Effect of the COVID-19 pandemic on stress, anxiety, and depressive disorders in German primary care: A cross-sectional study

Abstract

Several studies revealed that mental disorders' prevalence increased during the COVID-19 pandemic, particularly in young and female individuals. Such studies represent individuals' subjective perceptions and not the number of mental health cases treated in primary care. Thus, this study aimed to describe the changes in depression, anxiety, and stress disorder diagnoses in General Practitioner (GP) practices during the COVID-19 pandemic. More than three million patients of 757 German GP practices were included in this cross-sectional analysis. Descriptive statistics were used to assess changes in the number of incident depression, anxiety disorders, and reaction to severe stress and adjustment disorders documented by GPs in 2020 compared to the average of the years 2017–2019. There was a tremendous decrease in mental health diagnoses during the first lockdown that was only slightly compensated later. Overall populations and the entire year 2020, there was no change in documented depression (0%) and stress disorders (1%), but anxiety disorders were more often documented (+19%), especially for the elderly population (>80 years; +24%). This population group also received more frequently new depression (+12%) and stress disorder diagnoses (23%). The younger population was diagnosed more frequently at the end of 2020, nine months after the first lockdown. Anxiety disorders but not depression and stress diagnoses were elevated, which is not in line with previously published studies. We speculate that the elderly population was affected most by the pandemic immediately after the first lockdown was announced. The younger population has probably become more and more affected the longer the pandemic lasts.

Anxiety Linked to COVID-19: A Systematic Review Comparing Anxiety Rates in Different Populations

“…Due to the influx of hospitalisations related to COVID, healthcare staff have had to work longer hours with limited resources increasing their vulnerability to burnout and stress [ 53 ]. This has, in turn, drastically affected mental health, with reports of heightened anxiety found in frontline healthcare staff across many countries [ 18 , 141 ]. Non-frontline workers also had an increase in anxiety.…”

“…Studies exploring different population groups affected by COVID-19 have identified some common risk factors associated with a higher likelihood of developing anxiety symptoms, including: younger age groups, being female, having pre-existing mental health issues, and lower socioeconomic status (SES) populations [ 18 , 19 ]. The effects of COVID-19 on healthcare workers, the general population, and other vulnerable groups such as pregnant women have been well documented.…”

Factors Associated with Non-Severe Adverse Reactions after Vaccination against SARS-CoV-2: A Cohort Study of 908,869 Outpatient Vaccinations in Germany

“…It has previously been shown that the panel of practices included in the Disease Analyzer database is representative of general and specialized practices in Germany [6]. Finally, this database has already been used in previous studies focusing on SARS-CoV-2 [7][8][9], specifically the psychological consequences of SARS-CoV-2 [10,11]. The "Disease Analyzer" database used for analysis contains anonymized electronic patient records.…”

1.5 years pandemic – Psychological burden over the course of the COVID-19 pandemic in Germany: A nine-wave longitudinal community study

“…Several studies tried to extrapolate results from previous (health-related) crises as well as first results from the early COVID-19 pandemic to predict further changes of mental health burden ( Fan et al, 2021 ; Santomauro et al, 2021 ). In this context, it was assumed that not only psychopathological symptoms would increase but also the prevalence rates of full-threshold mental disorders ( Bohlken et al, 2021 ; Santomauro et al, 2021 ). For example, based on a systematic review, Santomauro et al (2021) estimated a global increase in anxiety disorders of 76.2 million (25.6 % increase) and an increase in major depressive disorders of 53.2 million (27.6 % increase) due to the COVID-19 pandemic.…”

“…Such predictions are prone to imprecision and uncertainty; nevertheless, they highlight the need for assessing psychopathological symptom changes as well as the incidence and persistence of mental disorders during this challenging time. It can be expected that potential changes in the incidence of full-threshold mental disorders only become evident in the longer run with a distinct delay ( Bohlken et al, 2021 ), which again emphasizes the need for ongoing assessments.…”