**1. Introduction**

In March 2020, the World Health Organization (WHO), declared the spread of the SARS-CoV-2 virus had reached pandemic levels. The circulation of a highly transmissible virus, potentially lethal and untreated, resulted in the imposition of behavioral norms to avoid contagion [1]. The main one involved social distancing that resulted in extensive home confinement [2]. Although it has varied locally, from instructions to stay at home to compulsory isolation, guidelines for social distancing were adopted by several countries.

It was quickly realized that COVID-19 and the measures to contain it were significant psychological stressors [2]. In addition to the possibility of contagion and the isolation, economic losses, changes in routine, and loss of social support also contributed to increased mental struggle [3]. Therefore, since the beginning of the pandemic, researchers have warned of the impacts on mental health and warned that health systems should be prepared to provide psychosocial support to the general population [2–4].

International and national survey studies corroborated these expectations by demonstrating the immediate impacts of the pandemic on mental health in the general population [5]. High rates of mental distress have been identified in cross-sectional studies conducted in countries such as China [6], Italy [7], the United States [8], and Brazil [9,10]. Worsening symptoms such as sadness, anxiety, sleep difficulties, and even suicidal ideation have been reported [6]. A relative consensus was established that belonging to the female

**Citation:** Zibetti, M.R.; Serralta, F.B.; Evans, C. Longitudinal Distress among Brazilian University Workers during Pandemics. *Int. J. Environ. Res. Public Health* **2021**, *18*, 9072. https:// doi.org/10.3390/ijerph18179072

Academic Editors: Paolo Roma, Merylin Monaro and Cristina Mazza

Received: 24 July 2021 Accepted: 23 August 2021 Published: 27 August 2021

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

gender, being younger, and having history of mental disorder, were risk factors for greater mental distress in this period [6,10,11].

In addition to the immediate mental health effects of the pandemic on the population, some studies have made comparisons before and after social distancing measures. For example, a study conducted in the United Kingdom indicated that the percentage of people classified as suffering from mental illness rose from 19.4% between the years 2017 and 2019 to 30.6% in the first month of isolation [12]. Similar data on deterioration, when compared to those before isolation measures, were obtained in other studies and stages of the pandemic in the United Kingdom [11]. A cross-sectional study conducted in the United States indicated that each day more during the early months of the pandemic predicted an increase of 11% in the odds to change to a higher category of mental distress [8]. These before versus during the pandemic between-group comparison studies presented a picture of psychological deterioration [13]. However, the absence of within-participant follow-up studies creates biases, making conclusions about the evolution of mental health indicators uncertain.

Longitudinal studies of the change in mental health indicators during the pandemic are emerging. A study conducted in China, with an interval of 30 days between the two collections during the pandemic, detected levels of stabilization of mental health indicators at levels below expectations [13]. In Latin America, data collected in Argentina in the first two weeks of the lockdown indicated changes with a small effect size in the indicators of depression, anxiety, and affection [14]. On the other hand, a study conducted in India reported worsening levels of stress, depression, and anxiety over the first two months of lockdown [15]. In Spain, a study carried out between the second and the fifth week of the pandemic indicated complex effects with worsening depression and stabilization of anxiety and post-traumatic stress [16].

Previous studies demonstrate the complexity of the pandemic effects and isolation measures on the general population's mental health. There are three obvious possibilities: (1) deterioration of mental health with aggravation of stressors over time; (2) stabilization of levels of distress due to the maintenance of conditions; (3) recovery of the initial impact due to the reorganization of the routine, individual resilience, and identification of support networks. A meta-analysis of longitudinal studies demonstrated modest effects on depression and anxiety and the absence of longitudinal effects on most of the investigated psychological variables [17]. This study also noted the great variability of effects reported in these studies. The different results are possibly associated with the different methods (sampling, measurement), forms and needs of fulfilling social isolation [17], personal differences in wealth and resources to survive [18], and the different governmental responses to the containment of the pandemic [19].

Longitudinal data on mental health during the pandemic in Brazil is scarce. The objective of the present study was to describe changing mental struggles during the pandemic in a specific group of Brazilian university workers. Few studies have been conducted with university workers, though they are interesting, having access to scientific information and often being able to move work activities to home. Cross-sectional studies conducted in Italy [20] and Spain [21] have reported high levels of anxiety and depression in the population. In addition to the stressors affecting the general population, university workers have found themselves under a particular pressure to keep up their teaching work and supporting their students, but at a distance [22]. In a previous study, we identified that the concern most mentioned by these professionals involved issues related to work, from the quality of the services provided to the pervasive pressures of remote office working [23]. In the same study, we identified that 98% of these professionals reported complying with the social distance measures.

The present study aimed to build on the earlier report by examining possible changes in psychological distress reported by university workers during the initial period of the pandemic, examining the effect of social isolation measures on this population. Secondary objectives were to verify the variables associated with the increase or decrease in suffering and to identify the concerns of people with a worsening mental health status.

#### **2. Materials and Methods**

#### *2.1. Study Design*

It was a longitudinal and mixed design (quantitative and qualitative). The study's approach was pragmatic as the primary intention of the survey was to provide support to the university community through screening for mental distress and the provision of support measures to these people (remote psychological first aid and referrals). The study used longitudinal data from the three months of the intervention project. This interval was designed based on the evolution of the pandemic's first wave and the end of the first semester of classes.
