The underestimation of depression in primary health care in Greece during the post-COVID-19 pandemic: A simulation study
Vol 9, Issue 12, 2024, Article identifier:
VIEWS - 7 (Abstract) 3 (PDF)
Abstract
Depression is the primary cause of psychological distress, particularly in a crisis like the SARS-CoV-2 pandemic. Primary healthcare structures don't seem to be able to identify and treat a sizable percentage of depressed individuals. This study aimed to examine the prevalence of undiagnosed depression in primary healthcare settings during the post-COVID-19 pandemic and its correlation with demographics and alcoholism. This cross-sectional study used the PHQ-9 (Patient Health Questionnaire-9) to measure depression levels and the FAST (Fast Alcohol Screening Test) to assess alcoholism. A total of 212 individuals (86 males, aged 51.22 ± 6.11, and 126 females, aged 49.75 ± 6.22) who visited a Primary Health Center in Western Greece between May 2022 and September 2022 were included in the study. Findings revealed the occurrence of undetected depression in a percentage of 63.2% of cases. More specifically, 36.8% of the sample showed no depressive symptoms at all, 28.3% had mild depression, 18.4% had moderate depression, and 16.5% had severe depression. However, gender and alcoholism did not seem to influence the occurrence of depressive symptoms somehow. The results offer significant evidence regarding the prevalence of depression and its inadequate diagnosis in primary healthcare settings throughout the post-COVID-19 era. Based on the findings, general practitioners, mental health professionals, and the personnel of a Primary Health structure can use these questionnaires as screening tools for depression and alcoholism problems during patients’ visits. Future longitudinal studies might be conducted to examine the enduring psychological impacts of the pandemic and develop a depression awareness campaign within the context of primary healthcare.
Keywords
Full Text:
PDFReferences
1. World Health Organisation. World Health Organisation. 2021. Depression. Available from: https://www.who.int/news-room/fact-sheets/detail/depression
2. Kim AW, Nyengerai T, Mendenhall E. Evaluating the mental health impacts of the COVID-19 pandemic : perceived risk of COVID-19 infection and childhood trauma predict adult depressive symptoms in urban South Africa. 2022;
3. Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychol Bull. 2017;143(8):783.
4. García‐Fernández L, Romero‐Ferreiro V, Padilla S, David López‐Roldán P, Monzó‐García M, Rodriguez‐Jimenez R. Gender differences in emotional response to the COVID‐19 outbreak in Spain. Brain Behav. 2021;11(1):e01934.
5. Argyropoulos K, Bartsokas C, Argyropoulou A, Gourzis P, Jelastopulu E. Depressive symptoms in late life in urban and semi-urban areas of South-West Greece: An undetected disorder? Indian J Psychiatry. 2015;57(3):295–300.
6. Kurniawidjaja M, Susilowati IH, Erwandi D, Kadir A, Hasiholan BP, Al Ghiffari R. Identification of Depression Among Elderly During COVID-19. J Prim Care Community Health. 2022 Mar 1;13.
7. Robb CE, de Jager CA, Ahmadi-Abhari S, Giannakopoulou P, Udeh-Momoh C, McKeand J, et al. Associations of Social Isolation with Anxiety and Depression During the Early COVID-19 Pandemic: A Survey of Older Adults in London, UK. Front Psychiatry. 2020 Sep 17;11.
8. Fekadu A, Demissie M, Birhane R, Medhin G, Bitew T, Hailemariam M, et al. Under detection of depression in primary care settings in low and middle-income countries : a systematic review and meta- analysis. Syst Rev [Internet]. 2022;1–10. Available from: https://doi.org/10.1186/s13643-022-01893-9
9. Akat M. Psychological Effects of COVID-19 Pandemic on Society and Its Reflections on Education. 2020;(August).
10. Sullivan LE, Fiellin DA, O’Connor PG. The prevalence and impact of alcohol problems in major depression: A systematic review. American Journal of Medicine. 2005;118(4):330–41.
11. Jacob L, Smith L, Armstrong NC, Yakkundi A, Barnett Y, Butler L, et al. Alcohol use and mental health during COVID-19 lockdown: A cross-sectional study in a sample of UK adults. Drug Alcohol Depend. 2021 Feb 1;219.
12. Gibney L, Saquib N, Metzger J. Behavioral risk factors for STD/HIV transmission in Bangladesh’s trucking industry. Soc Sci Med. 2003;56(7):1411–24.
