Association between COVID-19 diagnosis and severe mental health symptoms in adolescents in southern Brazil

OBJECTIVE: To evaluate the association between self-reported COVID-19 and the occurrence of severe mental health symptoms such as anxiety, stress, and depression among high school students in southern Brazil. METHODS: Cross-sectional study with high school adolescents from the Instituto Federal do Rio Grande do Sul, Brazil. The outcomes were anxiety, depression, and severe stress assessed through the "Adolescent Anxiety, Depression, and Stress Scale" (DASS-21), and the diagnosis of COVID-19 was obtained through self-report. Descriptive and bivariate analyses were performed. Poisson regression with robust variance adjustment and multinomial logistic regression were used to verify associations. RESULTS: Of the 462 participants, 16.6, 15.6, and 9.9% reported severe symptoms of depression, anxiety, and stress, respectively, and 41% reported a diagnosis of COVID-19. In the adjusted analysis, adolescents diagnosed with COVID-19 were more likely to have severe anxiety symptoms (prevalence ratio - PR 2.12; 95% confidence interval - 95%CI 1.35-3.33) and three times more likely (OR 2.98; 95%CI 1.35-6.56) to develop severe symptoms of two of the three disorders investigated. CONCLUSIONS: Adolescents who reported a COVID-19 diagnosis experienced worse mental health outcomes, with associations observed for severe anxiety and for the presence of multiple severe symptoms of depression, anxiety, or stress. These findings highlight the need for further clinical and epidemiological research to better understand and address the impact of COVID-19 on adolescent mental health.