Trends in depression & anxiety symptom severity among mental health service attendees during the COVID-19 pandemic

Background: General population surveys have shown that some groups, particularly young women, experienced increased distress during nationally mandated restrictions to control the spread of COVID-19. However, there has been limited research on such trends among people with pre-existing mental health conditions, leaving mental health services ill equipped to plan for current and future lockdowns. Methods: Mean weekly scores on the GAD-7 and PHQ-9 between 01/01/2020-22/06/2020 (n=9,538 individuals) for all patients of two psychological treatment services (Improving Access to Psychological Therapies) in London, were compared to mean weekly scores from the same time periods in 2017-2019 (n=37,849). The proportion of scores which were above the clinical thresholds for `caseness' each week were compared, and scores between groups based on gender, age group, and ethnicity, were also compared. Results: Confirmed community transmission in the UK (26/02/2020-03/03/2020) and the announcement of the national 'lockdown' (23/03/2020) were associated with significant increases in anxiety symptom scores. `Lockdown' was associated with a decrease in depression scores. These changes were not maintained during lockdown. Significant increases in depression and anxiety were observed at week 23, as restrictions were eased. Limitations: This was an exploratory analysis in two services only. Residual confounding and selection biases cannot be ruled out. Conclusions: Differences in the weekly average symptom scores were short-term; they did not continue throughout 'lockdown' as might have been expected, except among older people. Replication of this study in other settings and investigating the potential benefits of more regular reviews or more intensive treatments for at-risk groups, are warranted.