Lidra Zikaj1, Sarah Qirjako2, Gentiana Qirjako1,2
Abstract
Aim: The COVID‑19 pandemic has posed unprecedented challenges to health systems worldwide, with significant implications for population mental health. The aim of this analysis was to compare incidence rates of mental disorders in countries of Southeastern Europe (SEE) before the pandemic (2018-2019), during the pandemic years (2020-2021), and in the post‑pandemic period (2022-2023)
Methods: This analysis was based on the data from the Global Burden of Disease (GBD) 2023 Study. Age‑standardized incidence rates of mental disorders were extracted for the period 2018-2023, expressed as percentages of the population at risk. Furthermore, age‑standardized incidence rates of COVID-19 were extracted for the years 2020-2021 (expressed as percentages of the population at risk too). Interrupted time‑series analysis using segmented regression was applied to assess temporal changes.
Results: There was evidence of substantial heterogeneity in COVID‑19 infection incidence across SEE, with Albania and North Macedonia reporting the highest rates in 2020, and Montenegro reaching the peak in 2021. Parallel to infection dynamics, mental disorder incidence was stable before 2020, increased sharply during the pandemic, and declined thereafter. By 2023, most countries had returned to pre‑pandemic levels, although Albania and Bosnia and Herzegovina exhibited persistently elevated rates. Regression analysis confirmed a significant increase in incidence during 2020-2021, followed by a decline in 2022-2023.
Conclusion: Findings from this analysis highlight both the vulnerability and resilience of SEE health systems, emphasizing the need for sustained investment in mental health infrastructure, workforce capacity, and integration into primary care to mitigate long‑term consequences and strengthen preparedness for future public health crises.
Keywords: COVID-19; Global Burden of Disease (GBD) Study; incidence rate; mental disorders; Southeastern Europe (SEE)