An IDIAPJGol study suggests that in the first year of the pandemic, fewer cases of anxiety and depression were detected in Primary Care

The researchers have analyzed data from more than 3 million people to calculate the expected incidence of these diagnoses during the first year of the pandemic, which they have subsequently compared with the incidence actually observed. A peak in anxiety diagnoses was observed at the start of the lockdown. Beyond this peak, the incidence of anxiety and depression diagnoses was lower than expected, especially in women, young adults, and people living in more disadvantaged areas.

In Catalonia, most studies on the impact of COVID-19 on mental health have been carried out based on self-administered surveys carried out during the initial stages of the pandemic. In these surveys, an increase in symptoms of anxiety and depression during confinement is intuited, especially among women and younger adults. However, health visits related to mental health problems were substantially reduced in primary care, emergency services and hospital settings after the announcement of the confinement in March 2020. The discrepancy between the increase in psychological distress in the population and the reduction in mental health diagnoses in the context of the pandemic may be indicative of a lack or a delay in the detection of these disorders. This fact is especially relevant in the case of anxiety and depression, since diagnostic delay is frequently associated with worse health outcomes in the adult population.

Some studies suggest that the effects of the pandemic on people's mental health and well-being may persist beyond confinement measures, causing an increase in the number and severity of long-term mental health problems . In this study, IDIAPJGol researchers have analyzed the incidence of anxiety disorders and depressive disorders to determine if their trends had been affected by the different stages of the COVID-19 pandemic in Catalonia. To do so, they have analyzed data from primary care of more than 3 million people over 18 years of age. Based on the incidence of these disorders during the two years prior to the pandemic, the researchers have made an estimate of the expected incidence, which they have subsequently compared with the incidence actually observed during the year after the start of confinement in Catalonia (from March from 2020 to March 2021).

Women, young adults and inhabitants of disadvantaged urban areas, the groups most affected

In this large population-based cohort study, researchers have observed large variations in the incidence of anxiety disorders and depressive disorders diagnosed in primary care during the different periods of the COVID-19 pandemic in Catalonia. The incidence of anxiety disorders showed a sudden spike at the start of the lockdown, rising 37% compared to expected values ​​in March 2020. This spike was followed by a 16% reduction in diagnoses during the months after the lockdown. confinement. On the other hand, the incidence of depressive disorders decreased sharply at the beginning of the pandemic, reaching its minimum value in April 2020. Compared with the expected data, the reductions in the diagnosis of depressive disorders were 46% during the confinement, and 22% in the following months.

“According to our model, the incidence of anxiety disorders and depressive disorders did not reach the expected values ​​one year after the start of the confinement in Catalonia. This suggests that the detection of these health problems has not yet recovered from the negative effects of the pandemic”, explains Berta Raventós, first author of the study. Although the negative impact on the incidence of anxiety disorders and depressive disorders seemed to occur in all sexes, age groups and socioeconomic levels, a greater affectation was observed among women, young adults and people living in the areas most disadvantaged urban areas.

"The reductions in diagnoses in these groups are especially worrying, since they had previously been identified as one of the most affected by the pandemic at the mental health level," adds Raventós. In addition, the study suggests that people between the ages of 18 and 34 were the only age group with significant increases in cases of anxiety disorders during the last quarter of 2020 (women) and the first quarter of 2021 (both women and men) in compared to the same periods in 2018 and 2019. The worsening mental health of this group can likely be attributed to the drastic disruption of their daily lives, including their access to education and job opportunities, and restrictions on social interactions.

The reduced number of new diagnoses observed, compared to the expected number obtained in this study, probably represents a large number of disorders that have not been diagnosed or treated. In the future, this could lead to an increase in the demand for mental health services, a greater use of emergency services due to problems of  mental health and an increased risk of suicide.     

The study has been published in the scientific journal BMJ Open and can be consulted here.