Coronavirus and GP diagnosed depression in England: 2020

• There was a 29.7% decrease in all diagnoses by GPs in England during the pandemic period covered in this report (23 March to 31 August 2020) compared with the same period in 2019. 

• During the same period, the number of depression diagnoses fell from 1,131,804 in 2019 to 863,578, a decrease of 23.7%; there was a bigger drop for men (27.4% decrease) than for women (21.4% decrease).

• Those aged 45 to 54 years are the age group with the largest fall in the number of depression diagnoses (30.1% decrease).

• In contrast, depression diagnoses as percentage of all diagnoses rose by 1.3 percentage points to 15.6%, when compared with the corresponding 2019 period.

• Depression diagnoses as a percentage of all diagnoses increased slightly among people aged 45 years and over, compared to the corresponding period in 2019; among those aged 25 to 34 years there was a drop of 2.3 percentage points.

• The Chinese ethnic group saw a 4.0 percentage point increase in depression diagnoses as a percentage of all diagnoses, the largest percentage point change of any ethnic group.

• As a percentage of all diagnoses, depression diagnoses increased most among people living in the second most deprived areas (1.5 percentage points); the increase was lowest (0.9 percentage points) among people living in the least deprived areas.

Statistician's comment

"While the number of GP-diagnosed cases of adult depression has fallen during the pandemic, these cases make up a larger percentage of overall diagnoses than pre-pandemic. Meanwhile self-reported feelings associated with depression continue to increase. The picture is one of a rising toll on mental health, with many people not necessarily accessing medical help.”

Theodore Joloza, Principal Research Officer, Office for National Statistics.

The number of depression diagnoses during the pandemic period was 863,578, a decrease of 23.7% compared with 1,131,804 in the corresponding period of 2019. This decrease is broadly in line with a fall in the number of all diagnoses during the pandemic period which fell by 29.7% (Figure 1).

Figure 1: Depression diagnoses and all diagnoses have seen a large drop in 2020

Number of depression diagnoses and all diagnoses during the pandemic period and corresponding periods in 2017, 2018 and 2019, England

Notes:

1. The pandemic period covers 23 March 2020 to 31 August 2020.

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There could be a variety of reasons for a change in the number of GP diagnosed cases of depression before and during the pandemic. This is not solely a result of changes in underlying levels of depression because of the coronavirus (COVID-19) pandemic. It is also important to note that associations between characteristics and the diagnosed depression cannot explain causality.

The release “Coronavirus and depression in adults in Great Britain”, also published on 5th May 2021, uses Opinion and Lifestyle Survey data and covers self-report depressive symptoms in January to March 2021 (and in 2020). In the following we will cross-reference to these results where insightful.

Diagnosed depression in spring lockdown and post-lockdown

During the spring lockdown of 2020 (23 March to 13 May 2020) there was a 29.4% decrease in depression diagnoses compared with the same period in the previous year. This was less than the decrease in all diagnoses, which fell by 32.9% (Figure 2). Depression diagnoses decreased by 22.4% while all diagnoses decreased by 29.4%, in the period after the spring lockdown (the post-lockdown period, 14 May to 31 August 2020), compared with the corresponding period in 2019.

Figure 2: The difference between drop in depression diagnoses and all diagnoses was larger during the post-lockdown period

Year-on-year percentage change in depression diagnoses and all diagnoses during the spring lockdown and post-lockdown periods and corresponding periods in 2018 and 2019

Notes:

1. The spring lockdown period covers 23 March 2020 to 13 May 2020. The post-lockdown period covers 14 May 2020 to 31 August 2020.

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Health service use overall decreased during the pandemic. Therefore, we also compare depression diagnoses as a percentage of all diagnoses during and before the pandemic.

During the pandemic period, depression diagnoses made up 15.6% of all GP diagnoses. During the spring lockdown it was slightly lower (15.0%) than in the post lockdown period (15.8%) (Table 1). For all three periods, these figures are higher than in the corresponding period in 2019. During the spring lockdown period, the increase in depression diagnoses as percentage of all diagnoses was 0.8 percentage points (from 14.2% to 15.0%). In the post-lockdown period it was larger with 1.4 percentage points (from 14.4% to 15.8%). For self-reported depressive symptoms, Office for National Statistics (ONS) analysis found a larger increase around that time period in Great Britain, from 10% of adults experiencing moderate to severe depressive symptoms before the pandemic (July 2019 to March 2020) to 19% in June 2020.

