of depression, with 29.5% of these cases being moderate or severe. The same pattern was observed regarding the frequency of anxiety symptoms, with a significant rate of them (33.2%) reporting moderate, severe, or extremely severe levels. Among psychologists, the frequency of symptoms was lower, as 20% self-reported symptoms of depression, with 8% of these cases being moderate or severe; and 12.7% reported symptoms of anxiety, with 7.8% of these cases being moderate, severe, or extremely severe, as presented in Table 2 .
Occurrence of symptoms of depression, anxiety, and stress of psychology students (n = 764) and professionals (n = 1,560)
Table 3 presents a comparison between psychology students and professionals concerning their history of therapy, mental disorders, use of psychotropic drugs, and measures of quality of life and mental health. The differences observed between the groups stand out: a significant number of students never attended therapy (20.7%), while this proportion was notably lower among professionals (4.9%). Moreover, students reported significantly higher levels of anxiety, depression, and stress (33.4%) compared to professionals (27.4%), especially regarding depression and anxiety, evincing a greater magnitude of mean differences. No significant differences were identified between the two samples on the use of psychotropic drugs. Concerning quality of life, students presented lower scores in all dimensions assessed by the WHOQOL-Bref instrument, suggesting a generally lower perception of quality of life.
Considering only the data of psychologists ( n = 1,560), analyses were performed comparing the characteristics among the professionals who worked ( n = 430) and did not work ( n = 1,130) on the forefront of the COVID-19 pandemic. No significant sociodemographic differences were found regarding sex, region of the country of origin, or profile of the university in which they graduated. However, a significant difference was identified for schooling level ( χ² = 15.18; p < 0.001; V’ = 0.099): among the professionals who worked on the forefront of the COVID-19 pandemic, a higher rate reported having obtained specialization in their areas of expertise.
Furthermore, professionals who worked on the forefront reported a significantly higher frequency of COVID-19 contamination compared to other professionals who did not work in this environment ( χ² = 22,74; p < 0.001; V’ = 0.121). Moreover, a significantly higher number of patient deaths were reported by professionals who worked on the forefront, so that the frequency of deaths among these professionals was almost four times higher than among those who were not on the forefront ( χ² = 146.6; p < 0.001; V’ = 0.307). Finally, the comparative analysis between the levels of quality of life and emotional problems of professionals who were on the forefront of the pandemic and those who were not showed a difference only in the perception of quality of life ( χ² = 5.81; p < 0.05; V’ = 0.004). Regarding emotional problems, no significant differences were observed between the groups.
Discussion
This study was the first to investigate the prevalence of symptoms of anxiety, depression, and stress, as well as assess the level of self-perception of quality of life in a specific sample of Brazilian psychology students and professionals, and compare these rates in the two groups of participants. The results revealed that both students and mental health professionals presented marked symptoms of depression, anxiety, and stress, in contrast to a satisfactory assessment of overall quality of life. Notably, most of the participants had already sought therapy at some previous point in their lives, although a small number had received diagnoses or were currently under psychopharmacological medication.
In the comparison of the two groups, psychology students presented significantly higher levels of depression, anxiety, and stress symptoms compared to their professional colleagues in activity. Moreover, they presented lower means in the psychological dimension of quality of life and reported diagnoses of mental disorders more frequently than psychologists. Possible explanations for the differences found may be that students often face academic pressures, uncertainties about their professional future, and the emotional burden of dealing with complex psychological issues still in the training phase, which may increase the risk of mental distress. Moreover, the transition to adulthood and financial independence can bring additional stress. In contrast, working professionals may have developed more effective coping strategies throughout their careers, in addition to greater financial stability and personal fulfillment (Zhang et al., 2020 ).
As for mental health outcomes, rates of 19.8% for depressive symptoms, 12.7% for anxiety, and 6.6% for stress were identified among the 1,560 psychologists who participated in the research. These results are lower than the findings of another similar study also conducted in the context of the COVID-19 pandemic. Campos et al. ( 2021 ) conducted a research to identify symptoms of mental disorders among Brazilian health professionals during the initial stage of the pandemic. The study included 1,609 health professionals, of whom 267 were psychologists, and found a high prevalence of depression (50.2%), anxiety (39%), and stress symptoms (43.10%). However, no statistically significant differences were identified between participants who were infected with the COVID-19 virus and those who were not.