13. Cubillos L, Bartels SM, Torrey WC, Naslund J, Uribe-Restrepo JM, Gaviola C, et al. The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries: systematic review. BJPsych Bull. 2021;45(1):40–52.
14. Merikanto I, Kortesoja L, Benedict C, Chung F, Cedernaes J, Espie CA, et al. Evening-types show highest increase of sleep and mental health problems during the COVID-19 pandemic—multinational study on 19 267 adults. Sleep. 2022;45(2):zsab216.
15. Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry. 2020;7(9):813–24.
16. Ferreira LN, Pereira LN, da Fé Brás M, Ilchuk K. Quality of life under the COVID-19 quarantine. Quality of Life Research. 2021;30:1389–405.
17. Algahtani FD, Hassan S un N, Alsaif B, Zrieq R. Assessment of the quality of life during COVID-19 pandemic: a cross-sectional survey from the Kingdom of Saudi Arabia. Int J Environ Res Public Health. 2021;18(3):847.
18. Mystakidou K, Parpa E, Tsilika E, Panagiotou I, Roumeliotou A, Symeonidi M, et al. Evaluation of instrumental activities of daily living in Greek patients with advanced cancer. International Journal of Rehabilitation Research [Internet]. 2013;36(1). Available from: https://journals.lww.com/intjrehabilres/Fulltext/2013/03000/Evaluation_of_instrumental_activities_of_daily.10.aspx
19. Dale R, Budimir S, Probst T, Humer E, Pieh C. Quality of life during the COVID-19 pandemic in Austria. Front Psychol. 2022;13:934253.
20. Epifanio MS, Andrei F, Mancini G, Agostini F, Piombo MA, Spicuzza V, et al. The impact of COVID-19 pandemic and lockdown measures on quality of life among Italian general population. J Clin Med. 2021;10(2):289.
21. Betty Pfefferbaum, M.D., J.D., and Carol S. North MD. Mental Health and the Covid-19 Pandemic. N Engl J Med. 2020;383(6):2020–2.
22. Kavoor AR. COVID-19 in people with mental illness: challenges and vulnerabilities. Asian J Psychiatr. 2020;51:102051.
23. Bowman C, Branjerdporn G, Turner K, Kamara M, Tyagi N, Reyes NJD, et al. The impact of viral epidemics and pandemics on acute mental health service use: an integrative review. Health Psychol Rev. 2021;15(1):1–33.
24. Carr MJ, Steeg S, Webb RT, Kapur N, Chew-Graham CA, Abel KM, et al. Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study. Lancet Public Health [Internet]. 2021;6(2):e124–35. Available from: http://dx.doi.org/10.1016/S2468-2667(20)30288-7
25. Sotiropoulou P, Ferenidou F, Owens D, Kokka I, Minopoulou E, Koumantanou E, et al. The Impact of Social Distancing Measures Due to COVID-19 Pandemic on Sexual Function and Relationship Quality of Couples in Greece. Sex Med [Internet]. 2021;9(3):100364. Available from: https://doi.org/10.1016/j.esxm.2021.100364
26. Halcomb E, Fernandez R, Mursa R, Stephen C, Calma K, Ashley C, et al. Mental health, safety and support during COVID‐19: A cross‐sectional study of primary health care nurses. J Nurs Manag. 2022;30(2):393–402.
27. Carr MJ, Steeg S, Webb RT, Kapur N, Chew-Graham CA, Abel KM, et al. Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study. Lancet Public Health. 2021 Feb 1;6(2):e124–35.
28. Peritogiannis V, Lixouriotis C. Mental health care delivery for older adults in rural Greece: Unmet needs. J Neurosci Rural Pract. 2019;10(04):721–4.
29. Betty Pfefferbaum, M.D., J.D., and Carol S. North MD. Mental Health and the Covid-19 Pandemic. N Engl J Med. 2020;383(6):2020–2.
30. Menges D, Ballouz T, Anagnostopoulos A, Aschmann HE, Domenghino A, Fehr JS, et al. Burden of post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study. PLoS One. 2021;16(7 July):1–19.
31. Pavli A, Theodoridou M, Maltezou HC. Post-COVID Syndrome: Incidence, Clinical Spectrum, and Challenges for Primary Healthcare Professionals. Arch Med Res [Internet]. 2021;52(6):575–81. Available from: https://doi.org/10.1016/j.arcmed.2021.03.010
32. Douglas M, Katikireddi SV, Taulbut M, Mckee M, Mccartney G. Mitigating the wider health effects of covid-19 pandemic. 2020;1557(April):1–6.
