¹Charles University, Hradec Králové, Czech Republic
²Uppsala University, Uppsala, Sweden
³WIdO, Berlin, Germany
⁴Strathclyde University, Glasgow, Scotland

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Background: The COVID-19 pandemic (March 2020 to May 2023) has placed immense strain on people’s health and well-being. In addition to the direct effects of the disease on physical health, the uncertainty regarding the disease and its long-term effects on health, well-being and the private economy also had detrimental effects on mental health; moreover, many countries implemented restrictions on social distancing and limited movements of people, which may have exacerbated this further, with differing influences on different demographic groups. The increasing prevalence of mental health conditions as a topic of concern predates the COVID-19 pandemic but has gained further attention since. Nevertheless, evidence on the specific effect of the COVID-19 pandemic on depression incidence and prevalence trends remains inconclusive, as research findings differ widely depending on study design, country, and time period studied. Our study aimed to explore the effects of the pandemic on dispensed volumes of antidepressants in outpatient settings in different regions of Europe and to assess potential age- and sex-related differences of its impact on incidence of antidepressant dispensing, applying consistent methodology to comparable data. - This presentation is based on a paper by Selke Krulichová et al.

Materials and Methods: We conducted a retrospective, observational, cross-national comparative study in eleven European countries/regions of different geographic locations, health systems, and administrative responses to the pandemic. The participating countries and regions were Croatia, Czechia, Finland, Germany, Lombardy (Italy), Slovenia, Sweden, Northern Ireland, England, Scotland, and Wales. For each country/region, we used monthly pharmacy dispensing data measured in DDD from January 2018 to December 2022. The data included all dispensed prescription antidepressants (ATC code N06A). For Croatia, Finland, Germany, Lombardy, Slovenia, Sweden, the data were stratified into five age groups (0–17, 18–44, 45–64, 65–74 and 75 years and over) and by sex. In addition, for these six countries/regions, monthly data on counts of incident recipients of antidepressants were used. We performed a descriptive analysis and an interrupted time series analysis using ARIMA methods. We introduced two types of external regressors: To capture the short-term changes in the first three months of the pandemic, we introduced a regressor that reflected the presumed stockpiling behaviour between March 2020 and May 2020. To assess the longer-term effect of the pandemic, we explored changes in trend. For this purpose, we used a ramp regressor with onset immediately subsequent to the shortterm regressor, i.e., in June 2020, and finishing at the end of the observation period. For six regions, we analysed volume and incident use stratified by age and sex.

Results: During the pandemic, the pre-existing long-term trend in unstratified dispensed volumes significantly increased only in Slovenia and Germany and weakened in Scotland and Wales (estimated changes in slope +0.16, +0.10, −0.23, and −0.68 defined daily doses per thousand inhabitants per day, respectively, for each month). In all regions except Slovenia there was a significant stock-piling effect in March 2020, followed by decreases in April and May. Remarkably, in Slovenia, the opposite occurred. The stratified quarterly analysis revealed the greatest relative increase in females aged 0–17 (+64% in Sweden to +167% in Croatia in the last quarter of 2022 compared with the last quarter of 2019). Both rate of change and difference between sexes were lower in higher age groups. Incidence increased most steeply in females aged 0–17, where the estimated pandemic-related increase explained 11% (Sweden) to 55% (Lombardy) of new patients receiving antidepressants.

Conclusion: The trends observed during the pandemic did not always significantly differ from the trends already established before the pandemic. However, there are substantial country-, age-, and sex-specific developments. The most marked changes in incidence during the later stages of the pandemic were observed in the youngest age group, especially in Lombardy, which belonged to the regions most affected by the COVID-19 pandemic and subsequent restrictive measures. However, an increase attributable to the pandemic, at least in the period until the end of 2021, also occurred in all other countries/regions in this age group, predominantly in females. In 2022, the incidence among the youngest stabilized except for Lombardy, where it continued to grow, and Slovenia, where it started to decrease again. The moderation of dynamics observed in most countries/regions may be a consequence of the easing of anti-COVID-19 measures or of growing resilience. Overall, we found a substantial set of common developments in these regions, most notably, a marked increase in antidepressant dispensing in female adolescents. Contrary to our initial expectations, older age groups, including the elderly, were substantially less affected. Also, in higher age groups, COVID-19-associated changes differed much less between males and females. Regions with high antidepressant use already before the pandemic showed no increase in the overall trend of dispensed volume. Further research is needed to investigate the effects of various restrictive measures on population subgroups and to find effective measures for increasing resilience and mitigating the impact of potential future public health crises on mental health, especially in young people. Such analysis may require development of a theoretical framework for assessing strategic, pandemic-scale interventions and also detailed patient-level data.

Literatur

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