The COVID-19 pandemic has taken its toll on people’s mental health. In this interview, we spoke to Dr Damian Santomauro and Dr Alize Ferrari about their latest research on COVID-19 and its impact on mental health.
The current COVID-19 pandemic has generated great scientific and medical interest. What prompted your latest research on mental health and COVID-19?
This study was conducted as part of the Global Burden of Disease (GBD) 2020 study which is currently estimating the prevalence, mortality and health burden of over 300 illnesses and injuries, including 12 mental disorders. .
We have suspected from past demographic shocks in history (e.g. war, localized pandemics, financial crises) that the prevalence of major depressive disorders and anxiety disorders has likely increased in 2020 due to the COVID-19 pandemic, our question was “by how much?” . Ignoring the pandemic could be interpreted as “no change” in the prevalence of these disorders for 2020, which we knew was not the case. We have therefore developed a new methodology to take into account the impact of the COVID-19 pandemic on the prevalence of these disorders.
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As many countries have entered lockdown in the past 18 months, what has been the impact of COVID-19 on mental health?
The COVID-19 pandemic has likely impacted mental health in different ways. The pandemic has created an environment where many determinants of mental health are affected.
Examples include (but are not limited to) reduced social contacts and interactions with peers, economic impacts, loss of livelihoods, increased rates of domestic violence and reduced access to health services. Mental Health.
Can you describe how you conducted your latest research on the impact of COVID-19 on mental health?
We performed a systematic review of the literature to compile survey data on the prevalence of depressive and anxiety disorders during the COVID-19 pandemic, with corresponding pre-pandemic prevalence estimates.
From there, we developed a model to quantify the association between the change in prevalence and indicators of the COVID-19 pandemic, in particular the daily COVID-19 infection rate and human mobility (movement of population). We didn’t have estimates of changes in prevalence for the world, but we did have estimates of these COVID-19 impact indicators across the world.
We therefore extrapolated the change in prevalence across the world based on the estimated association between the change in prevalence of these disorders and the impact indicators of COVID-19. We had pre-pandemic estimates of the prevalence of these disorders from the Global Burden of Disease study (informed by data prior to 2020) and therefore were able to adjust these pre-pandemic estimates by the change estimates. extrapolated prevalence rates.
What did your results show? Were there any differences observed between the different sexes? If so, what were the differences and what are the explanations?
We have estimated that the prevalence of major depressive disorders has increased by 28% globally and that anxiety disorders have increased by 26% globally. This corresponds to 53 million people with major depressive disorders and 76 million people with anxiety disorders due to the COVID-19 pandemic.
The observed change was higher for women, and we believe this is because women are more likely to be affected by the social and economic consequences of the pandemic. Women are more likely to take on additional caregiving and household responsibilities due to school closures or family member unease. Women also tend to have lower wages, less savings and less secure jobs than men, and therefore are more likely to be financially disadvantaged during the pandemic.
There is also evidence that domestic violence has increased during times of foreclosure, and women are more likely than men to be victims of domestic violence.
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Were there any limits to your research? If so, what were they?
There were several limitations that I think are important for people to take into consideration when interpreting our estimates. First, most of the data we obtained to shed light on the association between the change in prevalence and the impact indicators of COVID-19 came from high-income countries, and we had to assume that this association is applicable to the global scale. We do not have data for some of the regions where we estimated the largest increases, for example South Asia and North Africa, and the Middle East.
There are also limits to our COVID-19 impact indicators, for example, human mobility is an index informed by anonymous data on cell phone mobility. If people of low socioeconomic status in a particular location are less likely to have a cell phone than people of high socioeconomic status, then human mobility from that location may only represent the mobility of people of high socioeconomic status. (which may have a greater capacity reduce their trips for work, etc.).
There were also few studies using diagnostic instruments, so we had to take advantage of studies that used symptom scales with established thresholds for probable diagnosis. Fortunately, we modeled the change in prevalence with these data (rather than the actual prevalence), and therefore assuming that the predictive validity of these scales for a full diagnosis remains constant before and mid-pandemic, the change in prevalence from these scales are equivalent to changes in diagnostic prevalence.
However, this is an additional hypothesis that we had to make, and there is currently not enough data to test this hypothesis.
Much of the research on the COVID-19 pandemic has focused on its causes and vaccine development. Why is it equally important to investigate the impacts of the lockdown and the virus itself not only on people’s physical health, but also on their mental health?
Even before the COVID-19 pandemic, major depressive disorders and anxiety disorders were the main causes of the disease burden in most countries, with mental health systems in most countries not well equipped to do so. faced with this high load.
Once again, the COVID-19 pandemic has created an environment in which many determinants of mental health are affected, meaning that the demand on these mental health systems has now increased. Mental disorders are not only personally disabling, they also increase the risk of other disabling health problems and suicide. They also have societal impacts including (but not limited to) reduced labor productivity, increased absenteeism, increased caregiver responsibilities, etc.
We need to seriously reassess how we are meeting the mental health needs of the population in the future.
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What can governments and policymakers do to help strengthen global mental health systems and what impact would this have on people with these disorders?
Even before 2020, major depressive disorders and anxiety disorders were already the main causes of the disease burden in most countries, with mental health systems in most countries not well equipped to cope with the burden. high. COVID-19 has caused the demand for these mental health systems to now increase.
We hope that governments, service planners and policymakers will factor in the additional burden of mental disorders in any contingency planning for the COVID-19 pandemic. Strategies should promote mental well-being and target the determinants of poor mental health exacerbated by the COVID-19 pandemic Effective treatments already exist for these disorders and strategies should promote interventions to treat people who develop the disorder mental.
What are the next steps for you and your research on the impact of COVID-19 and mental health?
This work is in progress and we still have a lot to do. We will soon start compiling new data released in 2021 and hope this resolves some of the limitations of our models by improving data coverage globally. We will also explore additional indicators of the impacts of the COVID-19 pandemic, as well as how the impacts of these indicators change throughout the pandemic.
We still need to quantify the impact of the COVID-19 pandemic on the prevalence of other mental disorders. Here we focused on major depressive disorder and anxiety disorders because we have seen from past population shocks that they are the disorders most likely to be affected. These disorders were also at the center of most of the available data. But there is new evidence of impacts on other mental disorders, such as eating disorders.
Where can readers find more information?
The document is freely available and can be downloaded free of charge to everyone at the following link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02143-7/fulltext
About Dr Damian Santomauro
Dr Damian Santomauro is a Senior Researcher in the Policy and Epidemiology Group (PEG) based at the Queensland Center for Mental Health Research (QCMHR).
He is also an adjunct research fellow at the School of Public Health at the University of Queensland and an Affiliate Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, for his work on the Global Burden of Disease where he is responsible for severity analysis and epidemiological modeling of mental disorders.
About Dr AlizÃ© Ferrari
Dr Alize Ferrari is Principal Investigator and Head of the Epidemiology and Burden of Disease Team at the Queensland Center for Mental Health Research. She is an Affiliate Assistant Professor of Health Metrics Sciences at the University of Washington and a National Council for Health and Medical Research Early Career Fellowship holder at the School of Public Health. University of Queensland.
Alize is the mental disorder team leader for the Global Burden of Disease study, led by the Institute for Health Metrics and Evaluation at the University of Washington. She oversees the team that is responsible for all mental disorder outcomes in the annual iterations of the study.