33. Basta M, Micheli K, Simos P, Zaganas I, Panagiotakis S, Koutra K, et al. Frequency and risk factors associated with depression in elderly visiting Primary Health Care (PHC) settings: Findings from the Cretan Aging Cohort. J Affect Disord Rep. 2021;4:100109.
34. Fountoulakis KN, Apostolidou MK, Atsiova MB, Filippidou AK, Florou AK, Gousiou DS, et al. Self-reported changes in anxiety, depression and suicidality during the COVID-19 lockdown in Greece. J Affect Disord. 2021;279:624–9.
35. Tsamakis K, Tsiptsios D, Ouranidis A, Mueller C, Schizas D, Terniotis C, et al. COVID19 and its consequences on mental health. Exp Ther Med. 2021;21(3):1.
36. Chaudhary R, Rohilla M, Chauhan S, Saini M, Aman S, Singla H, et al. The pandemic’s unseen wounds: COVID-19’s profound effects on mental health. Annals of Medicine and Surgery. 2023;85(10):4954–63.
37. Chan VKY, Chai Y, Chan SSM, Luo H, Jit M, Knapp M, et al. 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. BMC Med. 2024 Dec 1;22(1).
38. Fountoulakis KN, Apostolidou MK, Atsiova MB, Filippidou AK, Florou AK, Gousiou DS, et al. Self-reported changes in anxiety, depression and suicidality during the COVID-19 lockdown in Greece. J Affect Disord [Internet]. 2021;279(November 2020):624–9. Available from: https://doi.org/10.1016/j.jad.2020.10.061
39. Tsamakis K, Tsiptsios D, Ouranidis A, Mueller C, Schizas D, Terniotis C, et al. COVID19 and its consequences on mental health (Review). Exp Ther Med. 2021;21(3):1–7.
40. Kotoulas AS, Karamanavis D, Lambrou GΙ, Karanikas P. A pilot study of the depression, anxiety and stress in Greek military personnel during the first year of the COVID-19 pandemic. BMJ Mil Health. 2023;169(4):297–301.
41. Moustakopoulou L, Adamakidou T, Plakas S, Drakopoulou M, Apostolara P, Mantoudi A, et al. Exploring loneliness, fear and depression among older adults during the covid-19 era: a cross-sectional study in greek provincial towns. In: Healthcare. MDPI; 2023. p. 1234.
42. Kintzoglanakis K, Gkousiou A, Vonta P, Sagmatopoulos A, Copanitsanou P. Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: different roles for glycemic control and self-care. SAGE Open Med. 2022;10:20503121221096604.
43. Gavana M, Papageorgiou DI, Stachteas P, Vlachopoulos N, Pagkozidis I, Angelopoulou P, et al. The psychological impact of COVID-19 pandemic on primary health care professionals in Greece. Psychiatriki. 2023;34(3):181–92.
44. Fountoulakis KN, Apostolidou MK, Atsiova MB, Filippidou AK, Florou AK, Gousiou DS, et al. Mental health and conspirasism in health care professionals during the spring 2020 COVID-19 lockdown in Greece. Acta Neuropsychiatr. 2022;34(3):132–47.
45. Aslanidis V, Tsolaki V, Papadonta ME, Amanatidis T, Parisi K, Makris D, et al. The impact of the COVID-19 pandemic on mental health and quality of life in COVID-19 department healthcare workers in Central Greece. J Pers Med. 2023;13(2):250.
46. Skalidou S, Anestis A, Skalidis E, Kontaxi O, Kyrezi A, Konstantinou P, et al. A repeated cross-sectional pilot study of physical activity, levels of depression and anxiety during the COVID-19 pandemic in young Greek adults. In: Healthcare. MDPI; 2023. p. 2493.
47. Kroenke K, Spitzer RL, Williams JBW. The PHQ‐9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.
48. Kroenke K, Spitzer RL, Williams JBW, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: A systematic review. Gen Hosp Psychiatry [Internet]. 2010;32(4):345–59. Available from: http://dx.doi.org/10.1016/j.genhosppsych.2010.03.006
49. Campo-Arias A, Pedrozo-Pupo JC, Cogollo-Milanés Z. PHQ-9 in screening of major depressive episode among COVID-19 survivors. Revista Colombiana de psiquiatria (English ed). 2021;
50. Adams DP, Holt JR, Martin JA, Houpy DM, Hollenbach KA. The effect of COVID-19 lockdown on PHQ depression screening scores for high school athletes. Int J Environ Res Public Health. 2022;19(16):9943.
