Mental health surveillance of German adults in the COVID-19 pandemic: trends in depressive symptoms

Abstract Background While literature on mental health in the COVID-19 pandemic has grown rapidly, studies reporting on developments beyond the first wave using continuous, population-based data are still scarce. We examined monthly estimates of depressive symptom levels in Germany’s adult population covering almost two years of the pandemic and the year prior. Methods We analyzed representative data from two population-based telephone surveys of German adults: “German Health Update (GEDA)” and “COVID-19 vaccination rate monitoring in Germany (COVIMO).” Core symptoms of depression measured using the Patient Health Questionnaire-2 (PHQ-2) were observed in approximately 1,000 randomly sampled participants monthly from April 2019 to December 2021. We estimated three-month moving means and proportions as well as smoothing curves to produce time series graphs. Statistical comparisons between specific time periods were used to verify results of visual inspection. Analyses were stratified by gender, age and level of education to assess potential time trend differences between subgroups. Results Both the mean population depressive symptom score and the proportion of the population with a positive PHQ-2 depression screen first decreased to below 2019 levels between the first wave and summer of the pandemic and then increased from autumn 2020, reaching levels significantly above 2019 in 2021 and remaining elevated. 2021 saw a 2.2% increase in positive screens compared to 2019. Women, the youngest and eldest adults, and those with a high level of education experienced a particular increase in depressive symptoms between 2019 and 2021. However, we found no corresponding changes in symptom level differences between population subgroups. Conclusions Our finding of elevated depressive symptoms among Germany’s adults following an increase in the second wave of the pandemic demonstrate the importance of continued surveillance to assess the further development of mental health in the ongoing crisis. Key messages • Monthly data from April 2019 to December 2021 suggests that depressive symptoms decreased at the start of the pandemic and then increased from autumn 2020, reaching levels above 2019 in 2021. • Continued mental health surveillance is needed to assess the further development of mental health indicators in the ongoing crisis and its aftermath.


Background:
Mental disorders are a major contributor to the global burden of disease. During the first year of the pandemic by COVID-19, increases of 25% in the prevalence of anxiety and depression were reported globally. In Portugal, studies conducted during lockdown showed an increase in the prevalence of these disorders. However, previous studies have shown that negative life events, such as exposure to disasters or grief, later lead to resilience or recovery. It is therefore necessary to study the evolution of these disorders in order to adapt mental health measures.

Methods:
The number of patients registered with ''P76 -Depressive Disorder'' and ''P74 -Anxiety Disorder/anxiety state'', according to ICPC-2 criteria, and the total number of patients registered in the Portuguese Health Centers for the months of January 2019 to 2022 were obtained from the Portuguese NHS Information and Monitoring System (SIM@SNS). We calculated the percentage of patients with each of the disorders, individually and combined. Data by health regions were also obtained in order to compare the evolution within each region (North, Center, Lisbon and Tagus Valley, Alentejo and Algarve).

Results:
Between January 2019 and 2022, the proportion of patients with anxiety disorder increased linearly from 8% to 9%. Similarly, the proportion of patients with depressive disorder increased from 11% to 12%. When considered together, anxiety and depression disorders affected 21% of users in mainland Portugal at the beginning of 2022. The Alentejo and Center regions have the highest prevalence of anxiety and depression (24.9% and 24%, respectively) and the Algarve region has the lowest (16.74%). The increases were consistent across health regions, with the largest increase in the North region (2.6%) and the smallest in the Central region (1.7%).

Conclusions:
Anxiety and depression disorders increased in mainland Portugal during the years of the COVID-19 pandemic.

Key messages:
Mental health has been an important factor in public health since before the pandemic. Monitoring depression and anxiety levels in the general public can guide priorities after the pandemic.

Background:
While literature on mental health in the COVID-19 pandemic has grown rapidly, studies reporting on developments beyond the first wave using continuous, population-based data are still scarce. We examined monthly estimates of depressive symptom levels in Germany's adult population covering almost two years of the pandemic and the year prior.

