Mental health, functioning, and quality of life in employees who worked in the office vs. from home during the first wave of COVID-19 in Brazil

Abstract Objective Coronavirus disease 2019 (COVID-19) was declared a global pandemic early in 2020, followed by a period during which governments imposed strict social distancing measures to slow transmission. However, most essential services remained open, and those working in offices faced a higher risk of infection compared to those working at home. We compare the occurrence and potential determinants of mental health outcomes, functioning, and quality of life (QoL) in a subset of a sample of Brazilian individuals who worked from home and a subset who worked in the office during the first wave of COVID-19. Methods Data were collected during the first wave of COVID-19, using an online survey to assess sociodemographic and clinical variables, functioning with the Digital Functioning Assessment Short Test (D-FAST), QoL with the European Health Interview Surveys QoL instrument (EUROHIS-QOL), depression with the Patient-Reported Outcomes Measurement Information System (PROMIS) depression instrument, anxiety with the PROMIS anxiety instrument, and stress symptoms with the Impact of Event Scale-Revised (IES-R) in a large sample comprising individuals who worked in offices (n = 1685) or worked from home (n = 1,338). Results Analysis revealed that depressive and post-traumatic stress symptoms were less prevalent in individuals who worked from home and showed that they had higher functioning and QoL than those working in the office. Individuals who worked in the office were younger, more likely to be female, had lower household income, had low educational level, and were more likely to be unmarried than the home working group. Conclusion Our findings support the notion of the negative impact of the COVID-19 pandemic on mental health in both office workers and those working from home. However, the group who worked from home seem to be more resilient with fewer psychiatric symptoms and better functioning.


Introduction
In December 2019, the coronavirus disease 2019 (COVID-19) was first recognized as a disease caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) with its initial infection site in Wuhan, Hubei Province, China. 1 Initially, the disease was believed to be confined to this area, but it quickly spread worldwide and there have been 532,201,219 confirmed cases of COVID-19 and 6,305,358 people have died around the world due to COVID-19 (as of 10th June 2022). 2,3[6] The burden of COVID-19 cases forced many countries around the world to impose lockdowns and social distancing practices, to avoid the spread of the coronavirus until vaccines arrived.However, many services were not interrupted, and a considerable number of employees working onsite faced a high risk of infection by the new coronavirus, including custodial staff and orderlies in hospitals, as well as teachers and child-care workers, grocery clerks and supermarket workers, delivery people, factory and farm workers, and restaurant staff. 7][7][8] Experience from previous pandemics showed that some factors might affect mental health in the general population, such as quarantine, fear of infection, frustration and boredom, inadequate supplies, and a lack of information. 6,70][11] In addition, early career and young health care workers and women are more vulnerable to additional impacts of mental health in the workplace. 11,12Taken together, these factors suggest employees working in the office are at a higher risk of psychological distress than those working from home, who do not face direct contact with sources of infection during the COVID-19 pandemic.
A meta-analysis of cross-sectional studies reported relatively high rates of anxiety, depression, posttraumatic stress disorder (PTSD), psychological distress, and stress in the general population during the COVID-19 pandemic in eight countries 13 and similar data were reported in Brazil. 14In particular, studies focused on working in the office also showed a substantial burden of mental health symptoms in this population in distinct cultures.In China, a cross-sectional study showed a considerable proportion of symptoms of depression, anxiety, insomnia, and distress in health care workers, with more severe symptoms in workers on the front line. 10Italy was one of the most severely affected countries in terms of the number of deaths in the ongoing pandemic and health care workers in the country reported high levels of depression, anxiety, and post-traumatic stress symptoms, with an increased risk for PTSD among front line workers. 15In the United States, Young et al. 16 reported that approximately 40% of medical staff suffered from mood disorders during the pandemic.In Canada, the prevalence of anxiety and depression among medical staff was also significant. 17A study conducted by Fournier et al. 11 demonstrated that the pandemic had a marked psychological impact on all professionals working in health care facilities in France, mainly due to increased stress related to the pandemic.Thus far, no studies have compared mental health outcomes, functioning, and quality of life (QoL) between individuals working from home and those working in the office in a sample selected during the COVID-19 pandemic.Our hypothesis is that employees who worked from home experienced lower levels of distress, anxiety, depression and, consequently, better functioning and QoL than those who worked in the office.Therefore, this study aimed to compare mental health outcomes, functioning, and QoL between individuals who worked from home and those who worked in the office.

Study population
We administered a cross-sectional web-based survey using an anonymous online questionnaire Approval for this study was obtained from the local institutional review board at Hospital de Clínicas de Porto Alegre (CAAE 30741920.8.0000.5327).Online informed consent was obtained from the participants.

Knowledge regarding COVID-19
The knowledge portion of the questionnaire consisted of 10 questions regarding clinical characteristics and prevention of COVID-19.These questions were answered on a true/false basis with an additional "I don't know" option. 18The proportions of correct answers were analysed.

