Impact of the COVID-19 pandemic on diagnoses of common mental health disorders in adults in Catalonia, Spain: a population-based cohort study

  1. Berta Raventós
  2. Andrea Pistillo
  3. Carlen Reyes
  4. Sergio Fernández-Bertolín
  5. Maria Aragón
  6. Anna Berenguera
  7. Constanza Jacques-Aviñó
  8. Laura Medina-Perucha
  9. Edward Burn
  10. Talita Duarte-Salles

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Abstract

To investigate how trends in incidence of anxiety and depressive disorders have been affected by the COVID-19 pandemic.

Design

Population-based cohort study.

Setting

Retrospective cohort study from 2018 to 2021 using the Information System for Research in Primary Care (SIDIAP) database in Catalonia, Spain.

Participants

3 640 204 individuals aged 18 or older in SIDIAP on 1 March 2018 with no history of anxiety and depressive disorders.

Primary and secondary outcomes measures

The incidence of anxiety and depressive disorders during the prelockdown period (March 2018–February 2020), lockdown period (March–June 2020) and postlockdown period (July 2020–March 2021) was calculated. Forecasted rates over the COVID-19 periods were estimated using negative binomial regression models based on prelockdown data. The percentage of reduction was estimated by comparing forecasted versus observed events, overall and by sex, age and socioeconomic status.

Results

The incidence rates per 100 000 person-months of anxiety and depressive disorders were 151.1 (95% CI 150.3 to 152.0) and 32.3 (31.9 to 32.6), respectively, during the prelockdown period. We observed an increase of 37.1% (95% prediction interval 25.5 to 50.2) in incident anxiety diagnoses compared with the expected in March 2020, followed by a reduction of 15.8% (7.3 to 23.5) during the postlockdown period. A reduction in incident depressive disorders occurred during the lockdown and postlockdown periods (45.6% (39.2 to 51.0) and 22.0% (12.6 to 30.1), respectively). Reductions were higher among women during the lockdown period, adults aged 18–34 years and individuals living in the most deprived areas.

Conclusions

The COVID-19 pandemic in Catalonia was associated with an initial increase in anxiety disorders diagnosed in primary care but a reduction in cases as the pandemic continued. Diagnoses of depressive disorders were lower than expected throughout the pandemic.

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  1. Version published to 10.1136/bmjopen-2021-057866
  2. ScreenIT

    SciScore for 10.1101/2021.08.06.21261709: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variableWe structured data in a monthly time-series format with incident and person-months at risk aggregated with stratification by sex (males and females), age group (18 to 34, 35 to 64, >65 years) and SES (quintiles of MEDEA deprivation index).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    MEDEA) deprivation index, linked to each residential census area of the population.
    MEDEA
    suggested: (MEDEA, RRID:SCR_013356)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    While telemedicine has ensured the continuity of care of many health care processes during lockdown, it might face limitations generating diagnoses that require more assessments.28 A recent study performed in Central Catalonia (a health administrative region of Catalonia) found an average decline of 31.1% in new diagnoses compared to 2019.28 This study found an association between the intensity of the pandemic and the increased monthly declines in new diagnoses across ICD-10 groups, highlighting the strain on capacity of the healthcare system to identify and address the healthcare needs of the population during the pandemic. Another study performed in Catalonia has found a reduction in primary care visits associated with diagnoses related to chronic pathologies, while visits associated with diagnoses related to socio-economic and housing problems have increased.29 Both studies found moderate reductions in diagnoses of mental health conditions, which were lower than the ones observed for other diagnoses groups.28,29 Similar studies performed in the UK have used the same modelling approach to forecast incidence of anxiety and depressive disorders during lockdown and the first months of its aftermath.22,30 Larger reductions were also found for adults aged 18 to 64 years and for patients registered at practices in more deprived areas.30 In contrast to our findings, none of these studies have found an increase in new cases of anxiety disorders during lockdown. Comparison between s...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.08.06.21261709v1 on medRxiv