A Columbia University Mailman School of Public Health studyResearcherreports high global prevalence of depression and anxiety during the COVID-19 pandemic. It also shows how implementing mitigation strategies, including public transportation and school closings, as well as staying at home orders, has affected such disruptions. Results will be published in Psychological medicine.
Our research found an increased global prevalence of these mental health problems during COVID-19 and also showed that there were large differences at the regional and country levels, says João Castaldelli-Maia, MD, PhD, NIDA-INVEST Postdoctoral Fellow in the Department of Epidemiology and first author . Asia in particular (most of the studies came from China) showed lower levels of anxiety and depression compared to other regions of the world. The closure of public transport increased fear, whether two weeks or four weeks after the closure was passed, especially in Europe.
With the end date July 29, 2020, the researchers analyzed data from Pubmed, MEDLINE, Web of Science and medRxiv on the prevalence of depression and anxiety, among others. They also checked the Oxford Covid-19 Government Response Tracker for the containment and closure policy indices; and the Global Burden of Disease Study for previous depression and anxiety. The WHO database was also used, which contains COVID literature for studies published on the same date.
A total of 226,638 people were examined in 60 included studies. The global prevalence of both depression and anxiety during the COVID-19 pandemic was 24 percent and 21 percent, respectively. Asia with rates of 18 percent each, and China in particular, had the lowest prevalence of both diseases. In terms of the mental health impact of mitigation strategies - whether it be public transport closures, school closings, workplace closures, public events being canceled or gatherings being restricted - only public transport closures have increased the prevalence of anxiety, particularly in Europe.
Castaldelli-Maia and colleagues found a worldwide prevalence of anxiety of 21 percent. Asia had lower levels of anxiety (18 percent) compared to other regions of the world (29 percent). In this case, Europe was no different from Asia and other regions of the world. Here too, a subgroup analysis at country level showed that China, at 16 percent, had a lower prevalence of anxiety than all other countries at 26 percent.
Our study confirms the importance of examining the extent of mental disorders and the potential impact of social distancing measures on mental health outcomes. says Silvia Martins, MD, PhD, associate professor of epidemiology at Columbia Mailman School and senior author. Mental health problems should be viewed not only as a delayed consequence of the COVID-19 pandemic, but also as an accompanying epidemic.
Within the subgroup of Asian countries, the estimates of the prevalence of depression ranged from 15 to 20 percent. When comparing the prevalence of depression in the pre- and post-COVID-19 era, the estimates are demonstrably greater between 1.3 and 3.4 percent after the onset of COVID-19.
Depression has been observed in 26 percent of the population in Europe and 39 percent in other non-Asian regions of the world. Further analysis showed that China had a lower prevalence of depression, 16 percent compared to 29 percent in other countries.
Similarly, as reported in the Asian countries subgroup, the prevalence of anxiety is higher after COVID-19. The fear rates of COVID-19 were between 2.1 and 4.1 percent compared to 18 percent in the present study. An increase in anxiety can be observed in countries outside Asia and Europe (3 to 7 percent vs. 29 percent).
The lower levels of depression and anxiety we found in Asian countries might be culture dependent, Martins observes.
The impact of public transport shutdowns on anxiety levels suggests the importance of these systems to world populations, particularly results in Europe but not Asia. These results could be related to the fact that, on average, Europe has more effective and better developed public transport networks, making Europeans more reliant on public transport than people in Asian countries, noted Martins.
The COVID-19 pandemic and the resulting physical distancing measures to contain the spread of the virus have certainly had an impact on the mental health of populations around the world, and the high prevalence of mental disorders is of considerable concern during the COVID era, Castaldelli-Maia said. These results have important implications for policy makers and show the urgent need for the health sector to increase support now for the prevention and early intervention of depression and anxiety.
Co-authors are Megan Marziali and Ziyin Lu, Columbia Mailman School.
The study was supported by the National Institute on Drug Abuse, National Institutes of Health.