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SA warnings of possible post-pandemic mental health crisis echo global study

Medical scheme warnings in South Africa of a surging mental health problems in the wake of COVID-19 echo warnings in a study in The Lancet that the pandemic has triggered a global surge in the prevalence of anxiety disorders and depression.

Discovery Health has sounded the alarm over a looming mental health crisis in the wake of the coronavirus pandemic, saying it has seen a marked increase in claims for psychology visits, reports BusinessLive.

Psychology visits per 1,000 lives in July 2021 were 16.2% higher than the corresponding period in 2019, at 28.4 visits per 1,000 lives in 2021 compared with 24.4 in 2019. “Mental health is another pandemic. What we are seeing is the tip of the iceberg,” said Discovery Healthʼs clinical policy unit head, Noluthando Nematswerani.

Discovery Health administers 19 medical schemes, the biggest of which is Discovery Health Medical Scheme.

“I think we are still going to see a significant mental health impact in future claims. What we are see right now is people who may not have an established mental health illness, but are presenting with stress-related disorders, which could progress to more serious conditions,” she said.

Discoveryʼs increase in psychology claims reflects the needs of a portion of the members it administers, because many people belong to options with limited mental health cover, but it resonates with a recent Lancet study that found the pandemic had triggered a global surge in the prevalence of anxiety disorders and depression. Countries hit hardest by the pandemic in 2020 had the greatest increases in these mental illnesses, with SA among the worst affected.

The prevalence of anxiety disorders in South Africa rose by more than 36%, while depression soared 38%, according to estimates in the Lancet study. Globally anxiety disorders jumped 26% and depression rose 28% above pre-pandemic levels.

Life insurer Momentum said it had not seen an increase in mental health- related claims, including suicide, since the pandemic began but expected a future surge.

“We are definitely worried. We do expect it to increase in the years ahead, but donʼt know to what extent,” Momentum Lifeʼs head of product development, Jenny Ingram, told BusinessLive. “By the time people are diagnosed with an event that qualifies for a payout they have gone through a long period of treatment that is failing,” she said.

Life insurer FMI, a division of Bidvest, said mental health claims, largely due to burnout, anxiety and depression, accounted for 3.5% of claims in 2020 and were the second most common reason for claiming on income protection.

Jasmin Kooverjee, principal psychologist at Chris Hani Baragwanath Hospital, said there had been a marked increase in anxiety and depression among children and adolescents, and a surge in burnout among healthcare workers. “As the pandemic wore on the losses became closer and closer, and that took a toll, as well as the long hours, shortages of resources, dealing with sick people and their anxieties, and the role they might play in making family sick,” she said.

Thanks to COVID-19 budget allocations, fortunately, the hospital was able to augment mental health services during the pandemic. “The additional staff are fully booked yet no matter how many extra posts we have, it wonʼt be enough because mental health [conditions] have soared,” she said.

The hospitalʼs mental health services were already running at full capacity before the pandemic, she said, and the rising demand meant state patients could expect to wait up to three months to see a psychologist and several weeks to see a psychiatrist.

Study details

Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic

COVID-19 Mental Disorders Collaborators

Published in The Lancet on 8 October 2021

Summary

Background
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.

Methods
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.

Findings
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.

Interpretation
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.

 

BusinessLive article – Discovery warns of a pandemic of mental illness in wake of Covid-19 disruptions (Restricted access)

 

The Lancet article – Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic (Open access)

 

The Lancet: Comment on Depression and anxiety disorders during the COVID-19 pandemic: knowns and unknowns (Open access)

 

See more from MedicalBrief archives:

 

Suicide levels in Malawi and Kenya rocket as pandemic bites

 

High COVID-related depression, anxiety and PTSD among health workers — Meta-analysis

 

COVID-related stress levels higher in paramedics than doctors — COVISTRESS survey

 

 

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