This is a quantitative, cross-sectional study with a non-probabilistic sample and a correlational design. Thus, the objective was not to establish a cause-and-effect relationship but to obtain measures of association between variables, as detailed later.

Table 1 displays the social determinants of health analyzed in the research. It can be seen that the sample is characterized by individuals with an average age of 27.8 years, predominantly female (75.8%), self-declared White (73.7%), single (83.8%), with completed or ongoing higher education (63.6%), students (54.5%), and a family income of up to three minimum wages (68.7%). The impacts of the pandemic can be seen in detail in Table 1. Noteworthy are the reported frequencies for feelings of sadness or depression (64.6%), anxiety or nervousness (90.9%), suicidal ideation (18.2%), and increased alcohol consumption (21.2%).

In the following tables, we present correlation analyses based on the outcomes of Alcohol Consumption, Feelings of Anxiety or Nervousness, Feelings of Depression or Sadness, and Suicidal Ideation. The latter, having not shown statistical significance as the primary comparative variable, is not included in the results. Statistical significance was observed solely in the comparison with alcohol consumption, as presented below. It is also important to highlight that the age variable did not correlate with the others and showed no difference between the compared means. Therefore, age-related data were also not included in the tables.

Table 2 contains data related to the comparison between reported Alcohol Consumption and social determinants of health. Variables that showed statistical significance in the comparison were: gender, post-pandemic income, and financial problems or unemployment. Regarding gender, there was a proportional increase in alcohol use among non-binary individuals (80%) and men (26.3%) (χ² = 11.86, p = 0.003). Concerning the first group, this difference in alcohol consumption proportion may have occurred due to the limited number of respondents identifying as non-binary. Financial problems during the pandemic period were also associated with increased alcohol consumption, with 24% of participants experiencing such problems showing an increase in consumption (χ² = 3.89, p = 0.049). Another variable with a significant association was the presence of suicidal ideation and increased alcohol consumption (44%) (χ² = 7.18, p = 0.008). The remaining variables did not show statistically significant differences in the comparison.

Table 3 presents data related to the comparison between the report of Feelings of Anxiety or Nervousness and social determinants of health. Only the income variable exhibited marginal significance in the data comparison. It is observed that 97.5% of the research participants experienced a decrease or total loss of income during the period and reported symptoms of anxiety (χ² = 3.53, p = 0.06). The remaining variables did not show statistically significant differences.

Table 4 presents data related to the comparison between the report of Feelings of Depression or Sadness and social determinants of health. Variables that showed statistical significance were: education and having received emergency financial aid from the government. A higher proportion of individuals with symptoms of depression was observed among those with lower educational attainment (80.6%) compared to those pursuing or having completed higher education (55.6%) (χ² = 6.27, p = 0.012). Regarding individuals who received emergency financial aid from the government, a higher report of symptoms of depression was observed (81.6%) compared to those who did not receive said benefit (54.1%) (χ² = 7.75, p = 0.005). The remaining variables did not show statistically significant differences in the comparison.

The Covid-19 pandemic has significantly impacted the lives of the global population by intensifying mental health problems and social inequalities, perpetuating a cycle of care precariousness. Given the specific aspects related to people’s lifestyles during this pandemic, it becomes crucial to explore the social determinants of health (Castro-Silva et al., 2021). In this regard, the results of this study allowed us to understand the relationship between some of these determinants and indicators of anxiety, depression, suicidal ideation, and alcohol consumption in a sample of users from an online mental health support service (Gomide et al., 2020).

The present study obtained more pronounced indicators of anxiety (90.90%) and depression (64.60%) among its respondents when compared to other countries and the national scenario. It is important to note that, despite higher levels, a significant increase in these indicators was observed across all of them. In Mexico, Pedroza-Cabrera et al. (2021) conducted a study with characteristics similar to this article (online care, clinical population, etc.), where participants exhibited depression and anxiety symptoms of 23.73% and 17.72%, respectively, highlighting an increase compared to earlier periods documented by their service.

Other studies, such as Serafín et al. (2021), observed that almost half of the participants expressed symptoms of depression (46.4%), anxiety (39.4%), and stress (42.2%). In Chile, Andrades-Tobar et al. (2021) found a prevalence of 49.5% of individuals with mild/high depression and 43.3% with mild/high anxiety. In a similar proportion, in Argentina, Alomo et al. (2020) pointed out that 45.0% of participants manifested feelings of sadness. In correlational analyses, similarities were found between the studies concerning anxiety, depression, work, and income.

In the research conducted by Andrades-Tobar et al. (2021), a correlation was observed between unemployment, depression, and anxiety, similar to the results obtained in this study, which indicated a significant correlation between decrease/loss of income after the start of the pandemic and anxiety symptoms. In addition, a significant correlation was also found between feelings of depression/sadness and receiving emergency financial aid from the government, a situation that in the Brazilian context indicates low income and/or unemployment. Similarly, Alomo et al. (2020) reported that depressive mood symptoms were correlated with the level of salary reduction since the beginning of the pandemic. Those who had a reduction of 80% or more showed the most significant negative mood changes.