A possible explanation for the discrepancies between the results of this study and the study by Campos et al. ( 2021 ) may be related to the phase of the pandemic in which the data were collected. The study by Campos et al. ( 2021 ) occurred between May and June 2020, when Brazil recorded 244,052 cases of COVID-19 and 16,201 deaths. During this period, the country faced high mortality and daily infection rates, had not yet implemented a coordinated national public policy, and was at the height of social isolation recommendations. In addition, there was no forecast for an effective vaccine. These factors, added to the saturation of information, may have contributed to an increase in distress about the situation, which, in turn, may have triggered or intensified symptoms of anxiety, depression, and stress (Tibério et al., 2020 ). Practically a year later, the data collection of this study took place (between April and May 2021), a period in which the pandemic was no longer a novelty, ANVISA had already approved the emergency use of two vaccines, and many people were already used to the new work routines. These measures may also have contributed to a greater sense of security about the pandemic.
Concerning the students in this study, 49.9% of them presented symptoms of depression, 45.9% of anxiety, and 29.1% of stress. These numbers are higher than those found in the meta-analysis by Fang et al. ( 2022 ), which included studies conducted exclusively during the pandemic. From the analysis of 104 surveys that involved 2,088,032 students, from primary to university level, on five continents, the authors estimated a prevalence of 32% for depressive symptoms, 28% for anxiety, and 31% for stress. Our findings also surpassed the results of a meta-analysis that incorporated 44 articles investigating the mental health of Brazilian students ( n = 37,486 undergraduate students) between October 2018 and January 2020 (Demenech et al., 2021 ). The latter identified grouped prevalences of 29% for symptoms of depression, 38% for anxiety, and 9% for suicidal behavior. Thus, it is evident that even before the pandemic, mental health problems among Brazilian students were already higher regarding anxiety and close concerning depressive symptoms, when compared to students from other countries, and probably worsened during the pandemic.
Additionally, the comparison between students and professionals in mental health outcomes revealed higher levels of symptom severity among students. This finding is in line with an online survey conducted with 2,530 members of a university in Spain, which indicated that higher levels of depression, anxiety, and stress were observed in students compared to university workers (Odriozola-González et al., 2020 ). The higher prevalence of mental health problems in students can be partially explained by the moment of transition and adaptation that these young people experience, including the formation of new friendship and social support networks, as well as the demands arising from new academic and professional responsibilities (Demenech et al., 2021 ).
Regarding the care of one’s own mental health, the research revealed that 79% of students and 95% of psychologists in the investigated sample reported having attended or attending therapy. These results corroborate previous studies that have also identified a high prevalence of psychotherapy use, with 79.4% of psychologists (Xavier & Daltro, 2015 ) reporting having attended therapy at some point in their careers. The search for psychotherapy is justified by its recognized role as one of the self-care strategies in the mental health area, and also by its inclusion in professional training guidelines, being strongly recommended by instructors in undergraduate courses (Meira & Nunes, 2005 ). A healthy diet, the practice of regular physical activity, and satisfactory social interactions are also recommended for psychologists to maintain a good emotional balance to take care of the mental health of other people (Pimenta & Rodriguez, 2021 ).
Data on the use of psychotropic drugs among psychology students in our sample (37%) showed higher prevalence compared to students from related fields in pre-pandemic research (22.3% to 36.7% reported by Bauchrowitz et al., 2019 ), and higher than the 15.5% observed by Souza et al. ( 2021 ), indicating a possible variation in the pandemic impact among different groups of students. This increase can be attributed to the additional stress and uncertainties associated with the pandemic context, as well as increased awareness and access to mental health treatments. On the other hand, the prevalence of psychotropic drug use among professionals (40.1%) remains consistent with previous studies, such as that of Schneider and Azambuja (2015), suggesting that, despite the additional pressures during the pandemic, mental health professionals may have greater stability and experience in managing their symptoms.
