Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic

Abstract

Prior to 2020, mental disorders were leading causes of health-related burden, with depressive and anxiety disorders being leading contributors of 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-todate
information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we sought to quantify the impact of the COVID-19 pandemic on the prevalence and burden of depressive and anxiety disorders globally in 2020.

Methods

We conducted a systematic review for data reporting the prevalence of depressive and anxiety disorders during the COVID-19 pandemic and published between 1 January 2020 and 29 January 2021. We searched PubMed, COVID-19: living map of the evidence by Eppi-centre, The DEPRESSD Project, World Health
Organization-COVID 19, COVID-minds, MedRxiv, and PsyArXiv, and consulted experts. The assembled data informed a meta-regression to estimate change in depressive and anxiety disorder prevalence between pre- and mid-pandemic via COVID-19 impact indicators. We then used this model to estimate the change from pre-pandemic prevalence (estimated via DisMod-MR 2.1) by age, sex, and location. Final prevalence estimates and disability weights were used to estimate years lived with disability (YLDs) and disability-adjusted life-years (DALYs) for major depressive disorder (MDD) and anxiety disorders.

Findings

Our search revealed 5683 unique data sources, of which 48 met inclusion criteria. Two COVID-19 impact indicators, specifically lower human mobility and larger daily COVID-19 infection rates, were associated with increased prevalence of MDD and anxiety disorders. Females and youth were impacted more than males and
seniors. The relationship between COVID-19 impact indicators and disorder prevalence meant countries hit hardest by the pandemic in 2020 experienced the greatest increases in prevalence of MDD and anxiety disorders. We estimated an additional 54·1 million (95% UI 46·6–62·8) cases of MDD globally (up 28·1%
[27·2–28·9]) due to the COVID-19 pandemic, bringing the total prevalence to 3164·5 cases (2745·7–3675·7) per 100 000 persons. We also estimated an additional 83·0 million (71·8–95·6) cases of anxiety disorders globally (up 27·9% [27·2–28·5]), bringing the total prevalence to 4889·9 cases (4205·5–5696·3) per 100 000 persons. After being adjusted for the impact of the COVID-19 pandemic, MDD increased from fifth to second leading cause of YLDs, explaining 5·6% of all YLDs globally. Anxiety disorders increased from seventh to third in YLDs, explaining 5·1% of all YLDs globally. Altogether, MDD caused 49·5 million (33·8–69·2) DALYs, and anxiety disorders caused 45·3 million (30·7–63·8) DALYs globally.

Interpretation

Our COVID-19 impact indicators incorporated effects from not only the spread of the virus within the population but also lockdowns, decreased transport, school and business closures, and decreased social interactions. The greater impact among females and youth was likely because they are more impacted by the social and economic consequences of the pandemic. This pandemic has created a greater 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 disorder. Taking no action to address the burden of MDD and anxiety disorders should not be an option.