QoL
QoL was assessed with the European Health Interview Surveys QoL instrument (EUROHIS-QOL) consisting of eight items (overall QoL, general health, energy, activities of daily living, self-esteem, social relationships, finances, and home).Each item is rated on a five-point response scale 19 based on the 2 weeks prior to survey participation.The total score is the sum of each item, with higher scores indicating better QoL.

Psychosocial functioning
The Functioning Assessment Short Test (FAST) 20 was used to assess multiple areas of functioning, namely, autonomy, work, cognition, finance, interpersonal relationships, and leisure.For the purposes of the present study, we used the FAST online scale to allow for assessment of the degree of functional impairment experienced during the COVID-19 pandemic.Items in each domain were rated on a four-point scale based on the 2 weeks prior to survey participation.The total score is the sum of each item, and a higher score indicates poor functioning.The FAST online was validated in a sample from the Brazilian population during the COVID-19 pandemic, presenting satisfactory psychometric properties. 21

Psychiatric assessment
The severity of depression, anxiety, and stress was measured as follows: a) The Patient-Reported Outcomes Measurement Information System (PROMIS) for depression (PROMIS Short Form v1.0 -Depression 8a) assesses negative mood (sadness, guilt), views of self (self-criticism, worthlessness), and social cognition (loneliness, interpersonal alienation), as well as decreased positive affect and engagement (loss of interest, meaning, and purpose). 22,23 The PROMIS Anxiety assesses self-reported fear (fearfulness, panic), anxious misery (worry, dread), hyperarousal (tension, nervousness, restlessness), and somatic symptoms related to arousal (racing heart, dizziness).22,23 c) The Impact of Event Scale-Revised (IES-R) is

Statistical analysis
Descriptive statistics (number and %) were used to present sociodemographic and clinical characteristics.

Previous psychiatric disorders
The prevalence of self-reported psychiatric disorders was greater in people working in the office than in people working from home (43.4 vs. 38.8%,respectively, p = 0.01).Those working from home had lower prevalence of depression (23.4 vs. 29.6%,p <0.001), self-reported panic disorders (6.1 vs. 10.7%, p <0.001), and social phobia (2.1 vs. 4.5% p < 0.001) than those working in the office (Table 2).

Knowledge about COVID-19
Regarding knowledge about COVID-19, those working in the office and working from home had similar responses, except for one question: "Persons with COVID-2019 cannot infect others when a fever  is not present" (93.9 vs. 87.4%,p <0.001) (Table 3).

Multivariate analysis
We used linear regression models to analyse determinant factors associated with the scores on IES-R, depressive PROMIS Depression scores, and anxious PROMIS Anxiety scores.In addition, we also included work status (working in the office or working from home) during the pandemic in the models.All models were statistically significant for predicting higher For the IES scores, seven variables significantly contributed to the model: gender (B = 1.9, 95%    5).

Discussion
The present study compared mental health outcomes, functioning, and QoL and associated variables between people working in the office and working from home during the first wave of the ongoing COVID-19 pandemic in Brazil.We show that both groups experienced a negative impact from COVID-19 on their mental health during the ongoing pandemic; however, participants who worked from home experienced lower levels of anxiety, stress, and depression than participants who worked in the office, even after controlling for possible confounders.
Regarding sociodemographic characteristics, people working in the office were younger, female, had lower family income, were more likely to be single, and had lower levels of education.[18][19][20][21][22][23][24][25][26] In addition, the psychological distress experienced by both groups (those working in the office and those working from home) corroborates other recent studies 5,10,11,[26][27][28][29][30] and, to some extent, can be explained by psychological overload, problems sleeping, physical distancing, and fear of spreading the virus. 5,11,20,26,27,292][33] In the working in the office subset, our results for the rates of symptoms of depression (71.9%) and anxiety (86.3%) were higher than those in a meta-analysis of cross-sectional studies in the general population, which reported prevalence of symptoms of depression as high as 48.3% and of anxiety as high as 50.6%. 13However, post-traumatic stress symptoms (38.9%) were in line with the range found in other countries (from 7 to 53.8%) in the same meta-analysis. 13mparing people working in the office with people working from home, we found more symptoms of depression and distress in the former.Our study is similar to research conducted in a Spanish population that found mental health problems in health professionals 31 and particularly in those individuals that were working on the frontline. 34In Italy, the prevalence of PTSD symptoms in front line health care workers was around 50% and slightly higher than the prevalence found in our in-office workers. 15In China, a cross-sectional study in a single centre reported a smaller proportion of participants with severe symptoms of depression and anxiety among medical and administrative staff compared to the rate in our subset of people working in the office. 32Finally, our data diverge from those of a cross-sectional study in the United Kingdom which showed that respondents self-declared as working in the office had lower levels of depressive symptoms than those working from home. 33In summary, some of the differences between studies are probably because we assessed people of any profession working in the office, in contrast with previous studies that reported results for health care workers only, as well as sociocultural differences.According to Sole et al., 35 psychiatric symptoms have traditionally been associated with poor functioning in clinical samples, in agreement with our study that lower psychiatric symptoms were associated with better functioning.
Our study showed that people who worked from home had fewer depressive symptoms, stress and anxiety than people who worked in the office, suggesting they were more resilient to cope with the adversities of the pandemic.This hypothesis is supported by previous studies that have shown associations between greater resilience with less severity of depression, suicidal ideation, and anxiety symptoms, and less concern about the effects of COVID-19. 36,37Additional studies are needed to assess mental health outcomes in the ongoing pandemic considering resilience as a mediator of pandemic stressors regarding working from home.
To the best of our knowledge, this is the first study to report data comparing mental health status between Brazilians working in the office and working from home during the ongoing COVID-19 pandemic.
Interpretation of our results should consider some limitations of the study.First, we used an online survey with a convenience sample method, which may not yield a representative sample of the overall Brazilian office worker and home worker population.Second, the subset working in the office was not drawn only from health care workers, but also included essential non-health care workers, which might constitute a bias, since the former were more exposed to infection by SARS-CoV-2 and death from COVID-19 than the latter.Third, all outcomes were self-reported instead of evaluated by a clinician.Finally, there is a chance that only individuals who were struggling with their mental health during the pandemic would be interested in answering the questionnaire.

