Podcast: COVID’s impact on mental health

The global pandemic: Three years later

Three years after we first began forecasting the trajectory of the COVID pandemic, we bring together IHME experts to discuss the ongoing effects of COVID and where we go from here.

In today’s episode, Pauline Chiou talks about the pandemic’s impact on mental health with Dr. Alize Ferrari and Dr. Damian Santomauro.

 Listen as a podcast

Key takeaways:

• Their research indicates that women and young people were more impacted by depression and anxiety during 2020. These populations were impacted a little less by 2021 as the world progressed to a different phase of the pandemic, though Dr. Ferrari noted that they’re still digesting the data.
• Data gaps are a concern. Dr. Santomauro urged governments to invest in high-quality surveys which can help inform policy decisions around mental health.
• COVID was essentially a population shock. “It’s important for us to learn from that so that we’re better prepared for the next population shock that comes along, whether it’s an economic shock or a shock around conflict, war, and violence – all these things that we already know do impact the prevalence of mental disorders,” said Dr. Ferrari.

Visit the mental health dashboard

Transcript

This transcript has been lightly edited for clarity

Pauline Chiou: Welcome to this special edition of the Global Health Insights podcast at the Institute for Health Metrics and Evaluation. I’m Pauline Chiou in Media Relations. As we mark the third year of the pandemic, we look at how COVID impacted mental health around the world. Alize Ferrari and Damian Santomauro are affiliate assistant professors at IHME, based out of the Queensland Center for Mental Health Research at the University of Queensland.

We know that mental health was and still is such a huge concern in the pandemic, and both of you have looked extensively at depression and anxiety. So Alize, let me start with you. After researching the many studies and the countries globally of where depression and anxiety stands with different demographics, what would you say the most important insights are that you're taking away from this research?

Dr. Alize Ferrari: Yeah, so it became pretty evident early on, at the beginning of the pandemic, that COVID was creating an environment where a lot of the determinants of mental health were being impacted, and particularly the determinants of common mental disorders like depression and anxiety disorders. The work we’ve done essentially tracked how the prevalence of these disorders changed during 2020 and 2021, and we did see an increase in cases of depression and anxiety disorders as a direct result of the pandemic.

What we saw were that women tended to be more impacted than men. Youth, children, adolescents tended to be more impacted than older populations. What we also saw was that countries where infection rates for COVID-19 were highest, countries where they had been most impacted in terms of mandates, in terms of lockdown, they were also more affected.

Pauline Chiou: So, Damian, let’s narrow down those two groups, women and younger people. What is it about those two demographics that depression and anxiety hit the hardest?

Dr. Damian Santomauro: We suspect that one of the reasons why women might have been impacted a bit more is the employments that women tend to be in were more impacted by the mandates, by the lockdowns with less secure employment, somewhat more likely to lose their jobs because of on average lower income, more likely to have less savings to buffer any kind of financial difficulties there.

We saw that the prevalence of domestic violence also increased during the pandemic, and that’s a risk factor for depression, anxiety. And we also know that women took a big brunt of the house, the caring responsibilities when people got sick, when children couldn’t go to school. So, women faced quite a lot during during the pandemic.

And we believe this might be why there was larger prevalence of depression and anxiety among women. Among youth, the youth are more likely to be impacted if there’s an economic shock, they’re more likely to lose their jobs, you know, less financially secure at the time. So they’re more likely to feel the brunt of these financial shocks that we saw that came about when the pandemic started.

What was a surprise to me, though, was, when I started this work, my hypothesis was that we would see greater prevalence in the older population because I thought that the lockdowns, the mandates would lead to more social isolation. But, you know, potentially the health being a bit riskier, that they might be at greater risk of infection. There might be more anxiety about catching COVID-19, but we just didn’t see that in the data.

We did consistently show that that youth were more likely to have elevated prevalence than senior people.

Pauline Chiou: Do you know why you didn’t see as heavy a prevalence in the older population? Because as you said, that was the worry at the beginning of the pandemic is that they are the high-risk population.

Dr. Damian Santomauro: I'm not too sure to be honest. It’s still a surprise to me today. 

Pauline Chiou: Alize, do you have any thoughts?

Dr. Alize Ferrari: It’s possible that that effect is there, but the surveys that we work with are not picking it up. If elderly population is more at risk of COVID, perhaps they’re less likely to be participating in these sorts of surveys. That’s kind of one premise. So it’s more about us not finding the data yet rather than, you know, that respect not existing.