In a comprehensive study conducted with the general population in Brazil, Barros et al. (2020) found less pronounced rates than those found in this article, but they demonstrated that during the period of pandemic-related social distancing, 40.4% of Brazilians constantly felt sad or depressed. Even more concerning, 52.6% reported feelings of anxiety and nervousness, especially among those with a history/diagnosis of depression. In contrast to the present study, where no association was found between age and feelings of depression/sadness and feelings of anxiety/nervousness, Barros et al. (2020) obtained higher indicators of these variables among younger respondents.

Regarding age, unlike our findings, a systematic review analyzing the association between social determinants and mental health during Covid-19 found that younger people were more affected by symptoms of depression and anxiety (Covid-19 Mental Disorders Collaborators, 2021). The same trend was observed concerning alcohol consumption (GBD 2020 Alcohol Collaborators & Wang, 2022). In our study, the absence of a difference regarding age may be attributed to the higher concentration of our sample among younger individuals (M = 27.8, SD = 10.6 years) and the fact that these individuals sought intervention services due to the presentation of some of these complaints.

Regarding alcohol consumption during the pandemic, an overall increase was observed among populations in various countries, although in varying proportions. In this study, an increase in consumption was observed among 21.2% of the participants. In a longitudinal study conducted by Pedroza-Cabrera et al. (2021), similar to the one mentioned earlier, the increase was 32.45% in the first measure and 30.51% in the second, becoming the primary reason for seeking online intervention. Before the pandemic, it was the second most stated reason for seeking intervention. Comparatively, a study conducted in the metropolitan area of Buenos Aires, Argentina, identified a higher growth in alcohol consumption than observed in this study, with 45% of respondents reporting an increase in alcohol consumption (Camarotti et al., 2020). In another study involving the general population of Argentina, an increase of approximately 35% in alcohol consumption was recorded (Etchevers et al., 2020), with reduced social interaction and the overall emotional state provoked by the quarantine highlighted as primary contributing factors (Camarotti et al., 2020). However, the main reasons indicated were anxiety (57%), the need for relaxation (47%) (Etchevers et al., 2020), and the length of the workday, either due to an increase or a decrease in working hours (Camarotti et al., 2020). This study aligns with the aforementioned studies in its correlation between heightened alcohol consumption and factors such as reduced income after the pandemic and financial challenges or unemployment.

In Brazil, in a nationwide study with 45,161 participants, Malta et al. (2020) pointed out a worsening of lifestyles and an increase in health-risk behaviors during the pandemic. The results indicated a 17.6% increase in alcohol consumption, similar to the 21.2% obtained in this study. Their study also suggested that the increase in alcohol consumption during the pandemic may be associated with stressors such as fears and uncertainties about the future and employment, the well-known risk of death, as well as sadness and anxiety. Indirectly, but similarly, in the present study, alcohol consumption was also associated with financial problems/unemployment and income after the pandemic. Additionally, in the research conducted by Ahmed et al. (2020) in China, similar characteristics were observed among the participants. There was a 29.1% increase in alcohol consumption, which was related to increased depression, anxiety, and reduced well-being resulting from restrictions and the total lockdown decreed by local authorities.

Studies around the world have indicated that, in the context of the Covid-19 pandemic, fear of the unknown, numerous uncertainties, and certain social determinants of health can lead to the progression of various mental health problems (Sandín et al., 2020; Serafim et al., 2021; Shigemura et al., 2020). The extent of the psychological impact of a pandemic on populations is likely influenced not only by the characteristics of the disease manifestation in that context, which encompass the cultural and social factors of the affected countries, but also by the methodologies employed for its measurement (Andrades-Tobar et al., 2021).

Finally, despite the relaxation of public health measures in 2022 and the increase in vaccine coverage, Covid-19 still deserves global attention. According to the report of the Covid-19 International Health Regulations Emergency Committee (IHR-2005), the pandemic should continue to be considered a Public Health Emergency of International Concern (PHEIC) (WHO, 2023b). Some countries still face various challenges with its progression and resulting comorbidities. In this regard, as new studies emerge over time, they may provide additional clarity on the magnitude of the impacts on mental health (Serafim et al., 2021). Psychological consequences are known to potentially be more prevalent and enduring than the direct consequences of Covid-19 (Ornell et al., 2020; Schmidt et al., 2020). It may be considered premature to categorically state its psychological and emotional consequences (Andrades-Tobar et al., 2021), although it is important to estimate them to adopt measures that can minimize the implications in societies.

