High-Frequency Surveillance of Mental Health Indicators in the Adult Population of Germany: Trends From 2022 to 2023

Three different indicators showed a substantial decline in the mental health of Germany’s adult population between April 2019 and June 2022. This development was reported in a previous study based on monthly survey data (1). The estimated proportion of the population scoring above the cut-off on an ultra-brief screening instrument for depressive disorders in the same spring/summer period each year rose from 11% in 2019 and 9% in 2020 to 13% in 2021 and further to 17% in 2022. The proportion above the screening cut-off on an anxiety disorder screener also increased between 2021 and 2022 (from 7% to 11%). Furthermore, self-rated mental health (SRMH) deteriorated: 40% of the population rated their mental health as very good or excellent in 2022, down from 44% in 2021.

The present study uses data collected up to May 2023 to examine whether these negative trends were only temporary, reached a plateau, or continued.

Methods

The analyses presented here are based on representative telephone survey data from the German Health Update study, which has used essentially the same design since 2019 (2). The analyses include data from a total of 47 098 adults (an average of 3120 participants each month) from mid-February 2022 (when data collection for that year began) to mid-May 2023.

We extended the time series for the proportion of the population with very good or excellent SRMH (3) and for proportions with scores above the respective cut-off for the Patient Health Questionnaire-2 (PHQ-2) (4) and the Generalized Anxiety Disorder Scale-2 (GAD-2) (5). Each time series comprises 3-month moving estimates and smoothing curves. Scores above cut-off indicate a need for further assessment for possible depressive or anxiety disorder, respectively.

For statistical analysis of changes, estimates for the period mid-February to the end of the previously reported observation period in mid-June 2022 (calendar weeks [CW] 6–24) were compared with estimates for mid-June 2022 to mid-May 2023 (CW 25–19) by means of Wald tests (p < 0.05). Comparisons stratified by age or sex were carried out only if the null hypothesis that there were no differences between time periods in any sex or age group was rejected in omnibus tests (p < 0.05). All estimates are weighted (weighting for design and adjustment by sex, age, level of education, and region) and additionally standardized by sex, age, and education level according to the 2018 microcensus. Subgroup estimates are standardized by the respective other characteristic (sex or age) and education level. The methods are described in detail in (1).

Results

The time series in the Figure show a further increase in the proportions of the population above the screening cut-offs for depressive and anxiety disorders until about late summer 2022, accompanied by a further decrease in those rating their own mental health as very good or excellent, followed by relatively stable estimates at these highest or lowest levels.

Figure

Estimates based on data from three (circle) or two (diamond) months within moving three-month time periods with 95 % confidence intervals and estimated smooths

Statistical comparisons of the estimates for February to June 2022 and June 2022 to May 2023 confirm the trends visible in the Figure. The proportion of persons whose depressive disorder screening scores were above cut-off rose from 17.2% (95% confidence interval [15.9; 18.6]) to 19.8% [19.1; 20.6]. Statistically significant increases are also seen in the standardized proportions of above cut-off screens for women and for 18- to 29-year-olds and 30- to 44-year-olds (Table).

Table

Statistical comparisons between two longer time periods stratified by sex and age

The proportion of persons whose anxiety disorder screening scores were above cut-off increased from 11.3% [10.2; 12.5] to 13.9% [13.2; 14.6]. Females and 30- to 44-year-olds show significant increases in the standardized percentages. Women and 18- to 29-year-olds showed a higher standardized proportion above screening cut-off for anxiety disorders than their respective comparison groups overall. The proportion of those who rated their own mental health as very good or excellent declined from 39.5% [38.1; 41.0] to 36.8% [36.0; 37.6]. The standardized proportions decreased among women and 18- to 29-year-olds. Overall, women and those aged 65 years and over exhibited the lowest proportions with very good or excellent SRMH.

Discussion

The negative trend in the mental health of Germany’s adult population observed between 2019 and mid-2022 continued until about late summer 2022, with no further developments in the remainder of the observation period ending mid-May 2023. Women and the younger age groups (18–29 years, 30–44 years) in particular appear to have been affected by this most recent decline; however, there is evidence for negative developments since 2019 in all sex and age groups (1).

Increased efforts to protect and promote mental health therefore seem indicated, particularly in light of multiple ongoing collective stressors following several years of pandemic, including the war in Ukraine, economic developments, and the worsening climate crisis. While the instruments employed cannot establish the presence of either mental illness or a need for treatment, health professionals should be alert to the possibility of increased mental health assessment needs among their patients. Continued surveillance is required.

Lena Walther, Stephan Junker, Julia Thom, Heike Hölling, Elvira Mauz

Funding

The project “MHS – Establishment of National Mental Health Surveillance at Robert Koch Institute” was funded by the Federal Ministry of Health (Grant Number: ZMI5–2519FSB402).

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 8 May 2023, revised version accepted on 20 July 2023.

Cite this as:
Walther L, Junker S, Thom J, Hölling H, Mauz E: High-frequency surveillance of mental health indicators in the adult population of Germany: trends from 2022 to 2023. Dtsch Arztebl Int 2023; 120: 736-7. DOI: 10.3238/arztebl.m2023.0180

References

1. Mauz E, Walther L, Junker S, et al.: Time trends in mental health indicators in Germany‘s adult population before and during the COVID-19 pandemic. Front Pub Health 2023; 11: 1065938

2. Allen J, Born S, Damerow S, et al.: German Health Update (GEDA 2019/2020-EHIS) – Background and Methodology. J Health Monitor 2021; 6: 66–79.

3. Ahmad F, Jhajj AK, Stewart DE, Burghardt M, Bierman AS: Single item measures of self-rated mental health: a scoping review. BMC Health Serv Res 2014; 14: 398

4. Löwe B, Kroenke K, Gräfe K: Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res 2005; 58: 163–71

5. Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B: Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007; 146: 317–25