But it’s also possible because a lot of those social determinants that we saw impacted early on are things around employment there, things about being sort of less able to move around your community about not going to school and, not being able to be more social. And those things perhaps tend to be more evident in that working-age group or the younger age group as opposed to the elderly age group.

It's important to recognize as well, as we’re progressing through different phases of the pandemic, the impact, the mental health impacts are changing. And those trends that we saw in 2020 with women in the younger populations being more impacted, that’s changing as well. So we saw a little bit less of that in 2021, and we’re still digesting the data from 2021 to make better sense of it.

But it’s important to recognize that was the landscape for 2020. This is a pandemic that’s going across the years, and the effects will change.

Pauline Chiou: So that’s encouraging to hear that the trends are changing and for the better. Yeah, and as you have identified, these determinants and you’ve got the data and you’re seeing the trends, what do we do with that information now? How can policymakers and the public use this information?

Dr. Alize Ferrari: I think it’s important to answer that question. It’s important to recognize that mental disorders was a leading cause of burden before the pandemic occurred, and we hadn’t seen a reduction in that burden at the global level. We haven’t seen that in the last 20 years leading up to COVID. What COVID did was essentially it was a population shock that meant that cases of depression and anxiety disorders increased further, making that burden grow even more.

But when we're considering our response to that burden, it’s important not just to consider the COVID response, but our response to the mental disorder burden more generally. What does the mental health service system, how does that need to change country by country to tackle the mental health demand and the distribution of mental disorders faced within these populations?

Pauline Chiou: And just out of curiosity, what are you working on next with COVID and mental health?

Dr. Alize Ferrari: So basically, we’re working on modeling how the impact on mental health changes across the different phases of the pandemic.

Pauline Chiou: So what you were talking about with the trends.

Dr. Alize Ferrari: Yeah, exactly. We’re trying to react as soon as the data comes out. We’re updating our models, essentially, and we’ve just finished an update looking at the 2021 data. And as the 2022 data becomes available, then we will be looking not just at our model but also how the indicators of mental health change as we progress through the different phases of the pandemic.

Also, I think the one thing I kind of wanted to say, but I didn’t get the chance is it’s important to learn from this in terms of how a population shock can change the prevalence of mental disorders and how the government response to that needs to be, because COVID was this big shock that basically changed everything when it comes to the landscape of mental health services and how people are accessing services for mental disorders.

In 2020, it’s important for us to learn from that so that we’re better prepared for the next population shock that comes along, whether it’s an economic shock or a shock around conflict, war, and violence, all these things that we already know do impact the prevalence of mental disorders. So that’s one thing we’re keeping in mind when we are thinking about research that’s to come.

How can we take this method that we’ve developed to measure the impact of COVID and adapt it so that we can measure the impact of another population shock.

Pauline Chiou: Speaking country by country? I mean, you look across the globe, and I don’t know if this is a fair question, but it’s a question that I’m very curious about. Is there a certain country that is doing it better or the best in the world in terms of addressing these mental health issues, knowing the trends and the data now?

Dr. Alize Ferrari: I think the data is still coming in and it’s hard to answer. Generally, we see that high-income countries have higher rates of treatment for mental disorders than low-income countries. They have a larger selection of treatment types available and they’re able to focus more on preventive strategies when it comes to preventing increases of mental disorder cases.

But having said that, the treatment for mental disorders even before COVID has been very low. We see that most people don’t receive or seek any treatment for their mental health issue, and if they do, they tend to be receiving it much later from when they first started those symptoms. And we know it’s very clear from the literature when it comes to mental disorders, early intervention is very important.

We also see that although people are receiving treatment, most of them are not getting the types of treatment that will make the most impact on reducing the severity of their symptoms. And they’re not getting those treatments for long enough. So when it comes to sort of the mental health response, it’s really about getting the message out that it’s important that more of the population are getting the evidence-based treatment that would make the most difference for their symptoms.

So that scale-up of treatment is very important. In terms of who’s doing better, then that's a very hard question to answer because the distribution of mental disease is quite different by population as well.

Pauline Chiou: So it sounds like it’s an investment issue, an investment of where you put the resources. And I did see a statistic from WHO saying that in low-income countries there was less than one mental health worker per 100,000 people. So if you take that statistic and magnify that, where does that leave you in terms of where do you even start with investment?

Dr. Alize Ferrari: There’s been a lot of work done around how best to scale up interventions for mental disorders in in resource-poor populations and how we would go about that differently, you know, in a low-income setting than we would in a high-income setting. It’s also about prioritizing, getting treatment to people who need it the most, those experiencing the most severe, the most debilitating symptoms or disorders.