51. Kapila AK, Ram A, D’Uva L, Farid Y, Talib M. The importance of assessing the self-reported impact of COVID-19 on clinician mental health. Eur J Psychiatry. 2020;34(4):223.
52. Hyphantis T, Kotsis K, Voulgari P V, Tsifetaki N, Creed F, Drosos AA. Diagnostic accuracy, internal consistency, and convergent validity of the Greek version of the patient health questionnaire 9 in diagnosing depression in rheumatologic disorders. Arthritis Care Res (Hoboken). 2011;63(9):1313–21.
53. Hodgson R, Alwyn T, John B, Thom B, Smith A. The FAST alcohol screening test. Alcohol and alcoholism. 2002;37(1):61–6.
54. Moussas G, Dadouti G, Douzenis A, Poulis E, Tselebis A, Bratis D, et al. The alcohol use disorders identification test (AUDIT): Reliability and validity of the Greek version. Ann Gen Psychiatry. 2009;8:1–5.
55. Subhani M, Sheth A, Unitt S, Aithal GP, Ryder SD, Morling JR. The effect of COVID-19 on alcohol use disorder and the role of universal alcohol screening in an inpatient setting: a retrospective cohort control study. Alcohol and Alcoholism. 2022;57(2):203–10.
56. Goldschmidt L, Mncina B, Langa M, Rebello S, Budaza T, Tshabalala J, et al. AUDIT-C as a possible source of referral during the COVID-19 pandemic for participants presenting patterns of high-risk alcohol consumption in a South African township. BMC Public Health. 2023;23(1):1890.
57. Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al. The prevalence of depression, anxiety, and sleep disturbances in COVID‐19 patients: a meta‐analysis. Ann N Y Acad Sci. 2021;1486(1):90–111.
58. Zhu C, Zhang T, Li Q, Chen X, Wang K. Depression and anxiety during the COVID-19 pandemic: epidemiology, mechanism, and treatment. Neurosci Bull. 2023;39(4):675–84.
59. Jeong H, Yim HW, Lee SY. Impact of the COVID-19 pandemic on gender differences in depression based on national representative data. J Korean Med Sci. 2023;38(6).
60. Hou F, Bi F, Jiao R, Luo D, Song K. Gender differences of depression and anxiety among social media users during the COVID-19 outbreak in China:a cross-sectional study. BMC Public Health. 2020 Dec 1;20(1).
61. Abreu L, Koebach A, Díaz O, Carleial S, Hoeffler A, Stojetz W, et al. Life With Corona: Increased Gender Differences in Aggression and Depression Symptoms Due to the COVID-19 Pandemic Burden in Germany. Front Psychol. 2021 Jul 27;12.
62. Vallières F, Murphy J, McBride O, Shevlin M, Gilmore B, Travers Á, et al. The role of psychosocial factors in explaining sex differences in major depression and generalized anxiety during the COVID-19 pandemic. BMC Public Health. 2022 Dec 1;22(1).
63. Herrera-Añazco P, Urrunaga-Pastor D, Benites-Zapata VA, Bendezu-Quispe G, Toro-Huamanchumo CJ, Hernandez A V. Gender Differences in Depressive and Anxiety Symptoms During the First Stage of the COVID-19 Pandemic: A Cross-Sectional Study in Latin America and the Caribbean. Front Psychiatry. 2022 Mar 17;13.
64. Ausín B, González-Sanguino C, Castellanos MÁ, Muñoz M. Gender-related differences in the psychological impact of confinement as a consequence of COVID-19 in Spain. J Gend Stud. 2021;30(1):29–38.
65. Banna MH Al, Sayeed A, Kundu S, Christopher E, Hasan MT, Begum MR, et al. The impact of the COVID-19 pandemic on the mental health of the adult population in Bangladesh: a nationwide cross-sectional study. Int J Environ Health Res. 2022;32(4):850–61.
66. Fu W, Wang C, Zou L, Guo Y, Lu Z, Yan S, et al. Psychological health, sleep quality, and coping styles to stress facing the COVID-19 in Wuhan, China. Transl Psychiatry. 2020;10(1):225.
67. Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, et al. Mental health problems and social media exposure during COVID-19 outbreak. PLoS One. 2020;15(4):e0231924.
