Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic.
Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic.
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DOI：
10.1016/s0140-6736(21)02143-7
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发表时间：
2021-11-06
期刊：
影响因子：
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通讯作者：
COVID-19 Mental Disorders Collaborators
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文献类型：
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作者：
COVID-19 Mental Disorders Collaborators
在2020年之前，精神障碍是全球健康相关负担的主要原因，抑郁症和焦虑症是造成这一负担的主要因素。COVID-19大流行的出现创造了一个环境，使许多精神健康状况不佳的决定因素恶化。我们迫切需要了解COVID-19对心理健康影响的最新信息，以便为卫生系统的应对措施提供信息。在这项研究中，我们旨在量化2019冠状病毒病大流行对2020年全球重度抑郁症和焦虑症的患病率和负担的影响。我们对2020年1月1日至2021年1月29日期间发表的COVID-19大流行期间报告重度抑郁症和焦虑症患病率的数据进行了系统性审查。我们检索了PubMed、Google Scholar、预印本服务器、灰色文献来源，并咨询了专家。符合条件的研究报告了2019冠状病毒病大流行期间代表一般人群的抑郁症或焦虑症患病率，并有大流行前的基线。我们在荟萃回归中使用收集的数据，通过COVID-19影响指标（人口流动性、每日SARS-CoV-2感染率和每日超额死亡率）估计大流行前和大流行中期（使用每项研究定义的时期）之间重性抑郁症和焦虑症患病率的变化。然后，我们使用该模型按年龄、性别和地点估计大流行前流行率的变化（使用疾病建模荟萃回归2.1版[称为DisMod-MR 2.1]估计）。我们使用最终的患病率估计值和残疾权重来估计重度抑郁症和焦虑症的残疾生存年和残疾调整生命年（DADs）。我们确定了5683个独特的数据来源，其中48个符合纳入标准（46个研究符合重度抑郁症的标准，27个符合焦虑症的标准）。两个COVID-19影响指标，特别是每日SARS-CoV-2感染率和人类流动性的减少，与重度抑郁症患病率的增加有关（回归系数[B] 0·9 [95%不确定性区间0·1至1·8; p=0·029]，人的移动性为18·1 [7·9至28·3; p=0·0005]每日SARS-CoV-2感染）和焦虑症（0·9 [0·1至1·7; p=0·022]和13·8 [10·7至17·0; p<0·0001]。女性比男性更容易受到这一流行病的影响（重性抑郁障碍的B 0·1 [0·1至0·2; p=0·0001]，焦虑障碍的0·1 [0·1至0·2; p=0·0001]），年轻组比老年组受影响更大（重性抑郁症为−0·007 [-0 stats 009 to −0·006; p=0·0001]，焦虑症为−0·003 [-0 stats 005 to −0·002; p=0·0001]）。我们估计，2020年受疫情影响最严重的地区，以人口流动性下降和每日SARS-CoV-2感染率衡量，重度抑郁症和焦虑症的患病率增幅最大。我们估计，由于COVID-19大流行，全球将额外增加5320万（4480万至6290万）例重度抑郁症病例（增加276%[2510万至3030万]），因此总患病率为每10万人口31529例（2725万至3654万）。我们还估计全球焦虑症病例增加了7620万（6430万至9060万）例（增加了256%[2320万至2800万]），因此总患病率为每10万人口48024例（41082万至5588万）。2020年，全球重度抑郁症和焦虑症共造成4940万（33.6至68.7）例抑郁症和4450万（30.2至62.5）例抑郁症。这一流行病使大多数国家加强精神卫生系统的紧迫性增加。缓解战略可以包括促进心理健康的方法，针对心理健康不良的决定因素和治疗精神障碍者的干预措施。不采取任何行动来解决重度抑郁症和焦虑症的负担不应该是一种选择。昆士兰州卫生、国家卫生和医学研究理事会以及比尔和梅林达盖茨基金会。
Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we aimed to quantify the impact of the COVID-19 pandemic on the prevalence and burden of major depressive disorder and anxiety disorders globally in 2020. We conducted a systematic review of data reporting the prevalence of major depressive disorder and anxiety disorders during the COVID-19 pandemic and published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google Scholar, preprint servers, grey literature sources, and consulted experts. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population during the COVID-19 pandemic and had a pre-pandemic baseline. We used the assembled data in a meta-regression to estimate change in the prevalence of major depressive disorder and anxiety disorders between pre-pandemic and mid-pandemic (using periods as defined by each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 infection rate, and daily excess mortality rate). We then used this model to estimate the change from pre-pandemic prevalence (estimated using Disease Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and location. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for major depressive disorder and anxiety disorders. We identified 5683 unique data sources, of which 48 met inclusion criteria (46 studies met criteria for major depressive disorder and 27 for anxiety disorders). Two COVID-19 impact indicators, specifically daily SARS-CoV-2 infection rates and reductions in human mobility, were associated with increased prevalence of major depressive disorder (regression coefficient [B] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 [7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders (0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were affected more by the pandemic than males (B 0·1 [0·1 to 0·2; p=0·0001] for major depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and younger age groups were more affected than older age groups (−0·007 [–0·009 to −0·006; p=0·0001] for major depressive disorder, −0·003 [–0·005 to −0·002; p=0·0001] for anxiety disorders). We estimated that the locations hit hardest by the pandemic in 2020, as measured with decreased human mobility and daily SARS-CoV-2 infection rate, had the greatest increases in prevalence of major depressive disorder and anxiety disorders. We estimated an additional 53·2 million (44·8 to 62·9) cases of major depressive disorder globally (an increase of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. Altogether, major depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020. This pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option. Queensland Health, National Health and Medical Research Council, and the Bill and Melinda Gates Foundation.