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, Damian F Santomauro, Ana M Mantilla Herrera, Jamileh Shadid, Peng Zheng, Charlie Ashbaugh, David M Pigott, Cristiana Abbafati, Christopher Adolph, Joanne O Amlag, Aleksandr Y Aravkin, Bree L Bang-Jensen, Gregory J Bertolacci, Sabina S Bloom, Rachel Castellano, Emma Castro, Suman Chakrabarti, Jhilik Chattopadhyay, Rebecca M Cogen, James K Collins, Xiaochen Dai, William James Dangel, Carolyn Dapper, Amanda Deen, Megan Erickson, Samuel B Ewald, Abraham D Flaxman, Joseph Jon Frostad, Nancy Fullman, John R Giles, Ababi Zergaw Giref, Gaorui Guo, Jiawei He, Monika Helak, Erin N Hulland, Bulat Idrisov, Akiaja Lindstrom, Emily Linebarger, Paulo A Lotufo, Rafael Lozano, Beatrice Magistro, Deborah Carvalho Malta, Johan C Månsson, Fatima Marinho, Ali H Mokdad, Lorenzo Monasta, Paulami Naik, Shuhei Nomura, James Kevin O'Halloran, Samuel M Ostroff, Maja Pasovic, Louise Penberthy, Robert C Reiner Jr, Grace Reinke, Antonio Luiz P Ribeiro, Aleksei Sholokhov, Reed J D Sorensen, Elena Varavikova, Anh Truc Vo, Rebecca Walcott, Stefanie Watson, Charles Shey Wiysonge, Bethany Zigler, Simon I Hay, Theo Vos, Christopher J L Murray, Harvey A Whiteford, Alize J Ferrari, COVID-19 Mental Disorders Collaborators, Damian F Santomauro, Ana M Mantilla Herrera, Jamileh Shadid, Peng Zheng, Charlie Ashbaugh, David M Pigott, Cristiana Abbafati, Christopher Adolph, Joanne O Amlag, Aleksandr Y Aravkin, Bree L Bang-Jensen, Gregory J Bertolacci, Sabina S Bloom, Rachel Castellano, Emma Castro, Suman Chakrabarti, Jhilik Chattopadhyay, Rebecca M Cogen, James K Collins, Xiaochen Dai, William James Dangel, Carolyn Dapper, Amanda Deen, Megan Erickson, Samuel B Ewald, Abraham D Flaxman, Joseph Jon Frostad, Nancy Fullman, John R Giles, Ababi Zergaw Giref, Gaorui Guo, Jiawei He, Monika Helak, Erin N Hulland, Bulat Idrisov, Akiaja Lindstrom, Emily Linebarger, Paulo A Lotufo, Rafael Lozano, Beatrice Magistro, Deborah Carvalho Malta, Johan C Månsson, Fatima Marinho, Ali H Mokdad, Lorenzo Monasta, Paulami Naik, Shuhei Nomura, James Kevin O'Halloran, Samuel M Ostroff, Maja Pasovic, Louise Penberthy, Robert C Reiner Jr, Grace Reinke, Antonio Luiz P Ribeiro, Aleksei Sholokhov, Reed J D Sorensen, Elena Varavikova, Anh Truc Vo, Rebecca Walcott, Stefanie Watson, Charles Shey Wiysonge, Bethany Zigler, Simon I Hay, Theo Vos, Christopher J L Murray, Harvey A Whiteford, Alize J Ferrari

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.

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.

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.

Figures

Figure 1
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
Figure 2
Change in the prevalence of major depressive disorder after adjustment for (ie, during) the COVID−19 pandemic, 2020
Figure 3
Figure 3
Change in the prevalence of anxiety disorders after adjustment for (ie, during) the COVID−19 pandemic, 2020
Figure 4
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.

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