Conclusion
Our findings support the notion of the negative impact of the COVID-19 pandemic on mental health among both people working in the office and people working from home.However, in our study, those working from home experienced lower levels of stress, anxiety, and depression than those working in the office, even after controlling for potential confounders.
These findings suggest that working from home may reduce the negative effects of the ongoing pandemic in terms of symptoms of depression and PTSD, most likely because of greater resilience and knowledge about COVID-19.
available via social networks (Facebook, Instagram, and Twitter), using a convenience sampling strategy to target members of the adult Brazilian population.Data were collected between May 20th and September 13th, 2020, the first peak period of COVID-19 contagion in Brazil.Individuals working from home were identified by the question "Do you work from home?"The online questionnaire consisted of sociodemographic items, questions used to assess participants' knowledge regarding COVID-19, prevalence of previous psychiatric disorders and previous chronic disease, symptoms of COVID-19, attitudes and practices with respect to COVID-19, QoL, cognitive functioning, the severity of depression and anxiety, and symptoms of PTSD.
a self-rated, 22-item questionnaire divided into three domains (avoidance, intrusion, and hyperarousal), which evaluates the distress caused by a traumatic event.Each item is rated on a 5-point response scale (0 = not at all; 1 = a little bit; 2 = moderately; 3 = quite a bit; 4 = extremely).The IES-R total score is the sum of the average of each domain.A total score greater than 5.6 indicates psychological stress.Each of the PROMIS instruments used comprises an eight-item questionnaire that assesses symptoms over the previous 7 days, with each item rated on a 5-point response scale (1 = never; 2 = rarely; 3 = sometimes; 4 = often; 5 =always).All PROMIS scores are presented as T-scores calculated by the Health Measures Scoring Service (https://www.assessmentcenter.net/ac_scoringservice) from the raw sum score, using T-scores from the United States general population.A T-score is a standardized score, with a mean of 50 and a standard deviation (SD) of 10.For depression and anxiety, a T-score lower than or equal to 55 indicates no significant symptoms, a higher score, from 55 to 60 indicates mild symptoms, a score from 60 to 70 indicates moderate symptoms, and a score from 70 to 84.1 indicates severe symptoms.For the purpose of our study, we classified both PROMIS Depressionand PROMIS Anxiety T-scores into two categories of severity: no significant/mild symptoms (normal/mild symptoms) and moderate/severe symptoms.24,25 df = degrees of freedom; Mdn = median; PROMIS = Patient-Reported Outcomes Measurement Information System; PTSD = post-traumatic stress disorder; EUROHIS-QOL = European Health Interview Surveys QoL instrument; IES-R = Impact of Event Scale-Revised.* Work from home (n = 1,316), work in the office (n = 1,557); † 1 BRL = 0.20 USD.

Table 1 -
Characteristics and mental health symptoms in people working from home and working in the office (n = 3,023)

Table 2 -
Self-reported psychiatric disorders in people working from home and working in the office (n = 3,023)

Table 3 -
Correct answers to questions about knowledge about COVID-19 of people working from home and working in the office (n = 3,023) Data presented as n (%).COVID-19 = coronavirus disease 2019; df = degrees of freedom.

Table 4 -
Events, attitudes, and practices related to COVID-19 among people working from home and working in the office (n = 3,023)

Table 5 -
Associations between PTSD, depression, and anxiety symptoms and gender, age, educational level, household income level, history of psychiatric illness, contact with someone with COVID, and marital status