The relationship between pre-COVID prevalence of common mental disorders and the impact of COVID-19

Abstract

BACKGROUND: The pandemic of respiratory illness (COVID-19) caused by a novel coronavirus has affected 8 million people and caused over 440, 000 deaths to date. COVID-19 prevalence and mortality rates have varied widely across nations. Psychosocial factors, such as common mental disorders, may influence the risk of disease spread and death during outbreaks, and these factors are in turn influenced by the prevailing environmental conditions. This study examined the correlation between the prepandemic prevalence of anxiety and depression and indices of the impact of COVID-19. METHODS: Data from 94 countries reporting at least 1000 cases of COVID-19 to date was included. The impact of COVID-19 was assessed using the prevalence and mortality rates per 1 million population and the case fatality rate. The prevalence rates of depression and anxiety were obtained from World Health Organization statistics. The correlations between these variables were examined after correcting for the confounding effects of population, median age and urbanization. RESULTS: The pre-COVID prevalence of depression and anxiety disorders were both positively correlated with COVID-19 prevalence (Spearman's ρ=0.433, P<0.001 for depression, ρ=0.387, P<0.001 for anxiety) and mortality rates (ρ=0.497, P<0.001 for depression, ρ=0.486, P<0.001 for anxiety). The association between anxiety disorder prevalence and COVID-19 mortality and case fatality rates remained significant after correcting for population, median age and degree of urbanization. CONCLUSIONS: These results provide preliminary evidence of a link between the pre-COVID prevalence of common mental disorders and COVID-19 prevalence and mortality rates. Alarge proportion of this relationship may be due to shared environmental vulnerability. However, in the case of anxiety disorders, more specific behavioral or biological mechanisms may also need to be considered.