This study, despite offering significant contributions to the fields of Psychology and Public Health, has some limitations. One limitation is that the sample consists of a clinical population, specifically individuals seeking mental health support services. While demonstrating regional variability and certain sociodemographic characteristics, the inferential analyses were confined to bivariate comparisons, limiting control over the commonality among the studied variables. Multivariate analyses could make it possible to test more robust predictive models, but the sample limitations compromise the parameters for such analyses (Field, 2009).

Additionally, the sample comprises participants with internet access and electronic devices, rendering it more specific and posing a challenge in reaching individuals lacking technological tools. However, this limitation is inherent to the population of users from the online service from which the sample was drawn. Regarding the issue of the observed low response rate in this study, it aligns with the expected reality in online research and has been acknowledged in the literature for decades (Galea & Tracy, 2007). Despite this, such a strategy allows for the potential recruitment of respondents from various locations at a low cost (Faleiros et al., 2016), along with the expeditious tabulation of results. Thus, online questionnaires are widely adopted, as was the case in this study.

Closely tied to this strategy is the challenge posed by the pandemic context, which made in-person questionnaire administration unfeasible, compounded by respondents residing in geographically distinct locations. Therefore, individuals lacking regular internet access or suitable electronic devices might not have responded to the questionnaire. Likely, these respondents represent a segment of individuals with disadvantaged living conditions or greater vulnerability (Andrades-Tobar et al., 2021), indirectly supported in this study by the higher proportion of participants with a family income above three minimum wages (26.3%) and whose income was maintained or increased after the pandemic (59.6%).

Another potential limitation is that estimates in this study did not employ specific screening instruments to assess symptoms of depression, anxiety, suicidal ideation, and alcohol consumption. Our questionnaire comprised self-report, survey-type questions, without the use of psychometric instruments based on any theoretical construct, with the primary outcomes composed of a single question. Therefore, measuring the validity of the questionnaire is not possible. However, the selection of a single, simplified self-perception questionnaire proved feasible due to a greater interest in exploring the relationship between feelings and general – non-diagnostic – states, along with some other variables of interest. Furthermore, it facilitated greater questionnaire conciseness and was conceived as a strategy to boost the number of potential participants by reducing the response time required for completion (Faleiros et al., 2016).

Finally, by collecting information from users originating from a single service, specifically those who agreed to participate and are individuals seeking help, there may have been a sampling bias. Conversely, the correlational and cross-sectional nature of the study itself anticipates the possibility and interest in investigating relationships between variables rather than generalizing results (Lau, 2017; Sousa et al., 2007). Moreover, the specificity of the studied population reinforces the uniqueness of the study. Additionally, the similarities in results found in other studies decrease the likelihood of participant recruitment bias and contribute to the convergence of evidence from various studies.

The Covid-19 pandemic has had a significant social and health impact on populations worldwide. This study demonstrated that, akin to other nations, in Brazil, this impact has exacerbated the challenges within an already unequal social context, leading to severe consequences for mental health. The associations found between alcohol consumption, feelings of anxiety or nervousness, depression or sadness, and certain social determinants in health underscore the importance of assessing the mental health impacts on the population during and after the pandemic, considering the psychological consequences reported by participants.

Another noteworthy factor was the reach of online care modalities, as exemplified by the service that facilitated participant recruitment for this study. Having access to immediate health support when seeking help is extremely important for a population experiencing intense suffering and social isolation. In a country of continental proportions like Brazil, amid a global crisis where access to in-person health services is limited, receiving initial care support with the option to seek further assistance when needed holds significant potential.

This study emphasizes the importance of further exploring studies on social determinants of mental health related to moments of health or social crises, extending beyond the Covid-19 pandemic. As expressed by several cited authors, the consequences of the pandemic should not be limited to that period and be considered as being in the past. On the contrary, these studies, investigations, and experiences should be used to understand the present repercussions/impacts this relationship had in each context, contributing to the creation and/or strengthening of online, in-person, or hybrid strategies, especially for unequal contexts. This aims to alleviate the impact that occurred, promoting mental health spaces within existing or new public policies and services.

In light of the above, the results obtained through the present study corroborate the widely disseminated and previously cited information regarding the global increase in cases of anxiety and depression as health conditions significantly aggravated during the pandemic. The experience of a global crisis has brought attention to this critical aspect of health, marked by an increased demand for emergency care, exposing the vulnerability of services and underscoring the necessity to tackle the worldwide shortage of resources for mental health support. The heightened challenges in the population’s health during the pandemic reinforce the urgency of maintaining and strengthening essential health services in the country. In particular, mental health services and psychosocial support in response to post-pandemic effects on the affected population and for future public health emergencies. Thus, this study emphasizes the importance of supporting the consolidation and updating of public policies in the country to address the population’s needs in crisis situations, with a greater focus on mental health.