Depression, Anxiety, and Stress in a Primary Care Population in Northern Portugal: A Cross-Sectional Study in the Post-COVID-19 Context

This is the authors' abstract. We don't add key points for this paper.

Background: The COVID-19 pandemic has had lasting psychological consequences, with primary care playing a key role in identifying emotional distress. Objective: Our objective was to characterize levels of depression, anxiety, and stress in a primary care population in the post-pandemic context and to examine their associations with sociodemographic and COVID-19-related variables. Methods: A cross-sectional study was conducted among 260 adult users of a Family Health Unit. Participants completed a sociodemographic questionnaire and the Depression, Anxiety, and Stress Scale (DASS-21). Group differences were assessed using Mann–Whitney U and Kruskal–Wallis tests, and multivariable generalized linear models (negative binomial regression for symptom scores and logistic regression for perceived impact) were used to identify factors independently associated with each outcome. Results: Most participants fell within normal symptom ranges (66.9% depression; 65.0% anxiety; 74.6% stress), although approximately one-third presented at least moderate levels of depressive or anxiety symptoms. In unadjusted analyses, women, older adults and professionally inactive individuals had significantly higher levels of psychological distress. Self-reported COVID-19 infection history was not associated with DASS-21 scores. In contrast, participants reporting a negative psychological impact from the pandemic and poorer self-rated mental health had significantly higher depression, anxiety, and stress scores. Conclusions: In this primary care sample, self-reported psychological impact from the pandemic and self-rated mental health were more strongly associated with psychological distress than self-reported COVID-19 infection history. Multivariable analyses identified independent associations between psychotropic medication use, self-rated health, and DASS-21 scores and the outcomes examined. These findings indicate associations between these variables within the cross-sectional sample; however, their temporal or causal relationships cannot be established.