Effects of COVID-19 pandemic on anxiety and depression in primary care: A retrospective cohort study

Abstract

Background : Population-based surveys indicate that many people experienced increased psychological distress during the COVID-19 pandemic. We aimed to determine if there was a corresponding increase in patients receiving services for anxiety and depression from their family physicians. Methods : Electronic medical records from the University of Toronto Practice Based-Research Network (UTOPIAN; N = 322,920 patients) were used to calculate incidence rates for anxiety/depression related visits and antidepressant prescriptions before the COVID-19 pandemic (January 2018-February 2020) and during the COVID-19 pandemic (March-December 2020). Data from the pre-pandemic period were used to predict expected rates during the pandemic period which was compared to the observed rate. Results : The number of patients presenting with anxiety/depression symptoms in primary care varied across age groups, sex, and time since pandemic onset. Among the youngest patients (ages 10-18 years), there were fewer patients than pre-pandemic visiting for new episodes of anxiety/depression and being prescribed antidepressants in April 2020, but by the end of 2020 this trend had reversed such that incidence rates for anxiety/depression related visits were higher than pre-pandemic levels. Among older adults, incidence rates of anxiety/depression related visits increased in April 2020 with the onset of the pandemic, and remained higher than expected throughout 2020. Limitations : A convenience sample of 362 family physicians in Ontario was used. Conclusion : Demand for mental health services from family physicians varied by patient age and sex and changed with the onset of the COVID-19 pandemic. By the end of 2020, more patients were seeking treatment for anxiety/depression related concerns.

Impact of COVID-19 on Trends in Outpatient Clinic Utilization

“…At 2 of the 3 sites, overall rates of BH visits slightly increased during the pandemic. During the COVID-19 pandemic, mental health diagnoses among adults, including anxiety and depression, increased 23,24,25. A systematic review examining the global prevalence of major depressive and anxiety disorders before and during the COVID-19 pandemic found an estimated 53.2 million cases of major depressive disorder and 76.2 million cases of anxiety disorder were due to the effects of the COVID-19 pandemic 23.…”

Telehealth treatment of patients with major depressive disorder during the COVID-19 pandemic: Comparative safety, patient satisfaction, and effectiveness to prepandemic in-person treatment

“…The cohorts thus differ in two ways—how treatment was delivered and the altered social zeitgeist due to the pandemic. The pandemic has had a negative impact on the mental health of the general population ( Bueno-Notivol et al, 2020 ; Jia et al, 2022 ; Kessler et al, 2022 ; Morin et al, 2021 ; Salari et al, 2020 ; Stephenson et al, 2022 ), as well as psychiatric patients ( Dalkner et al, 2022 ; Fleischmann et al, 2021 ; Lewis et al, 2022 ). We speculated that the impact of the pandemic on social engagement, employment, education, and parental responsibilities would impede achieving positive treatment outcomes in the telehealth group.…”

“…The COVID-19 pandemic has been depressogenic ( Bueno-Notivol et al, 2020 ; Jia et al, 2022 ; Kessler et al, 2022 ; Morin et al, 2021 ; Salari et al, 2020 ; Stephenson et al, 2022 ). Major disruptions in lifestyle due to social isolation, job loss, financial strain, and deaths of neighbors, family and friends are potential contributors to the increased levels of depression due to the pandemic.…”

Patient visits and prescriptions for attention-deficit/hyperactivity disorder from 2017–2021: Impacts of COVID-19 pandemic in primary care

“…Records that meet minimum data quality criteria [31] are available for use in research studies. The Ontario government introduced new billing codes in response to the COVID-19 pandemic to allow family physicians to offer care virtually via telephone or video [32,33]. Prior to this policy change, the use of virtual care in Ontario was extremely limited [33,34].…”

“…Eligibility was assessed at the end of each calendar year, recognizing that some patients will join and leave a family medicine practice over time. Patients were enrolled in the cohort based on the following criteria: 1) they were registered to a physician for whom the data extracted met minimum quality criteria, 2) they had age and sex recorded in the EMR, 3) they had at least one billing code for an office or virtual visit with a family physician [32,35,36] within the past 5 years, 4) they were aged 5-55 years, and 5) at least 1 year of data was recorded in the EMR (i.e., 1 or more years since their first visit). Patients were excluded five years after their most recent visits.…”