Notes:

1. The pandemic period covers 23 March to 31 August 2020. The spring lockdown period covers 23 March to 13 May 2020. The post lockdown period covers 14 May to 31 August 2020.
2. Depression diagnoses as a percentage of all diagnoses are calculated by dividing the number of depression diagnoses by number of all diagnoses and multiplying by 100.

Even when patients do access GP services for depression, only symptoms might be recorded at the first consultation, a formal diagnosis is often not recorded until a later point. It is therefore possible that patients who consulted a GP for depression during the pandemic period, later received a diagnosis code for depression that has not been included in this analysis.

Sex and Age

The number of depression diagnoses during the pandemic period fell compared with the corresponding period in 2019 for men from 437,382 to 317,545 (27.4% drop) and for women from 694,422 to 546,033 (21.4% drop). Among men and women, the proportion of depression diagnoses of all GP diagnoses is slightly higher during the pandemic period (women 18.5%, men 12.2%) than the corresponding 2019 period (women 16.8%, men 11.6%).

There were fewer depression diagnoses in all age groups in the pandemic period compared with the corresponding period in 2019. The largest decrease in depression diagnoses are among people aged 45 to 54 years (30.1% drop); the smallest decrease was among people aged 75 years and over (14.8% drop) and among young adults aged 16 to 24 years (20.9% drop) and 25 to 34 years (20.8% drop) (Figure 3).

Figure 3: Those aged 45 to 54 years experienced the largest drop in depression diagnoses in the pandemic period 2020

Number of depression diagnoses and all diagnoses during the pandemic period and corresponding periods in 2017, 2018 and 2019, England

Notes:

1. The pandemic period covers 23 March 2020 to 31 August 2020.
2. Depression diagnoses as a percentage of all diagnoses are calculated by dividing the number of depression diagnoses by number of all diagnoses and multiplying by 100

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Depression diagnoses as a percentage of all diagnoses in the pandemic period, compared with the corresponding period in 2019, increased slightly among people aged 45 years and over. The largest percentage point increase was among people aged 55 to 64 years (0.8 percentage points, from 9.8% to 10.6%) (Figure 3). The largest decrease in depression diagnoses as a percentage of all diagnoses occurred among people aged 25 to 34 years (2.3 percentage points, from 50.9% to 48.6%).

Depression diagnoses as a percentage of all diagnoses was similar (among those aged 16 to 24 years) or decreased (amongst those aged 25 to 34 years) during the pandemic period in comparison with the corresponding period in 2019. In contrast, different Office for National Statistics (ONS) analysis has found that the percentage of young adults (aged 16 to 39 years) in Great Britain reporting depressive symptoms has more than doubled from 11% (July 2019 to March 2020) to 31% in June 2020.

Ethnicity

During the pandemic period, the number of depression diagnoses decreased across all ethnic groups compared with the same period in 2019. The biggest decrease was among the White ethnic group (24.0% drop), while the smallest decrease was among the Indian ethnic group (13.8% drop) (Figure 4).

Figure 4: Number of depression diagnoses decreased across all ethnic groups

Number of depression diagnoses and depression diagnoses as a percentage of all diagnoses during the pandemic period by age group and corresponding period 2019, England

Notes:

1. The pandemic period covers 23 March 2020 to 31 August 2020.

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The depression diagnoses as a percentage of all diagnoses during the pandemic period changed the most within the Chinese ethnic group. This increased by 4.0 percentage points compared with 2019. The smallest change in depression diagnoses as a percentage of all diagnoses compared with 2019 was in the White ethnic group (1.1 percentage points higher) (Figure 5).

Figure 5: Depression diagnoses as a percentage of all diagnoses increased the most across the Chinese ethnic group

Depression diagnoses as a percentage of all diagnoses during the pandemic period and corresponding period in 2019 by ethnic group, England

Notes:

1. The pandemic period covers 23 March 2020 to 31 August 2020.
2. Depression diagnoses as a percentage of all diagnoses are calculated by dividing the number of depression diagnoses by number of all diagnoses and multiplying by 100.

