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ABSTRACT BACKGROUND: Emotional distress increases, also affected by the setting. OBJECTIVE: To estimate changes in prevalence of severe anxiety and depressive symptoms and associated factors. DESIGN AND SETTING: This cross-sectional study included adults living in Manaus selected through a three-stage probability sampling in 2015 and 2019. METHODS: This is an analysis of two surveys conducted. The outcomes were assessed by Generalized Anxiety Disorder 7-item (≥ 15 points) and Patient Health Questionnaire 9-item (≥ 20), and changes were tested by chi-square goodness-of-fit. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated by Poisson regression. RESULTS: Severe anxiety symptoms increased from 3.3% (95%CI = 2.7–3.9) in 2015 (n = 3,479) to 8.7% (95%CI = 7.5–9.8) in 2019 (n = 2,321); severe depressive symptoms changed from 2.5% (95%CI = 2.0–3.0) to 8.5% (95%CI = 7.3–9.6). Variations were more pronounced in social vulnerability (P < 0.05). Outcomes were higher in women (anxiety: PR = 1.27; 95%CI = 1.20–1.34, depression: PR = 1.35; 95%CI = 1.27–1.44), low-income individuals (anxiety: PR = 1.90; 95%CI = 1.20–3.00, depression: PR = 1.98; 95%CI = 1.22–3.19), less educated individuals (anxiety: PR = 2.20; 95%CI = 1.16–4.18, depression: PR = 2.37; 95%CI = 1.23–4.60), and individuals with poor health status (anxiety: PR = 9.06; 95%CI = 6.72–12.21, depression: PR = 8.99; 95%CI = 6.67–12.12). CONCLUSION: Severe anxiety and depression tripled in Manaus, potentially reflecting Brazilian socioeconomic crises. BACKGROUND increases setting OBJECTIVE factors SETTING crosssectional cross sectional threestage three stage 201 METHODS conducted 7item item 7 ≥ ( 1 points 9item 9 20, 20 , 20) chisquare chi square goodnessoffit. goodnessoffit goodness fit. fit goodness-of-fit (PR 95 95CI CI regression RESULTS 33 3 3.3 2.7–3.9 2739 2 n 3,479 3479 479 87 8 8.7 7.5–9.8 7598 5 2,321 2321 321 2,321) 25 2.5 2.0–3.0 2030 0 85 8.5 7.3–9.6. 7396 7.3–9.6 . 6 7.3–9.6) P 0.05. 005 0.05 05 0.05) (anxiety 1.27 127 27 120134 34 1.20–1.34 1.35 135 35 1.27–1.44, 127144 1.27–1.44 44 1.27–1.44) lowincome low income 1.90 190 90 120300 00 1.20–3.00 1.98 198 98 1.22–3.19, 122319 1.22–3.19 22 19 1.22–3.19) 2.20 220 116418 16 4 18 1.16–4.18 2.37 237 37 1.23–4.60, 123460 1.23–4.60 23 60 1.23–4.60) 9.06 906 06 6721221 72 12 21 6.72–12.21 8.99 899 99 6.67–12.12. 6671212 6.67–12.12 67 6.67–12.12) CONCLUSION crises 3. 2.7–3. 273 3,47 347 47 8. 7.5–9. 759 2,32 232 32 2. 2.0–3. 203 739 7.3–9. 0.0 1.2 12013 1.20–1.3 1.3 13 12714 1.27–1.4 1.9 12030 1.20–3.0 12231 1.22–3.1 2.2 11641 1.16–4.1 2.3 12346 1.23–4.6 9.0 672122 6.72–12.2 8.9 89 667121 6.67–12.1 2.7–3 3,4 7.5–9 75 2,3 2.0–3 73 7.3–9 0. 1. 1201 1.20–1. 1271 1.27–1. 1203 1.20–3. 1223 1.22–3. 1164 1.16–4. 1234 1.23–4. 9. 67212 6.72–12. 66712 6.67–12. 2.7– 3, 7.5– 2, 2.0– 7.3– 120 1.20–1 1.27–1 1.20–3 122 1.22–3 116 1.16–4 123 1.23–4 6721 6.72–12 6671 6.67–12 2.7 7.5 2.0 7.3 1.20– 1.27– 1.22– 11 1.16– 1.23– 672 6.72–1 667 6.67–1 7. 1.20 1.22 1.16 1.23 6.72– 66 6.67– 1.1 6.72 6.67 6.7 6.6 6.