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      Differential impact of the COVID-19 pandemic on primary care utilization related to common mental disorders in four European countries: A retrospective observational study

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          Abstract

          Background

          The COVID-19 pandemic is commonly believed to have increased common mental disorders (CMD, i.e., depression and anxiety), either directly due to COVID-19 contractions (death of near ones or residual conditions), or indirectly by increasing stress, economic uncertainty, and disruptions in daily life resulting from containment measure. Whereas studies reporting on initial changes in self-reported data frequently have reported increases in CMD, pandemic related changes in CMD related to primary care utilization are less well known. Analyzing time series of routinely and continuously sampled primary healthcare data from Sweden, Norway, Netherlands, and Latvia, we aimed to characterize the impact of the pandemic on CMD recorded prevalence in primary care. Furthermore, by relating these changes to country specific time-trajectories of two classes of containment measures, we evaluated the differential impact of containment strategies on CMD rates. Specifically, we wanted to test whether school restrictions would preferentially affect age groups corresponding to those of school children or their parents.

          Methods

          For the four investigated countries, we collected time-series of monthly counts of unique CMD patients in primary healthcare from the year 2015 (or 2017) until 2021. Using pre-pandemic timepoints to train seasonal Auto Regressive Integrated Moving Average (ARIMA) models, we predicted healthcare utilization during the pandemic. Discrepancies between observed and expected time series were quantified to infer pandemic related changes. To evaluate the effects of COVID-19 measures on CMD related primary care utilization, the predicted time series were related to country specific time series of levels of social distancing and school restrictions.

          Results

          In all countries except Latvia there was an initial (April 2020) decrease in CMD care prevalence, where largest drops were found in Sweden (Prevalence Ratio, PR = 0.85; 95% CI 0.81–0.90), followed by Netherlands (0.86; 95% CI 0.76–1.02) and Norway (0.90; 95% CI 0.83–0.98). Latvia on the other hand experienced increased rates (1.25; 95% CI 1.08–1.49). Whereas PRs in Norway and Netherlands normalized during the latter half of 2020, PRs stayed low in Sweden and elevated in Latvia. The overall changes in PR during the pandemic year 2020 was significantly changed only for Sweden (0.91; 95% CI 0.90–0.93) and Latvia (1.20; 95% CI 1.14–1.26). Overall, the relationship between containment measures and CMD care prevalence were weak and non-significant. In particular, we could not observe any relationship of school restriction to CMD care prevalence for the age groups best corresponding to school children or their parents.

          Conclusion

          Common mental disorders prevalence in primary care decreased during the initial phase of the COVID-19 pandemic in all countries except from Latvia, but normalized in Norway and Netherlands by the latter half of 2020. The onset of the pandemic and the containment strategies were highly correlated within each country, limiting strong conclusions on whether restriction policy had any effects on mental health. Specifically, we found no evidence of associations between school restrictions and CMD care prevalence. Overall, current results lend no support to the common belief that the pandemic severely impacted the mental health of the general population as indicated by healthcare utilization, apart from in Latvia. However, since healthcare utilization is affected by multiple factors in addition to actual need, future studies should combine complementary types of data to better understand the mental health impacts of the pandemic.

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          Most cited references31

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          Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

          Summary The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
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            Mental Health and the Covid-19 Pandemic

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              COVID-19 pandemic and mental health consequences: systematic review of the current evidence

              Highlights • COVID-19 patients displayed high levels of PTSS and increased levels of depression. • Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. • Higher levels of psychiatric symptoms were found among health care workers. • A decrease in psychological well-being was observed in the general public. • However, well conducted large-scale studies are highly needed.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                09 January 2023
                2022
                09 January 2023
                : 13
                : 1045325
                Affiliations
                [1] 1Department of Global Public Health, Karolinska Institutet , Stockholm, Sweden
                [2] 2Department of Brain and Behavioral Sciences, University of Pavia , Pavia, Italy
                [3] 3Department of Economics and Management, University of Pavia , Pavia, Italy
                [4] 4Department of Public Mental Health, National Institute of Mental Health , Klecany, Czechia
                [5] 5Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University , Prague, Czechia
                [6] 6Department of Demography and Geodemography, Faculty of Science, Charles University , Prague, Czechia
                [7] 7Department of Electrical, Computer and Biomedical Engineering, University of Pavia , Pavia, Italy
                [8] 8Telfer School of Management, University of Ottawa , Ottawa, ON, Canada
                [9] 9Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet , Stockholm, Sweden
                [10] 10Department of Neurobiology, Care Sciences and Society, Center for Social Sustainability, Karolinska Institutet , Stockholm, Sweden
                [11] 11Center for Epidemiology and Community Medicine , Stockholm, Sweden
                Author notes

                Edited by: Mencia R. Gutiérrez-Colosía, Universidad Loyola Andalucía, Spain

                Reviewed by: Inese Gobina, Riga Stradiņš University, Latvia; Jürgen Zielasek, LVR-Institute for Research and Education, Germany

                *Correspondence: Pär Flodin, par.flodin@ 123456ki.se

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2022.1045325
                9868724
                36699500
                9eb3958b-243f-49ae-9d88-be3b6f3300d1
                Copyright © 2023 Flodin, Sörberg Wallin, Tarantino, Cerchiello, Mladá, Kuklová, Kondrátová, Parimbelli, Osika, Hollander and Dalman.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 15 September 2022
                : 13 December 2022
                Page count
                Figures: 4, Tables: 3, Equations: 0, References: 34, Pages: 14, Words: 8527
                Funding
                This study has been funded by the European Union’s Horizon 2020 Research and Innovation Program, under grant agreement 101016233 through the Periscope project.
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                covid-19,primary healthcare,common mental disorder,containment measures,time series analysis

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