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Area deprivation

Depression diagnoses as a percentage of all GP diagnoses increased for people living in all types of areas (Figure 6). The largest increase during the pandemic period compared with the corresponding period in 2019 was in the second most deprived areas (1.5 percentage points). The smallest was in the least deprived areas (0.9 percentage points).

Figure 6: People in the second most deprived areas experienced the biggest change in depression diagnoses as a percentage of all diagnoses during the pandemic period 2020

Depression diagnoses as a percentage of all diagnoses during the pandemic period and corresponding period in 2019, by Index of Multiple Deprivation quintile, England

Notes:

1. The pandemic period covers 23 March 2020 to 31 August 2020.
2. Depression diagnoses as a percentage of all diagnoses are calculated by dividing the number of depression diagnoses by number of all diagnoses and multiplying by 100.
3. Deprivation quintiles are based on the English Index of Multiple Deprivation, version 2019.

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Adult

In this release, we use the term adult to refer to anyone aged 16 years or over.

Depression

Depression is among the most common types of mental disorders experienced by adults in England. It can affect people in different ways and can cause symptoms ranging from lasting feelings of unhappiness and hopelessness to losing interest in the things they used to enjoy. Further information can be found on the NHS website.

Ethnicity

Information on ethnicity was added from the census, supplemented with information from General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) if census information was missing. The ethnic groups used are Bangladeshi and Pakistani, Black, Chinese, Indian, Mixed, Other, White.

Pandemic period, spring lockdown, post lockdown period

The term pandemic period refers to the overall period covered by this analysis, 23 March to 31 August 2020. Spring lockdown is defined as starting on 23 March 2020 and ending on 13 May 2020. The end date follows previous analysis by Office for National Statistics (ONS). The post lockdown period is defined as the remaining period for which data were available, starting on 14 May, ending on 31 August 2020. This analysis does not consider sub-national restrictions that were in place during this time.

General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) extract

GDPPR is a data extract from the General Practice Extraction Service created in response to the coronavirus (COVID-19) pandemic. The data collects information on all patients registered at a GP practice in England. It excludes records of around 1.3 million patients with recorded dissent from secondary use of GP patient identifiable data.

Diagnosed depression

A depression diagnosis is a newly assigned diagnosis code for a depression disorder in a patient's GP record. This measure is likely an underestimate of depression diagnoses as GPs do not record all depression diagnoses in this way.

All diagnoses

All diagnoses are defined as all recorded disorders in the GDPPR data. This is not a complete measure of all diagnoses GPs have made, as GDPPR only includes diagnosis codes relevant for COVID-19. Many common health conditions, such as asthma, cancer, coronary heart disease, kidney disease, diabetes, dementia and stroke, are included.

Only diagnoses classified as disorders are included because for depression only these codes are available in the data. Diagnoses classed as findings (which include both normal and abnormal findings) are not included.

The percentage of depression diagnoses of all diagnoses is calculated by dividing the number of depression diagnoses by the number of all diagnoses and multiplying by 100.

Comparison period

The comparison period for each of the 2020 time periods, pandemic period, spring lockdown and post lockdown period, is the same calendar period in 2019.

Area deprivation

The Index of Multiple Deprivation 2019, England, is created through ranking small geographical populations known as Lower layer Super Output Areas (LSOAs) based on their deprivation score from most to least deprived and grouping them into 5 divisions. The score is based on the area as a whole and not everyone within a LSOA necessarily experiences the same level of deprivation.

Strengths of this data include:

• that in comparison with survey data, the information used here is not self-reported and the large sample size enables subgroup analysis

Limitations of this data include that:

• not everyone who has depressive symptoms consults a GP, therefore GP diagnosed depression may be an underestimation of depression cases; the data do not capture the other ways in which people can be diagnosed with depression (for example, through Improving Access to Psychological Therapies)

• we have accounted for the overall drop in GP service use during the pandemic by looking at depression diagnoses as a percentage of all diagnoses; however, we do not know if GP service use for depression and for other health problems dropped equally

• results cannot be compared across age groups as they are not age standardised

• this analysis does not determine whether differences are statistically significant; although the sample size is very large, many differences are small and should be interpreted with caution

• these are experimental statistics as the methods are still being developed and subject to modification