Methods:
We analyzed representative data from two population-based telephone surveys of German adults: ''German Health Update (GEDA)'' and ''COVID-19 vaccination rate monitoring in Germany (COVIMO).'' Core symptoms of depression measured using the Patient Health Questionnaire-2 (PHQ-2) were observed in approximately 1,000 randomly sampled participants monthly from April 2019 to December 2021. We estimated three-month moving means and proportions as well as smoothing curves to produce time series graphs. Statistical comparisons between specific time periods were used to verify results of visual inspection. Analyses were stratified by gender, age and level of education to assess potential time trend differences between subgroups.
15th European Public Health Conference 2022

Results:
Both the mean population depressive symptom score and the proportion of the population with a positive PHQ-2 depression screen first decreased to below 2019 levels between the first wave and summer of the pandemic and then increased from autumn 2020, reaching levels significantly above 2019 in 2021 and remaining elevated. 2021 saw a 2.2% increase in positive screens compared to 2019. Women, the youngest and eldest adults, and those with a high level of education experienced a particular increase in depressive symptoms between 2019 and 2021. However, we found no corresponding changes in symptom level differences between population subgroups.

Conclusions:
Our finding of elevated depressive symptoms among Germany's adults following an increase in the second wave of the pandemic demonstrate the importance of continued surveillance to assess the further development of mental health in the ongoing crisis.

Background:
University life can be a particularly challenging phase in the development of young adults. Current research shows that mental disorders occur more frequently in students compared to workers of the same age. The coronavirus pandemic has exacerbated the problem. The TUDo! Study, done in cooperation with the FU Berlin, aimed to assess the health status of students at TU Dresden, with a focus on mental health.

Methods:
In 2020/2021 students at TU Dresden (excluding students in the medical school) completed an online-based questionnaire. Validated questionnaires, e.g. the PHQ 4 (depressive disorder and generalized anxiety disorder) and the ERI student (student gratification crisis) were used. We evaluated descriptively and analytically, according to the questionnaire-specific specifications.

Results:
A total of 2,683 students (12.3%) at the TU Dresden took part in the survey. The majority of study participants were female (n = 1,507; 56.7%) and had an average age of 22.9 years (SD = 4.3). 32.8% (n = 856/2,611) of the participating students reported a depressive syndrome and 32.5% (n = 848/2,612) a generalized anxiety disorder. Almost half of participating students (40,0%; n = 515/1,310) indicated an imbalance between effort (E) and reward (R) (ER ratio>1). 51.23% (n = 693/1,50) of respondents reported a decline of mental well-being because of the coronavirus pandemic.

Discussion:
Unlike similar studies, this study shows that TU Dresden students were particularly affected with regards to perceived psychological stress and complaints. The existing differences seem to be partly due to the coronavirus pandemic. These results indicate that universities should regularly check their studying conditions and provide appropriate preventive measures.
Key messages: Students are at higher risk than workers of the same age for mental health problems. Students reported a decline in mental well-being due to the coronavirus pandemic.
Abstract citation ID: ckac131.489 The effectiveness of interventions to prevent loneliness in the community-dwelling elderly population

Background:
Loneliness and social isolation have comparable health effects to widely acknowledged and established risk factors. Although the elderly are particularly affected, the effectiveness of interventions to prevent and/or mitigate social isolation and loneliness in the community-dwelling elderly is unclear. The aim of this review of reviews was to pool the findings of systematic reviews addressing the question of effectiveness.

Methods:
Ovid MEDLINE Õ , Health Evidence, Epistemonikos and Global Health (EBSCO) were searched from January 2017 to November 2021. Two reviewers independently assessed each systematic review in two consecutive steps based on previously defined eligibility criteria and appraised the methodological quality using AMSTAR 2. One author extracted data from both systematic reviews and eligible studies; another checked this. We conducted meta-analyses to pool the study results. We report the results of the random-effects and common-effect models.

Results:
We identified 5 systematic reviews containing a total of 30 eligible studies, 16 with a low or moderate risk of bias. Our random-effects meta-analysis indicates an overall SMD effect of 0.63 [95% CI: -0.10; 1.36] for loneliness and was unable to detect an overall effect of the interventions on social support [SMD: 0.00; 95% CI: -0.11; 0.12].

Discussion:
The results show interventions can potentially reduce loneliness in the non-institutionalised, community-dwelling elderly population living at home. As confidence in the evidence is low, rigorous evaluation is recommended.

Key messages:
The meta-analysis indicates that psychosocial interventions have the potential to reduce loneliness in the communitydwelling elderly population. As confidence in the evidence is low, healthcare providers should only implement interventions that are, firstly, based on a sound theory of change and, secondly, subject to rigorous evaluation.