Depression Symptoms Severity and Factors Associated with Referral Patterns in The Primary Health Care Corporation Centers in Qatar Before and During the COVID-19 Pandemic (2018-2021): A Comparative Cross-Sectional Study

Abstract

Background: Mental health issues have shown a growing burden in Qatar, with COVID-19 pandemic contributing to increased levels of anxiety and depression. Research evidence on depression symptoms severity (DSS) and factors associated with referral patterns in the Primary Health Care Corporation (PHCC) centers in Qatar before and during the COVID-19 pandemic is lacking. Aim: To assess the association between DSS and COVID-19, and identify factors associated with referrals to mental health clinics in PHCC and secondary care, examining the periods before and during the COVID-19 among the adult population registered with PHCC. Methods: A comparative cross-sectional study of adults aged ≥18 years screened in PHCC for depression using the Patient Health Questionnaire (PHQ-9) from January 1st, 2018, to December 31st, 2021. Multilevel multivariable ordinal regression was used to assess the association between DSS and COVID-19, while multilevel multivariable logistic/multinomial regression were used to examine potential factors influencing referral patterns. Multilevel modeling accounted for between-group variations (PHCC level) and within-group variations (individual level). The odds ratio (OR) was used as a measure of association, with a 95% confidence interval. Results: Individuals screened during COVID-19 timeframe had 42% increased odds of presenting with higher DSS as compared with those screened before COVID-19 (95% confidence interval (CI):[26-60%]). PHQ-9 assessments conducted during the COVID-19 pandemic were associated with 32% increase in the odds of referral to any mental health clinic compared to those conducted before the pandemic (95% CI:[18-46%]). Being female and younger age were associated with increased odds of referral while individuals with asthma or type 2 diabetes had decreased odds of referral. During the COVID-19 pandemic, the odds of referrals to secondary clinics were 24% lower than those to PHCC clinics (95% CI:[4-40%]). Conclusion: The findings of this study highlight that COVID-19 pandemic was associated with increased DSS and increased overall referral to mental health clinics in the PHCC as compared to secondary care clinics. Additionally, DSS and other factors significantly were associated with referral patterns highlighting the need for future studies to understand the underlying factors and improve access to mental health services in Qatar.