When it comes to mental disorders, there is a lot of literature out there showing how particular intervention strategies can help decrease symptoms of mental disorders. So it’s just about getting those strategies and those platforms that scale up to policymakers and in a language that they understand and they’re able to listen to. And I think GBD does a good job at putting that data out there.

And you have other platforms, like the Countdown to Global Mental Health 2030, and it’s also a good mechanism of doing that.

Pauline Chiou: What more data would you like?

Dr. Damian Santomauro: One of my biggest concerns during this task, to be honest, was actually the data quality. When we were compiling all this data, there was such a large amount of noise that we had to filter through. And so our hit rate for good-quality data was so low compared to what was out there. And even today, I really want to see a lot more of these high-quality surveys coming out.

And some of these are starting to come out. So we’ve got Australian National Health Survey that just recently came out, which is a very good-quality random population survey with diagnostic interviews, and some of these surveys are coming out as well around the world. But I would like to see a lot more of them coming out and in a timely manner so that we can actually analyze this data and react accordingly.

Pauline Chiou: I’m glad you brought up the quality of data because the Countdown to Global Mental Health 2030 has just come out with its report and its dashboard, and they do talk about countries that are missing data. And so you can look at a table of countries, and so can you both tell me why that’s important and how do we get more data from all the countries around the world? And then also, how can we use this dashboard?

Dr. Alize Ferrari: Well, I think the Countdown to Global Mental Health 2030 dashboard is important. It’s essentially a monitoring platform. It holds within it a wealth of indicators around mental health, so that can range from the types of indicators we generate as part of the Global Burden of Disease study. So prevalence and burden estimates, but also it has indicators around attitudes towards mental health, around stigma, it has indicators around service utilization, around environmental impacts or the social determinants of mental health.

Essentially, when we put all of that together, it’s a monitoring platform that allows us to track how these indicators change over time and essentially hold governments, policymakers, and all the stakeholders accountable for how these indicators are changing and whether it’s within the direction that we need to reduce the burden of mental disorders within those countries. We’ve seen in the GBD that data can be a very powerful tool.

Health metrics can be very powerful. And the Countdown to Global Mental Health is another example of a tool we can use to try and guide the mental health response in different countries. There’s a lot of data missing you would have seen from the tool. That’s true in the work that we do within the GBD as well.

And it’s important to take the opportunity to kind of recognize that, but also use these tools as a way to highlight where the big gaps in the data is and where more research on mental health is needed.

Pauline Chiou: And Damian, did you want to add to that about the dashboard?

Dr. Damian Santomauro: Just that I think that one of the biggest limitations in this field is, is that the limitations in where we get the data so that the gap, those data gaps, most of our data that we tend to compile does tend to be from high-income countries. And the data in low- and middle-income countries does tend to be quite sparse.

And in our work we try very hard to try to compile these data sources just because it is so important to offer proper representation of all of the globe, the global population. And in GBD, we have this philosophy that we leave no gaps. We leave no gaps in our estimates because when there’s no estimate available, it is often interpreted as well, that doesn’t exist.

So if we say there’s no prevalence, we don’t report a prevalence of depression in a location where there is no data, then that’s often actually interpreted as, we’re not even going to look at depression in that country because if we just ignore it, there’s no data available. It’s often treated as if the prevalence is zero, which it isn’t.

And so we often try to find ways to incorporate maybe neighboring data sources or try to find ways to still generate a modeled estimate for every location where we can so, that there are no data gaps. And so that no one can make the argument that this is all well, we don’t have to worry about depression or anxiety in our country because it doesn’t exist, when it clearly does.

Pauline Chiou: So is the solution to spur governments to actually invest in doing these surveys, or private donors?

Dr. Damian Santomauro: I would put that onus on the governments if they want. Governments should be motivated to have good data of mental health in their own locations, in their own countries. That’s relevant to them. So if they don’t have that, then the next best estimate will be something that’s derived either through a modeled estimate or from a neighboring country or a similar country.

But I would say that governments should be prioritizing mental health, that they should be trying to find out how many people are going to be experiencing disability from these disorders. What’s the current service use in my country? What's the service demand in my country to help inform the policy decisions?

Pauline Chiou: Well, hopefully this podcast and the dashboard will all work towards that. Damian and Alize, thank you so much for the conversation.

Dr. Damian Santomauro: Thank you, Pauline.

Dr. Alize Ferrari: Thanks, Pauline.