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. 2024 Apr 22;22(1):169.
doi: 10.1186/s12916-024-03386-z.

Impact of COVID-19 pandemic on depression incidence and healthcare service use among patients with depression: an interrupted time-series analysis from a 9-year population-based study

Vivien Kin Yi Chan #  1 , Yi Chai #  1   2 , Sandra Sau Man Chan  3 , Hao Luo  4 , Mark Jit  5   6 , Martin Knapp  4   7 , David Makram Bishai  6 , Michael Yuxuan Ni  6   8   9 , Ian Chi Kei Wong  10   11   12   13 , Xue Li  14   15   16   17
Affiliations

Impact of COVID-19 pandemic on depression incidence and healthcare service use among patients with depression: an interrupted time-series analysis from a 9-year population-based study

Vivien Kin Yi Chan et al. BMC Med. .

Abstract

Background: Most studies on the impact of the COVID-19 pandemic on depression burden focused on the earlier pandemic phase specific to lockdowns, but the longer-term impact of the pandemic is less well-studied. In this population-based cohort study, we examined the short-term and long-term impacts of COVID-19 on depression incidence and healthcare service use among patients with depression.

Methods: Using the territory-wide electronic medical records in Hong Kong, we identified all patients aged ≥ 10 years with new diagnoses of depression from 2014 to 2022. We performed an interrupted time-series (ITS) analysis to examine changes in incidence of medically attended depression before and during the pandemic. We then divided all patients into nine cohorts based on year of depression incidence and studied their initial and ongoing service use patterns until the end of 2022. We applied generalized linear modeling to compare the rates of healthcare service use in the year of diagnosis between patients newly diagnosed before and during the pandemic. A separate ITS analysis explored the pandemic impact on the ongoing service use among prevalent patients with depression.

Results: We found an immediate increase in depression incidence (RR = 1.21, 95% CI: 1.10-1.33, p < 0.001) in the population after the pandemic began with non-significant slope change, suggesting a sustained effect until the end of 2022. Subgroup analysis showed that the increases in incidence were significant among adults and the older population, but not adolescents. Depression patients newly diagnosed during the pandemic used 11% fewer resources than the pre-pandemic patients in the first diagnosis year. Pre-existing depression patients also had an immediate decrease of 16% in overall all-cause service use since the pandemic, with a positive slope change indicating a gradual rebound over a 3-year period.

Conclusions: During the pandemic, service provision for depression was suboptimal in the face of increased demand generated by the increasing depression incidence during the COVID-19 pandemic. Our findings indicate the need to improve mental health resource planning preparedness for future public health crises.

Keywords: COVID; Cohort study; Depression; Electronic medical records; Health resource utilization; Health service use; Incidence; Interrupted time series; Pandemic.

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Conflict of interest statement

X Li received research grants from the Hong Kong Health and Medical Research Fund (HMRF, HMRF Fellowship Scheme, HKSAR), Research Grants Council Early Career Scheme (RGC/ECS, HKSAR), Janssen, and Pfizer; internal funding from the University of Hong Kong; and consultancy fees from Merck Sharp & Dohme and Pfizer; she is also a non-executive director of Advanced Data Analytics for Medical Science (ADAMS) Limited Hong Kong; all are unrelated to this work. ICK Wong received research funding outside the submitted work from Amgen, Bristol-Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, Takeda, the Hong Kong Research Grants Council, the Hong Kong Health and Medical Research Fund, National Institute for Health Research in England, European Commission, National Health and Medical Research Council in Australia, and the European Union’s Seventh Framework Programme for research and technological development. He has also received consulting fees from IQVIA, the WHO, and expert testimony for Appeal Court in Hong Kong over the past 3 years. He is an advisory member of Pharmacy and Poisons Board, Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, and the Advisory Panel on COVID-19 Vaccines of the Hong Kong Government. He is also a non-executive director of Jacobson Medical Hong Kong, Advanced Data Analytics for Medical Science (ADAMS) Limited, and OCUS Innovation Limited (Hong Kong, Ireland, and UK), and the founder and a director of Therakind Limited (UK). Other authors declared no competing interests related to this study.

Figures

Fig. 1
Fig. 1
Interrupted time series analysis plot of pandemic impact on depression incidence
Fig. 2
Fig. 2
Trend of healthcare resource utilization from 2014 to 2022
Fig. 3
Fig. 3
Impact of the pandemic on the ongoing healthcare resource utilization among the 2014–2016 cohorts
See this image and copyright information in PMC

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