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Rates of depression and anxiety climbed globally by more than 25% in 2020, a devastating ripple effect of the Covid-19 pandemic that has particularly affected women and young people, according to a new study.

“We knew Covid would have an impact on these mental disorders, we just didn’t know how big the impact was going to be,” said Alize Ferrari, a lead researcher at the Queensland Center for Mental Health Research in Australia and co-author of the study, published Friday in the Lancet.

In a systematic review, researchers analyzed data from dozens of studies that reported the prevalence of major depressive disorder and anxiety disorders in the pandemic, calculating that each increased by 28% and 26%, respectively, last year globally. That’s tens of millions more cases of depression and anxiety, in addition to the hundreds of millions already occurring around the world. All told, the researchers estimated there were about 3,153 total cases of major depressive disorder per 100,000 people and 4,802 total cases of anxiety disorders per 100,000 worldwide in 2020, after adjusting for uptick associated with the pandemic.

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“That’s not trivial, that number,” Ferrari said.

The new study is the first worldwide estimate of the mental impact of Covid-19, according to the researchers, who analyze the global burden of mental disorders every year. Most previous studies on the pandemic’s impact, including those analyzed in the review, have focused on specific locations or regions.

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The results mirror findings from past studies that have documented how major disruptive events affect mental health. Women are often the most impacted in a crisis, as they’re more likely to lose their job and to have household or family obligations. They’re also more likely to be victims of domestic violence, which may have increased during the pandemic as well. In 2020, women experienced an almost 30% increase in major depressive disorders and an almost 28% increase in anxiety disorders worldwide, while men saw increases of 24% and 22%, respectively. Overall, women were twice as likely to experience major depressive disorder than men.

Younger age groups saw greater increases in depression and anxiety than older groups, with 20- to 24-year-olds seeing the greatest spikes. The disruption to education experienced by young people across the globe — estimated to be the biggest in history by the United Nations Educational, Scientific and Cultural Organization — left 1.6 billion people out of school.

Local increases were highest in places hardest hit by Covid-19, correlating most strongly with high average daily case rates of the virus and with limited ability to move or travel for residents. But the analysis was limited by the data available, which came mostly from high-income Western countries and excluded lower-income countries whose populations were likely affected in greater numbers.

“‘No estimate’ is often interpreted as if there is no change, which we don’t believe at all,” said lead author Damian Santomauro, also of the Queensland Center for Mental Health Research. They estimated changes in countries with limited or no data, but hope to have more accurate numbers in a forthcoming analysis of 2021 data. They are also hoping to identify more contributing factors to the trends, including the economic strain many people were under after losing jobs.

Even before the pandemic, depression and anxiety were widespread, making the top 25 causes of disease burden in 2019 according to the annual Global Burden of Disease Study, to which both Santomauro and Ferrari have contributed. As Covid-19 continues to spread, they predict another increase in depression and anxiety could follow, particularly in countries like India, where the first major Covid-19 surge didn’t occur until early in 2021.

Santomauro and Ferrari both hope that governments and policymakers will consider the global increases in depression and anxiety in their policymaking and provide more treatment for those that need it.

“It’s worse if you don’t deal with people’s mental health issues as they arise,” Ferrari said. “We just need that dialogue going, and we hope that this paper can help generate that.”

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