Background The pandemic of the coronavirus disease 2019 (COVID-19) has led to an increased burden on mental health. Aims To investigate the development of major depressive disorder (MDD), generalized anxiety disorder (GAD), and suicidal ideation in the Netherlands during the first fifteen months of the pandemic and three nation-wide lockdowns.
Method Participants of the Lifelines Cohort Study –a Dutch population-based sample-reported current symptoms of MDD and GAD, including suicidal ideation, according to DSM-IV criteria. Between March 2020 and June 2021, 36,106 participants (aged 18–96) filled out a total of 629,811 questionnaires across 23 time points. Trajectories over time were estimated using generalized additive models and analyzed in relation to age, sex, and lifetime history of MDD/GAD.
Results We found non-linear trajectories for MDD and GAD with a higher number of symptoms and prevalence rates during periods of lockdown. The point prevalence of MDD and GAD peaked during the third hard lockdown at 2.88 % (95 % CI: 2.71 %–3.06 %) and 2.92 % (95 % CI: 2.76 %–3.08 %), respectively, in March 2021. Women, younger adults, and participants with a history of MDD/GAD reported significantly more symptoms. For suicidal ideation, we found a significant linear increase over time in younger participants. For example, 20-year-old participants reported 4.14× more suicidal ideation at the end of June 2021 compared to the start of the pandemic (4.64 % (CI: 3.09 %–6.96 %) versus 1.12 % (CI: 0.76 %–1.66 %)).
Limitations Our findings should be interpreted in relation to the societal context of the Netherlands and the public health response of the Dutch government during the pandemic, which may be different in other regions in the world.
Conclusions Our study showed greater prevalence of MDD and GAD during COVID-19 lockdowns and a continuing increase in suicidal thoughts among young adults suggesting that the pandemic and government enacted restrictions impacted mental health in the population. Our findings provide actionable insights on mental health in the population during the pandemic, which can guide policy makers and clinical care during future lockdowns and epi/pandemics.
The pandemic of the coronavirus disease 2019 (COVID-19) had a major impact on societies and led to increases in major depressive disorder (MDD), generalized anxiety disorder (GAD), and suicidality across the world (COVID-19 Mental Disorders Collaborators, 2021; Dub´e et al., 2021a; Robinson et al., 2022a). These conditions are severe and disabling and represent major contributors to the global burden of disease and mortality (Naghavi and Global Burden of Disease Self-Harm Collaborators, 2019). How the prevalence of MDD/GAD and their symptoms in the population changed over time during the COVID-19 pandemic, and which groups are most at risk, especially during periods of lockdown, remains unclear.
In summary, we investigated the development of (symptoms of) MDD and GAD and suicidal thoughts in the Northern Dutch population during the COVID-19 pandemic and observed higher prevalence during periods of lockdown, in particular the third hard lockdown. We furthermore found an alarming linear increase in suicidal thoughts among young adults that warrants for alertness in psychiatric care services. Further studies are needed to investigate mechanisms underlying these rising prevalence rates. Our findings provide important insights into the impact of the pandemic on the mental health of the population, which can help guide policy makers and clinical care during future lockdowns and epi/pandemics.