gms | German Medical Science

Background: It is well-known that mental health problems are more prevalent in lower socioeconomic groups. People with low socioeconomic status have also been shown to be more burdened in times of crisis. Accordingly, there were concerns that their mental health would be particularly affected during the COVID-19 pandemic. However, there are mixed results regarding a potential widening of the social gradient in mental health during the pandemic. Despite the pandemic, further stressors may apply, such as the war in Ukraine, worsening of the climate crisis and economic developments such as increasing energy and food prices. Our aim was therefore to assess trends in socioeconomic inequalities in symptoms of depression across Germany during a time when multiple stressors might impact mental health.

Methods: Data stems from the “German Health Update” (GEDA) study, a representative telephone survey of the adult population in Germany. Depressive symptoms were measured using the established screening instrument “Patient Health Questionnaire-2” (PHQ-2) and observed on a monthly basis from April 2019 until January 2024. Data collection comprised approximately 1,000 participants monthly over the years 2019-2021, and 2,000-4,000 participants monthly for 2022-2024. We produced time series graphs of 3-month moving estimates for proportions of positive screens for potential depressive disorder (PHQ-2 scores ≥ 3) as well as smoothing curves. Analyses were stratified by sex, age, education and income. We furthermore calculated monthly trends on educational and income inequalities in depressive symptoms, using regression-based Relative Index of Inequality and Slope Index of Inequality.

Results: The proportion of positive screens in the general population first decreased from 11% in 2019 to 9% in 2020 and then rose to 13% in 2022, 17% in spring/early summer 2022 [1] and reached 20% from late summer 2022 until May 2023 [2]. The social gradient with a higher prevalence of depressive symptoms in lower education groups persisted throughout the observation period until June 2022. However, by 2022, the proportion of positive screens in the medium and high education group was significantly higher than before the pandemic and the high education group stands out with an early and continuous increase [1]. Our study will present updated time series until 01/2024 and present new time series stratified by income. We will also show results from analyses using summary measures of inequalities for a more precise assessment of trends in inequalities.

Discussion: Socioeconomic inequalities in depressive symptoms during the past 5 years will be discussed. Continuous monitoring of trends in mental health inequalities is crucial as it may identify health policy needs, such as rising mental health assessment needs in specific populations and target health policy interventions, particularly during times of crises.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.