AUTHOR=Flodin Pär , Sörberg Wallin Alma , Tarantino Barbara , Cerchiello Paola , Mladá Karolína , Kuklová Marie , Kondrátová Lucie , Parimbelli Enea , Osika Walter , Hollander Anna-Clara , Dalman Christina 

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

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 13 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.1045325

DOI=10.3389/fpsyt.2022.1045325

ISSN=1664-0640

ABSTRACT=Background: The COVID-19 pandemic is commonly believed to have increased common mental disorders (CMD, i.e., depression and anxiety). By analyzing time series in primary health care data from Sweden, Norway, Netherlands, and Latvia, we aimed to characterize the impact of the pandemic on CMD prevalence. Furthermore, by relating these changes to country specific time-trajectories of containment measures, we evaluated the differential impact of containment strategies on CMD rates. 
Methods: For the four investigated countries, we collected time-series of monthly counts of unique CMD patients in primary health care from the year 2015 (or 2017) until 2021. 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 prevalence, where largest drops were found in Sweden followed by Netherlands and Norway Whereas prevalence ratios (PR) 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 prevalence were weak and non-significant. In particular, we could not observe any relationship of school restriction to CMD prevalence in children or parental age groups. 
Conclusions: CMD 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. We found no evidence of associations between school restrictions and CMD 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 health care utilization, apart from in Latvia. However, since health care 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.