Covid has hit hard everywhere, including mental health. In 2020, the prevalence of major depression and anxiety disorders increased by more than a quarter: by 28 and 26% respectively. The highest price was paid by women and young people, and by the populations of the areas of the world where the virus has hit the most and where it was necessary to implement more stringent measures to contain the Sars-cov-2 infection. On the eve of World Mental Health Day on October 10, Lancet publishes global estimates of the pandemic’s impact on mental well-being with a study that quantified the prevalence of anxiety and major depression based on age, gender and geographic location in 214 countries and regions around the world in the 2020 annus horribilis.
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The authors carried out a systematic review of 48 selected studies from over 5,600 conducted worldwide – mostly in European and North American high-income countries (22 in Western Europe and 14 from North America) – published between the 1st January 2020 and January 29, 2021, representative of the general population and taking into account the prevalence of anxiety and major depression in pre-pandemic times. The meta-analysis evaluated gender, age, geographical location, and, as indicators of the impact of Covid-19, it used the infection rates and the possibility of people to move, in essence the social mitigation measures of the infection adopted in the different areas or countries.
In 2020, the greatest increases in the prevalence of major depressive disorder and anxiety disorders were recorded in areas of the world with the highest infection rates and where restrictions on people’s movement (as a result of blockages, school closures, offices etc …) were more stringent.
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Even before the pandemic, major depressive disorder and anxiety disorders were among the main contributors to the global burden of mental illness, already affecting millions of men and women of all ages, everywhere. The authors therefore calculated how things would have gone if the pandemic had not existed: in the absence of Covid-19 in 2020 there would have been 193 million cases of major depression (i.e. 2,471 cases per 100,000 inhabitants), but they were 246 million ( 3,153 per 100,000 inhabitants), or 53 million more: over 35 million concern women, almost 18 million men. In the same year, 298 million cases of anxiety disorders should have been counted in the world (3,825 per 100,000 inhabitants), while 374 million cases were counted (4,802 per 100,000), 76 more than expected: 52 million they concerned women and 24 million men.
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Young people were the most affected by major depressive disorder and anxiety disorders, in particular the peak increase was recorded in the 20-24 age group (1,118 more cases of major depressive disorder per 100,000 inhabitants and 1,331 of anxiety per 100,000).
Why women …
“The Covid-19 pandemic has exacerbated many inequalities already present and the social determinants (the social, economic, welfare conditions in which an individual lives, ed) of mental disorders – he declared Alize Ferrari, researcher in Psychiatric Epidemiology at the University of Queensland, Australia, and co-author of the publication on Lancet. “Unfortunately – is the expert’s reflection – for many reasons, women have been more likely to be more affected by the social and economic consequences of the pandemic, to live in more precarious working and therefore economic situations. Additional caring responsibilities and household chores tend to fall on them. Furthermore, women are the ones most at risk of being victims of domestic violence, which has increased during this pandemic ”.
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“School closures and extensive restrictions limiting young people’s ability to learn and interact with peers, combined with the increased risk of unemployment, have also resulted in them being heavily affected by major depressive disorder and of anxiety during the pandemic. It is imperative that policymakers take these factors into account as part of measures to strengthen mental health services, ”the authors said. Which remind us of a fact: for UNESCO the covid caused the most drastic interruption of education in history, which involved 290 million students in the world, who for more or less long periods have always stopped attending schools and universities. places of learning, but also of social interaction.
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“We found that major depressive and anxiety disorders increased in 2020 due to the Covid-19 pandemic. Anxiety and depression even before Covid were the main causes of the global burden of mental disorders, despite intervention strategies. Coping with this additional (assistance) demand due to Covid-19 for mental health services will be difficult, but not impossible – the authors wrote in the text of the publication. Governments should promote mental well-being and identify the determinants of mental ill health exacerbated by the pandemic, and put in place interventions to treat those who develop a mental disorder.
The new WHO Atlas: a disappointing situation
Also on the occasion of the Day of 10 October, the World Health Organization has published the updated 2020 version of the Atlas of Mental Health. The document shows how the global resources allocated to people suffering from mental illness or neurological disorders are still largely insufficient to cope with the increased needs. Needs amplified by covid-19. The document, which comes out every three years, is a collection of data on mental health policies, legislation, funding, human resources, availability and use of services provided by all countries. And it is also a tool for monitoring the state of the art around the world towards achieving the goals of the World Health Organization’s Global Mental Health Action Plan. The document just published clearly highlights how investments in the mental health sector are still lacking: a failure, in essence, of the offer of the services that people need, “in a moment – underline the WHO experts – in which the the covid-19 pandemic is bringing out a growing need for support ”.
“It is very worrying that despite the evident and growing need for mental health services that emerged during the covid-19 pandemic, good intentions are not being supported with adequate investments,” said the director general of the World Health Organization. Tedros Adhanom Ghebreyesus. “We must pay attention – he added – to act on this alarm bell and drastically accelerate the increase in investments in mental health, because there is no health without mental health“.
Definitely far from the objectives
Only 51% of the 194 WHO member states reported having mental health policies or plans in place that were in line with international and regional human rights instruments, well below the 80% target set in the WHO Global Action Plan for 2020. And only 52% have reached the target for promotion and prevention programs: also below the 80% set. The only goal achieved was a 10% reduction in the suicide rate. The percentage of health budgets destined for mental health has changed little in recent years, still fluctuating around 2% (in Italy we are at 3%).
Decentralizing assistance: too slow a process
Although WHO has long recommended decentralizing psychiatric care across the country, only 25% of countries have met all the criteria for integration into primary mental health care. And while there has been progress in training and supervision, the provision of drugs and psychosocial care in primary health services remains limited in most countries.
This situation is reflected in the way government funds are allocated: more than 70% of total public spending on mental health has been allocated to psychiatric hospitals in middle-income countries, in high-income countries, 35 %.
The percentage of countries reporting that treatment of people with mental health problems is included in national health insurance or expense reimbursement systems has increased from 73% in 2017 to 80% last year.
Few receive treatment
Global estimates of people accessing mental health care remained below 50%: on average 40% of those with depression and only 29% of those suffering from psychosis receive treatment.
The increase in countries reporting having mental health prevention and promotion programs was more encouraging: in 2014 it was 41% of the Member States in 2020 it was 52%.
The number of operators in the sector has slightly increased from nine dedicated workers in 2014 to 13 workers per 100,000 inhabitants in 2020. But there is a big difference between countries: in high-income countries the number of workers employed in the sector of mental health is more than 40 times higher than in low-income countries.
New goals for 2030
The global goals reported in the Mental Health Atlas are those of the WHO Global Mental Health Action Plan which contained targets for 2020 approved by the World Health Assembly in 2013. This plan has been extended to 2030, and it includes new goals, for example relating to emergencies, the integration of mental health into primary health care and research.
“The new data from the Mental Health Atlas tells us we still have a long way to go to make sure everyone, everywhere, has access to quality mental health care,” he said. Devoured Kestel, Director of the Department of Mental Health and Substance Use at WHO. “But I am encouraged by the renewed vigor we have seen from governments as the new goals for 2030 have been discussed and agreed upon and I am confident that together we can do what is needed to turn small steps into giant steps over the next 10 years.”
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