Association of Unemployment and Government Stringency With the Increased Burden of Anxiety and Depression Amid the Public Health Emergency: A Global Perspective.

BACKGROUND: The COVID-19 pandemic has coincided with marked increases in anxiety and depressive disorders. Beyond infection risks, socioeconomic stressors such as rising unemployment and stringent government responses may have contributed substantially to these burdens but remain poorly quantified globally. METHODS: We conducted an ecological country-level cross-sectional study using data from the Global Burden of Disease 2021 database, World Bank Open Data, and Our World in Data, covering 169 countries and territories. Primary outcomes were changes in age-standardized incidence rates (ASIRs) of anxiety and depressive disorders between 2019 and 2020. Exposures included changes in unemployment rates and the government stringency index (GSI) during the same period. Associations were examined overall and stratified by sex, age, and sociodemographic index (SDI). RESULTS: Globally, ASIRs of anxiety and depressive disorders increased in 2020 compared with 2019. Median increases were larger in high- than low-SDI countries for anxiety (17.12% vs. 11.2%) and depressive disorders (17.04% vs. 9.04%). Greater increases in unemployment were associated with larger increases in ASIR of anxiety (β = 1.43, 95% CI: 0.56-2.29) and depressive disorders (β = 1.70, 95% CI: 0.78-2.62). Higher GSI was also positively associated with increases in ASIR of anxiety (β = 1.08, 95% CI: 0.19-1.98) and depressive disorders (β = 1.34, 95% CI: 0.41-2.28). Associations were stronger in females than males and most pronounced in children and adolescents. CONCLUSION: Rising unemployment and stringent government responses were significantly associated with the global increase in anxiety and depressive disorders during the COVID-19 pandemic, highlighting the need for future public health strategies that balance infection control with economic protections and mental health support.