Research article:

Impact on mental health due to COVID-19 pandemic: Cross-sectional study in Portugal and
Brazil (Passos et al., 2020)

The main objective of the study is to describe the mental health status of the general adult
population in Portugal and Brazil during the COVID-19 pandemic by measuring their perceived
satisfaction with one’s life as well as their level of anxiety and depression manifested. The study
employs a quantitative cross-sectional study through the use of survey questionnaires. The
questionnaire is composed of four sections: the sociodemographic factors of respondents
including the isolation status during the COVID-19 pandemic as well as alcohol consumption
measured by the CAGE questionnaire; the Satisfaction With Life Scale (SWLS) that measures
the level of satisfaction with one’s life; the Generalized Anxiety Disorder-7 (GAD-7), which
measures the degree of anxiety classified as normal, mild, moderate, and severe; and the Patient
Health Questionnaire-2 (PHQ-2) that measures the state of depression of the respondents. The
SWLS, GAD-7, and PHQ-2 questionnaires are Likert-type questionnaires with high Cronbach
alpha of 0.87, 0.90, and 0.83, respectively. Cronbach alpha is a measure of reliability and internal
consistency of the survey questions in Likert-type questionnaires (Bonnett & Wright, 2014). The
acceptable Cronbach alpha value should be at least 0.70 or higher. If the calculated value is
higher than 0.7, no revisions will be made on the survey questions. However, if the results show
that it is less than 0.7, some questions may be deleted or revised to obtain desirable results.
The data collection has been conducted during the first few months of the spread of the
COVID-19 virus (i.e., May-July 2020) after it has been declared as a pandemic by the World
Health Organization (WHO) in mid-March of 2020. A total of 550 adult residents in Portugal
and Brazil act as respondents in the study. To meet the study objectives, the researchers perform
a multiple linear regression to describe and determine the relationship between the independent
variables (age, gender, etc.) with the continuous dependent variable, which is the mental health
of the respondents characterized by satisfaction with one’s life and the varying levels of anxiety
and depression that are measured by the SWLS, GAD-7, and PHQ-2 questionnaires. It is also
stated in the study that multiple linear regressions are conducted per outcome (i.e., satisfaction
with one’s life, anxiety, and depression). To determine which independent variables will be
included in each multiple linear regression, simple linear regressions are conducted with each
variable including the sociodemographic factors, satisfaction with one’s life (SWLS), anxiety
(GAD-7), and depression (PHQ-2). Variables that correlate with the outcomes (SWLS, GAD-7,
and PHQ-2) at p ≤ 0.20 in simple linear regressions have been included in the calculation of the
multiple linear regressions (Passos et al., 2020).
Results reveal that gender, educational level, professional status, co-living status, and
depression (PHQ-2) appear to be significant factors for life satisfaction (SWLS), wherein life
satisfaction scores of women are higher compared to men; higher level of education equates to
higher life satisfaction scores; students’ life satisfaction are higher compared to those who are
employed; and those who are living or cohabiting with family members or partners during the
COVID-19 pandemic show higher life satisfaction scores. However, higher levels of depression
show a significant reduction of life satisfaction levels. In terms of anxiety (GAD-7), the
significant factors included in the calculation of multiple linear regressions include gender and
depression (PHQ-2). The anxiety levels of women appear to be higher compared to men, while
higher levels of depression equate to an increase in anxiety levels. With regard to depression
(PHQ-2), the variables that appear to be significant include social isolation, life satisfaction
(SWLS), and anxiety (GAD-7). Results show that being in isolation, either by self-isolation as a
preventive measure to avoid contracting the COVID-19 virus or through medical isolation as a
result of COVID-19 infection, is associated with heightened levels of depression. However, high
levels of life satisfaction reduce depression, while increased levels of anxiety are associated with
increased levels of depression (Passos et al., 2020).
The study states that one of the limitations is in terms of identifying and selecting
qualified respondents of the study. The researchers opt to use the snowball sampling method in
selecting its target respondents. The problem in using snowball sampling is that the survey
questionnaires are sent to a specific group of people through a referral-type system, which may
have a significant impact on the outcomes of the study. Sociodemographic factors pertaining to
level of education reveal that most of the respondents (51.3%) have completed their
post-graduate degree (Masters or Phd), which means that majority of the respondents are highly
educated. While this may not mean something considering the complexity of statistical
techniques employed in the study, other researchers may wonder what might be the outcome of
the study if there are less highly-educated respondents. The researchers should have considered
using purposive sampling or simple random sampling method to ensure that each member of the
population has an equal chance or probability of being selected. Another problem in the study is
the limited number of respondents, in which the researchers admit that they find it challenging to
generalize their findings considering the limited number of respondents included in their study.
There is a strong possibility that the results may be different if the researchers decide to increase
their sample size.
If the study will be recreated, researchers may explore some of the alternatives to
multiple linear regression such as discriminant analysis, logistic regression, analysis of variance
(ANOVA), logit analysis, factor analysis, and multidimensional scaling (Bieber, 1988). Another
method that researchers may explore is the use of moderation analysis to determine whether the
sociodemographic variables moderate the relationship between life satisfaction and the levels of
anxiety or depression. According to Netemeyer et al. (2001), for moderation to be supported, two
conditions need to be met. First, the independent variable, life satisfaction, must significantly
predict the levels of anxiety or depression (Step 1). Second, the interaction model (Step 3) must
account for more variance of the levels of anxiety or depression than the non-interaction model
(Step 2). If either of these conditions are not met, it means there is no moderation effect.

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Passos, L., Prazeres, F., Teixeira, A., & Martins, C. (2020). Impact on mental health due to
COVID-19 pandemic: Cross-sectional study in Portugal and Brazil. International Journal
of Environmental Research and Public Health, 17(18), 1-13.
https://doi.org/10.3390/ijerph17186794