The burden of mental health on Canadian primary care following Covid-19

Context: In Canada, most of the population relies on their family doctor for their mental healthcare needs.

Objective: To measure and compare the proportion of primary care visits associated with mental health before and after the COVID-19 pandemic.

Study Design and Analysis: An interrupted time series (ITS) analysis was conducted. The time horizon was anchored in January 2012: pre-pandemic period was defined as January 2012 to March 2020, and the pandemic period as April 2020 to June 2022. A primary care visit for a mental health concern was defined as any visit with a diagnosis indicating a mental health condition.

Dataset: Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database.

Outcome Measures: The monthly prevalence was calculated as the percent of mental health visits (MHV) among all visits to a provider in that month. Modeling used segmented time-series regression. We stratified effects by age and sex.

Results: There were 25,930,660 visits evaluated prior to the pandemic, and 9,946,004 visits evaluated during the pandemic. Pre-pandemic, the MHV rate was 0.127/month with a significant upward trend of +0.0004 (p<.0001). In April 2020 the MHV rate rose to 0.141/month. In the subsequent months the MHV rate slowly decreased, with a slope of -0.0002 (p<.0001). The pandemic had a greater impact on females, with MHV rates rising to 0.143/month after the onset of the pandemic compared to 0.137/month in males. The effect modification by age group was significant. Pre-pandemic, MHV rates were highest in 15–24-year-olds (0.227/month) and are increasing most rapidly in this age group (p<.0001). During the pandemic we observed a significant increase in MHV in all age groups, but the degree of change varied within groups. Those <15 years and 15-24 years noted the largest increase of 0.0290/month and 0.0289/month, respectively. Following the onset of the pandemic the MHV trend decreased in adults 25 years and older (age groups 25-44, 45-64 and 65+). In contrast, the rate of MHV in those <15 years and 15–24-year-olds continued to rise at a rate of +0.00047 and +0.00101, respectively.

Conclusions: The COVID-19 pandemic had a significant impact on the volume of visits to Canadian primary care for mental health concerns. The immediate impact, in April 2020, on middle aged and older adults is returning to pre-pandemic rates, but the mental health visit rate continues to rise in young people, (<25 years old), particularly in females.