COVID-19 Pandemic Led to Stark Rise in Depression and Anxiety Disorders Globally

The COVID-19 pandemic led to a sharp rise in depressive and anxiety disorders worldwide in 2020, with women and young people being the most affected. Credit: The Lancet

Initial global estimates of the impact of the COVID-19 pandemic on mental health in 2020 suggest that an additional 53 million cases of major depressive disorder and 76 million cases of anxiety disorders were attributable to the pandemic. Women and young people were most affected by depressive and anxiety disorders in 2020. Countries hardest hit by the pandemic in 2020 had the largest increase in cases of major depressive disorder and anxiety disorders. The authors call for urgent action by governments and policymakers to strengthen mental health systems worldwide to meet the increased demand caused by the pandemic.

Cases of major depressive disorder and anxiety disorders have increased by more than a quarter worldwide in 2020 as a result of the COVID-19 pandemic, according to the first global estimates of the pandemic’s effects on mental health, published in The Lancet.

In 2020, the number of cases of major depressive disorder and anxiety disorders increased by 28% and 26%, respectively. Women were more affected than men, and younger people were more affected than older age groups. Countries with high COVID-19 infection rates and large reductions in people’s traffic – due to measures such as lockdowns and school closures – had the largest increases in the prevalence of major depressive disorder and anxiety disorders.

Even before the COVID-19 pandemic, depressive disorders and anxiety disorders — which can increase the risk of other health effects such as suicide — contributed significantly to the global burden of disease, affecting millions of men and women of all ages around the world.

Lead author Dr Damian Santomauro, of the Queensland Center for Mental Health Research, School of Public Health, University of Queensland, Australia, said: “Our findings highlight the urgent need to strengthen mental health systems to tackle the growing burden of major depressive disorder and anxiety disorders worldwide. Promoting mental well-being, addressing factors that contribute to poor mental health exacerbated by the pandemic, and improving the treatment of people who develop mental illness should be central to efforts to support the Even before the pandemic, mental health systems in most countries were historically under-resourced and disorganized in their services. It will be challenging to meet the additional demand for mental health services due to COVID-19 , but taking no action would be no should be an option.”

So far, no studies had analyzed the global impact of the COVID-19 pandemic on the prevalence of major depressive and anxiety disorders in 2020. Most of the previous work involved surveys of specific locations over a short period of time.

The new study is the first to assess the global effects of the pandemic on major depressive disorders and anxiety disorders, quantifying the prevalence and burden of the disorders by age, gender and location in 204 countries and territories by 2020.

A systematic literature search was conducted to identify population survey data published between January 1, 2020 and January 29, 2021. Eligible studies reported the prevalence of depressive or anxiety disorders that were representative of the general population and had a prepandemic baseline. Using a disease modeling meta-analysis tool, data from eligible studies were used to estimate changes in the prevalence of major depressive disorder and anxiety disorders due to COVID-19 based on age, gender, and location, including in sites for which no eligible studies were available. Estimates of the daily COVID-19 infection rate and the movement of people were used as indicators of the impact of the pandemic on the population.

The systematic review identified 5,683 unique data sources, of which 48 (one of which reported in two regions) met the inclusion criteria. Most studies came from Western Europe (22) and high-income North America (14), while others from Australasia (5), high-income Asia (5), East Asia (2) and Central Europe (1).

The meta-analysis indicates that an increased number of COVID-19 infections and reduced people’s exercise were associated with an increased prevalence of major depressive and anxiety disorders, suggesting that the countries most affected by the pandemic in 2020 had the largest increase in the prevalence of the disorders.

Without the pandemic, model estimates suggest that by 2020 there would have been 193 million cases of major depressive disorder (2,471 cases per 100,000 population) worldwide. However, the analysis shows that there were 246 million cases (3,153 per 100,000), a 28% increase (another 53 million cases). More than 35 million of the additional cases were in women, compared with nearly 18 million in men.

Model estimates suggest that by 2020 there would have been 298 million cases of anxiety disorders worldwide (3,825 per 100,000 population) had the pandemic not occurred. The analysis shows that in 2020 there were an estimated 374 million cases (4,802 per 100,000), an increase of 26% (another 76 million cases). Nearly 52 million of the additional cases were in women, compared with about 24 million in men.

Younger people were more likely to suffer from depressive and anxiety disorders in 2020 than older age groups. The excess prevalence of these disorders peaked in the 20-24 age group (1,118 additional cases of major depressive disorder per 100,000 and 1,331 additional cases of anxiety disorders per 100,000) and decreased with increasing age.

Co-author Alize Ferrari, Team Leader GBD Mental Disorders at the Queensland Center for Mental Health Research, School of Public Health, University of Queensland, Australia, said: “The COVID-19 pandemic has many existing inequalities and social determinants of mental health. Unfortunately, for a variety of reasons, women were always more likely to be worse affected by the social and economic impact of the pandemic. Additional care and household responsibilities usually fall on women, and as women are more likely to be victims of domestic violence, which increased at different stages of the pandemic.

“School closures and broader restrictions that limited young people’s ability to learn and relate to their peers, coupled with the increased risk of unemployment, also meant that young people were also more severely affected by depressive and anxiety disorders during the pandemic. It is crucial that policymakers consider these kinds of underlying factors as part of measures to strengthen mental health.”

The authors acknowledge that their study was limited by a lack of high-quality data on the effects of the COVID-19 pandemic on mental health in many parts of the world, especially low- and middle-income countries. As a result, they say extrapolated estimates generated for countries where data was missing should be interpreted with caution and argue for better coverage and quality of the data globally. Most of the available data was based on self-reported symptom scales that estimate only probable cases of major depressive disorder and anxiety disorders. More data from mental health diagnostic studies representative of the general population — only three of which covered the study period — will improve understanding of the pandemic’s effects on mental health. The prevalence of other mental health disorders — such as eating disorders — may also have been impacted by the COVID-19 pandemic, and the authors say these should be assessed as new mental health studies are conducted.

dr. Maxime Taquet and Professor Paul Harrison, of the University of Oxford, and Professor Emily Holmes, of Uppsala University and the Karolinska Institute, who were not involved in the study, wrote in a linked comment: “The first global insight into the burden of depressive and anxiety disorders during the pandemic by Santomauro and colleagues clearly highlights the impact of the pandemic on mental health worldwide.” They echo the study authors’ call for action to strengthen mental health systems, saying: “The study therefore urgently needs to stimulate more research to explore the fuller geographic distribution of depression and anxiety, the prevalence of depressive and anxiety disorders and the underlying mechanisms to improve mental health in the context of the COVID-19 pandemic worldwide.”

Reference: “Global Prevalence and Burden of Depressive and Anxiety Disorders in 204 Countries and Territories in 2020 Due to the COVID-19 Pandemic” Oct 8, 2021, The Lancet.
DOI: 10.1016/S0140-6736(21) 02143-7

This study was funded by Queensland Health, National Health and Medical Research Council and The Bill and Melinda Gates Foundation. It was conducted by researchers from the University of Queensland, Queensland Center for Mental Health Research, Australia, and the University of Washington School of Medicine, USA.