Data on quality of life revealed that both students and psychologists reported a high self-perception of general quality of life, with averages of 82.8 and 91.3, respectively, higher values than those observed in previous studies. Barbosa et al. ( 2018 ) and Nunes et al. ( 2021 ) found averages of 71.99 and 56.1 among professionals, while Silva & Matos ( 2022 ) reported an average of 71.68 among university students. These results indicate a positive perception of quality of life among participants, possibly reflecting resilience and effective coping mechanisms. However, the comparison between the groups highlights a disparity, with students presenting lower levels of quality of life in all dimensions evaluated, with the psychological dimension of WHOQOL being the most affected. This can be explained by the academic pressures, uncertainties about the future, and emotional challenges faced by students, contrasting with the greater stability and professional experience of psychologists, which may contribute to a more positive perception of their quality of life.
Concerning practices and care during the pandemic, no significant differences were identified between students and psychologists. Most participants in both groups adhered to social isolation and did not require hospitalization. Nevertheless, there were discrepancies in the context of professional practices during the pandemic. Psychologists reported a higher number of infected or deceased patients as a result of COVID-19, which was expected. On the other hand, in contrast to previous hypotheses and research, this study did not identify significant differences in symptoms between professionals who worked on the forefront of the pandemic and those who did not, nor between those who were contaminated by COVID-19 and those who were not. A review conducted by Chen et al. ( 2022 ), covering 1,704,072 participants, indicated that although the rates were similar, health professionals on the forefront had higher risks of health impairments (27%) compared to those who were not on the forefront (25%). Other studies that looked at people previously infected with the COVID-19 virus found significantly higher levels of burnout, anxiety, depression, stress, hypervigilance, and avoidance behavior compared to uninfected individuals (Klaser et al., 2021 ).
Currently, there is no consensus in the literature on an increase in the prevalence or severity of mental suffering resulting from the COVID-19 pandemic. According to Brunoni et al. ( 2023 ), the occurrence of mental disorders has not shown significant changes in recent years and continues to affect a little more than 20% of the population, even in the face of the negative impacts of the pandemic. The authors attribute this phenomenon to three factors: (1) previous high levels of disorders and symptoms that did not allow a substantial increase - known as the “ceiling effect”; (2) the minimization of social isolation by digital connections and home office work; and (3) the presence of depressive and anxious symptoms as adaptive responses, which do not necessarily translate into diagnoses of disorders. In turn, the meta-analysis of Robinson et al. ( 2022 ) found worsening of symptoms in the general population, but not in specific populations, in longitudinal studies.
In short, this study represented a significant advance in research by investigating symptoms of depression, anxiety, and stress, as well as quality of life, in a sample composed of both professionals and students in the field of psychology, in the context of the COVID-19 pandemic in Brazil. Although the sample was not representative of the entire population of the country, we obtained responses from psychologists and students from all geographical regions of Brazil.
However, some limitations of this study stand out, such as the impossibility of establishing temporal relationships and tracking the development of symptoms over time, due to the strictly observational nature of the research. Moreover, the convenience sampling used may introduce a potential selection bias; for example, participants who agreed to respond to the survey may have a greater interest in mental health or may be experiencing more intense symptoms. Based on the findings, future research should be aimed at deepening the understanding of the process of psychological illness that affects psychology professionals and students, from their academic background to the development of their careers. For managers of higher education institutions, we recommend programs of continuous and accessible psychological support for students, including the integration of self-care practices and stress management techniques into the curriculum. For professional psychologists, we recommend the creation of support networks and continuous supervision, as well as continuing education programs that include coping and resilience strategies.
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How to cite this article:
Lima Junior, A. M., França, G. H. B., Oltramari, G., Andrade, A. L. M., & Lopes, F. M. (2024). Mental health of psychology professionals and students in Brazil: A comparative analysis. Paidéia (Ribeirão Preto), 34, e3433. doi: https://doi.org/10.1590/1982-4327e3433
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Article derived from the master’s thesis of the first author under the supervision of the last two, defended in 2023 in the Graduate Program in Psychology of the Universidade Federal de Santa Catarina.
Edited by
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Associate editor:
José Egídio de Oliveira