68. Islam MS, Ferdous MZ, Potenza MN. Panic and generalized anxiety during the COVID-19 pandemic among Bangladeshi people: An online pilot survey early in the outbreak. J Affect Disord. 2020;276:30–7.
69. Shi L, Lu ZA, Que JY, Huang XL, Liu L, Ran MS, et al. Prevalence of and risk factors associated with mental health symptoms among the general population in China during the coronavirus disease 2019 pandemic. JAMA Netw Open. 2020;3(7):e2014053–e2014053.
70. Zhao H, He X, Fan G, Li L, Huang Q, Qiu Q, et al. COVID-19 infection outbreak increases anxiety level of general public in China: involved mechanisms and influencing factors. J Affect Disord. 2020;276:446–52.
71. Wang C, Pan R, Wan X, Tan Y, Xu L, McIntyre RS, et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behav Immun. 2020;87:40–8.
72. Wickens CM, Hamilton HA, Elton-Marshall T, Nigatu YT, Jankowicz D, Wells S. Household-and employment-related risk factors for depressive symptoms during the COVID-19 pandemic. Canadian Journal of Public Health. 2021;112:391–9.
73. Burgard SA, Brand JE, House JS. Toward a better estimation of the effect of job loss on health. J Health Soc Behav. 2007;48(4):369–84.
74. Paul KI, Moser K. Unemployment impairs mental health: Meta-analyses. J Vocat Behav. 2009;74(3):264–82.
75. Posel D, Oyenubi A, Kollamparambil U. Job loss and mental health during the COVID-19 lockdown: Evidence from South Africa. PLoS One. 2021;16(3):e0249352.
76. McCracken LM, Badinlou F, Buhrman M, Brocki KC. Psychological impact of COVID-19 in the Swedish population: Depression, anxiety, and insomnia and their associations to risk and vulnerability factors. European Psychiatry. 2020;63(1):e81.
77. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;88:559–65.
78. Lotzin A, Krause L, Acquarini E, Ajdukovic D, Ardino V, Arnberg F, et al. Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic–First results of the ESTSS COVID-19 pan-European ADJUST study. Eur J Psychotraumatol. 2021;12(1):1964197.
79. Sullivan PF, Neale MC, Ph D, Kendler KS. Reviews and Overviews Genetic Epidemiology of Major Depression : Review and Meta-Analysis. 2000;(October):1552–62.
80. Wu P, Hoven CW, Okezie N, Fuller CJ, Cohen P. Alcohol abuse and depression in children and adolescents. J Child Adolesc Subst Abuse. 2008;17(2):51–69.
81. Shield KD, Chrystoja BR, Ali S, Sohi I, Rehm J, Nigatu YT, et al. Changes in Alcohol Consumption in Canada During the COVID-19 Pandemic: Associations With Anxiety and Self-Perception of Depression and Loneliness. Alcohol and Alcoholism. 2022 Mar 1;57(2):190–7.
82. Stanton R, To QG, Khalesi S, Williams SL, Alley SJ, Thwaite TL, et al. Depression, anxiety and stress during COVID-19: Associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. Int J Environ Res Public Health. 2020 Jun 1;17(11):1–13.
83. Vera BDV, Carmona-Márquez J, Lozano-Rojas ÓM, Parrado-González A, Vidal-Giné C, Pautassi RM, et al. Changes in alcohol use during the covid-19 pandemic among young adults: The prospective effect of anxiety and depression. J Clin Med. 2021 Oct 1;10(19).
84. Munaretto V, Reggiani G, Munerol C, Maran E, Perdibon M, Frigo AC, et al. Quality of Life in Children, Adolescents and Young Adults with Sickle Cell Disease and Their Caregivers during Standard of Care and after Bone Marrow Transplantation: A Single Center Report. Blood. 2021;138:3032.
85. Athyal V, Stinis S. Follow-up care of patients with newly diagnosed depression after widespread implementation of telemedicine. Annals Family Med; 2023.
DOI: https://doi.org/10.59429/esp.v9i12.3017
(7 Abstract Views, 3 PDF Downloads)
Refbacks
- There are currently no refbacks.
Copyright (c) 2024 Angeliki Tsapara, Panagiotis Plotas, Anastasios Giakoumis, Anastasios Kantanis, Nikolaos Trimmis, Philippos Gourzis, Eleni Jelastopulu
This work is licensed under a Creative Commons Attribution 4.0 International License.