Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic - PubMed (original) (raw)
Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic
COVID-19 Mental Disorders Collaborators. Lancet. 2021.
Abstract
Background: Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we aimed to quantify the impact of the COVID-19 pandemic on the prevalence and burden of major depressive disorder and anxiety disorders globally in 2020.
Methods: We conducted a systematic review of data reporting the prevalence of major depressive disorder and anxiety disorders during the COVID-19 pandemic and published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google Scholar, preprint servers, grey literature sources, and consulted experts. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population during the COVID-19 pandemic and had a pre-pandemic baseline. We used the assembled data in a meta-regression to estimate change in the prevalence of major depressive disorder and anxiety disorders between pre-pandemic and mid-pandemic (using periods as defined by each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 infection rate, and daily excess mortality rate). We then used this model to estimate the change from pre-pandemic prevalence (estimated using Disease Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and location. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for major depressive disorder and anxiety disorders.
Findings: We identified 5683 unique data sources, of which 48 met inclusion criteria (46 studies met criteria for major depressive disorder and 27 for anxiety disorders). Two COVID-19 impact indicators, specifically daily SARS-CoV-2 infection rates and reductions in human mobility, were associated with increased prevalence of major depressive disorder (regression coefficient [B] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 [7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders (0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were affected more by the pandemic than males (B 0·1 [0·1 to 0·2; p=0·0001] for major depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and younger age groups were more affected than older age groups (-0·007 [-0·009 to -0·006; p=0·0001] for major depressive disorder, -0·003 [-0·005 to -0·002; p=0·0001] for anxiety disorders). We estimated that the locations hit hardest by the pandemic in 2020, as measured with decreased human mobility and daily SARS-CoV-2 infection rate, had the greatest increases in prevalence of major depressive disorder and anxiety disorders. We estimated an additional 53·2 million (44·8 to 62·9) cases of major depressive disorder globally (an increase of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. Altogether, major depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020.
Interpretation: This pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option.
Funding: Queensland Health, National Health and Medical Research Council, and the Bill and Melinda Gates Foundation.
Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of interests C Adolph reports support from the Benifcus Foundation. A Flaxman holds stock in Agathos, and consults and advises Janssen, SwissRe, Sanofi, and Merck for Mothers on simulation modeling, outside of the submitted work. S Nomura reports support from the Ministry of Education, Culture, Sports, Science and Technology of Japan. All other authors declare no competing interests.
Figures
Figure 1
Global prevalence of major depressive disorder (A) and anxiety disorders (B) before and after adjustment for (ie, during) the COVID-19 pandemic, 2020, by age and sex
Figure 2
Change in the prevalence of major depressive disorder after adjustment for (ie, during) the COVID−19 pandemic, 2020
Figure 3
Change in the prevalence of anxiety disorders after adjustment for (ie, during) the COVID−19 pandemic, 2020
Figure 4
Global burden of major depressive disorder and anxiety disorders by age and sex, 2020 Baseline refers to pre-pandemic DALYs and additional refers to additional burden due to the COVID−19 pandemic. DALYs=disability-adjusted life-years.
Comment in
- Depression and anxiety disorders during the COVID-19 pandemic: knowns and unknowns.
Taquet M, Holmes EA, Harrison PJ. Taquet M, et al. Lancet. 2021 Nov 6;398(10312):1665-1666. doi: 10.1016/S0140-6736(21)02221-2. Epub 2021 Oct 8. Lancet. 2021. PMID: 34634251 Free PMC article. No abstract available. - Depression and anxiety during COVID-19 - Authors' reply.
Santomauro DF, Whiteford HA, Ferrari AJ. Santomauro DF, et al. Lancet. 2022 Feb 5;399(10324):518-519. doi: 10.1016/S0140-6736(21)02800-2. Lancet. 2022. PMID: 35123688 Free PMC article. No abstract available. - Depression and anxiety during COVID-19.
Daly M, Robinson E. Daly M, et al. Lancet. 2022 Feb 5;399(10324):518. doi: 10.1016/S0140-6736(22)00187-8. Lancet. 2022. PMID: 35123689 Free PMC article. No abstract available.
Similar articles
- Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.
GBD 2019 Mental Disorders Collaborators. GBD 2019 Mental Disorders Collaborators. Lancet Psychiatry. 2022 Feb;9(2):137-150. doi: 10.1016/S2215-0366(21)00395-3. Epub 2022 Jan 10. Lancet Psychiatry. 2022. PMID: 35026139 Free PMC article. - Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010.
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray CJ, Vos T. Whiteford HA, et al. Lancet. 2013 Nov 9;382(9904):1575-86. doi: 10.1016/S0140-6736(13)61611-6. Epub 2013 Aug 29. Lancet. 2013. PMID: 23993280 Review. - Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
Global Burden of Disease Study 2013 Collaborators. Global Burden of Disease Study 2013 Collaborators. Lancet. 2015 Aug 22;386(9995):743-800. doi: 10.1016/S0140-6736(15)60692-4. Epub 2015 Jun 7. Lancet. 2015. PMID: 26063472 Free PMC article. Review.
Cited by
- Prevalence and correlates of post-stroke anxiety in Changde, China during 2023 following the lifting of COVID-19 restrictions.
Luo S, Hong Y, Wen J, Zhang X. Luo S, et al. Front Psychiatry. 2024 Sep 30;15:1430034. doi: 10.3389/fpsyt.2024.1430034. eCollection 2024. Front Psychiatry. 2024. PMID: 39403325 Free PMC article. - A multiscale inflammatory map: linking individual stress to societal dysfunction.
Vodovotz Y, Arciero J, Verschure PF, Katz DL. Vodovotz Y, et al. Front Sci. 2024;1:1239462. doi: 10.3389/fsci.2023.1239462. Epub 2024 Mar 11. Front Sci. 2024. PMID: 39398282 Free PMC article. - Association between dietary total antioxidant capacity and sleep problems and depressive symptoms among U.S. adults.
Pan H, Lin S. Pan H, et al. Front Nutr. 2024 Sep 19;11:1450815. doi: 10.3389/fnut.2024.1450815. eCollection 2024. Front Nutr. 2024. PMID: 39391679 Free PMC article. - Cognitive Orientation to daily Occupational Performance (CO-OP) for mood, anxiety, and adjustment disorders: a pilot study.
Wong SR, Chan MR, Chong E, Dancza KM. Wong SR, et al. Front Psychiatry. 2024 Sep 26;15:1428811. doi: 10.3389/fpsyt.2024.1428811. eCollection 2024. Front Psychiatry. 2024. PMID: 39391086 Free PMC article. - Possible roles of neuropeptide/transmitter and autoantibody modulation in emotional problems and aggression.
Værøy H, Skar-Fröding R, Hareton E, Fetissov SO. Værøy H, et al. Front Psychiatry. 2024 Sep 24;15:1419574. doi: 10.3389/fpsyt.2024.1419574. eCollection 2024. Front Psychiatry. 2024. PMID: 39381606 Free PMC article. Review.
References
- Patel V, Chisholm D, Parikh R, et al. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition. Lancet. 2016;387:1672–1685. - PubMed
- Institute for Health Metrics and Evaluation . Institute for Health Metrics and Evaluation, University of Washington; Seattle, WA: 2020. COVID-19 projections.https://covid19.healthdata.org/
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous