Introduction

The global prevalence of depression and anxiety is estimated to be 4.4% and 3.6%, respectively, with higher rates among women. In the Americas region, the rates are concentrated at 15% and 21%.¹ The COVID-19 pandemic, caused by the SARSCoV-2 virus, has become a trigger for stressful experiences in the general population, leading to the onset or worsening of mental illnesses. Reports have shown an increase in cases of depression, anxiety, psychological distress, and suicidal behavior.² Following the start of the pandemic in China, there was a rapid increase in negative emotions such as anxiety and depression in the week,³ resulting in a prevalence of 23.8% and 28.8% for depression and anxiety, respectively.⁴

Over the past few decades, the prevalence of mental disorders in Mexico has been on the rise. According to data from the National Health Survey 2019, 17.9% of adults exhibited depressive symptoms indicative of moderate or severe depression.⁵ Similarly, there has been an increase in alcohol and illicit substance use before the pandemic.⁶ The increasing prevalence of mental disorders has had an impact on the demand and supply of mental health services, which is particularly challenging in countries like Mexico where access to these services is limited.⁷ It is worth noting that the treatment gap for these disorders in Latin American countries can be as high as 80%.⁸ This study aims to compare the demand for mental health care between June and December in 2019 and 2021 at a public psychiatric hospital in Mexico City.

The Fray Bernardino Álvarez Psychiatric Hospital (HPFBA, for its acronym in Spanish) was the sole medical-psychiatric facility in Mexico City that remained operational throughout the COVID-19 pandemic caused by the SARS-CoV-2 virus.

Method

This study is an observational, descriptive, retrospective comparative study. A non-probabilistic sample was used, consisting of all patient records who sought medical-psychiatric care during the periods of June to December in 2019 and 2021. All patients included in the study were over 18 years of age.

Results

During the June-December period of 2019, there were a total of 14,602 appointments, with 6,369 requested by males and 8,233 by females. The main reason for consultation was categorized as schizophrenia, schizotypal, and delusional disorders (42.09%), followed by personality disorders (19.5%) and depressive disorders (10.87%) (Table 1).

In the June-December period of 2021, there were a total of 5,707 cases, with a distribution of 2,614 males (45.8%) and 3,093 females (54.2%). The mean age was 37.6 years (SD=15.0; min-max: 18-92) (Table 1). The main reason for consultation during this period was depressive disorders, followed by psychotic disorders, as well as neurotic and stressrelated disorders; another frequent reason was substance use disorders. There were no statistically significant differences between males and females in relation to diagnoses; however, affective disorders (depression and bipolar) and neurotic, stress-related, and somatoform disorders were more common in females. On the other hand, psychotic disorders (schizophrenia, schizotypal disorders, delusional disorders) and substance use disorders were more common in males.

Table 1 shows that there was a significant increase in demand for substance use disorders (208%), depressive disorders (275%), and neurotic disorders (mainly anxiety, 485%) when comparing the two periods. In contrast, there was a decrease of 56.7% in demand for care for patients with schizophrenia and 51.7% for bipolar disorders.

The population seeking care predominantly resided in Mexico City, the State of Mexico, and Morelos, which together accounted for 96.25% of the total. A very low percentage of patients (0.9%) reported symptoms compatible with COVID-19 (Table 1).

When comparing the total demand, it was observed that in 2021, it decreased by more than 50% compared to the same period in 2019 (Table 2); the months of June, September, and November had the most drastic reductions. The differential demand for care was -5,830 appointments, with statistically significant differences (p=<0.05).

When comparing the daily number of COVID-19 cases in Mexico City between June and December 2021 with the demand for care, a notable pattern emerged. It was observed that the demand for care tended to increase during weeks with a higher number of infections. This trend persisted until September and then showed some fluctuations, with irregular increases observed throughout October (see Figure 1).

Figure 1 Variation in demand for care and daily COVID-19 cases. 

Discussion

The June-December period of 2021 witnessed a notable 50% reduction in the total demand for mental health care compared to the same period in 2019. This decline aligns with the 100% reduction in new and subsequent consultations reported by the General Directorate of Health Information in 2020,¹⁰ confirming the persistence of this trend throughout 2021.

This decrease in demand can be attributed to mobility restrictions and reduced staff in mental health centers and psychiatric hospitals, which limited access to health services. Similar trends of decreased demand were observed in psychiatric hospitals in Spain, where demand decreased by 58% compared to 2019.¹¹

Despite the overall decrease in demand, certain mental disorders exhibited increasing trends. Depression and anxiety showed a significant increase in demand, with the latter quadrupling. Substance-related disorders also displayed a rising trend. While some studies reported an increase in the prevalence of anxiety disorders during the pandemic, others indicated no significant changes in alcohol consumption.^12,13 Furthermore, there was a confirmed increase in the number of mental disorder cases proportionate to the reported rise in COVID-19 infections, consistent with findings from other studies.¹⁴

One dire consequence of the lack of mental health care is suicide. Mexico was already experiencing a steady increase in suicide deaths, which was exacerbated by the reduction in mental health services during the pandemic. The demand for care related to depression and anxiety quadrupled, while the demand for psychotic disorders decreased. This likely contributed to the highest number of suicide cases reported since 1994, with 7,896 cases in 2020.¹⁵

Another crucial aspect to consider is the accessibility of mental health services. Our results showed that only 65% of individuals seeking care at the hospital were residents of Mexico City, indicating that 35% were unable to receive care in their local areas. This issue should be addressed through policies that aim to enhance actions and improve access to mental health services at the primary care level.¹⁶

Conclusions

Based on these findings, it is evident that there has been a reduction in the demand for mental health care and an increase in the demand for depressive and neurotic disorders. Mental health services face significant challenges in addressing this demand and developing strategies to meet the accumulated needs. The findings of this study provide insight into the situation in the country, considering the role of the Fray Bernardino Álvarez Psychiatric Hospital, which attends to approximately 15% of outpatient consultations nationwide7 and remained operational throughout the pandemic. However, further research is necessary to estimate the impact of mobility restrictions and the shortage of mental health professionals (such as doctors, nurses, psychologists, and social workers) in the context of the pandemic. Acknowledgments

The authors would like to thank the authorities of the Fray Bernardino Álvarez Psychiatric Hospital.