Anxiety and depression

1. Key messages

2. The prevalence of anxiety and depression from 2020 onwards

On Sciensano’s epidemiological dashboard, one can explore dynamic data visualizations about mental health during the COVID-19 crisis up to June 2022. Additionally, an interactive app provides updated data on mental and social health from the BELHEALTH cohort since October 2022. It is important to note that the COVID-19 and BELHEALTH surveys were not designed to be fully representative of the Belgian population, but rather to track trends in mental health disorders within the study population. 

Tracking anxiety and depression disorders over time with online surveys

During the COVID-19 crisis, there was a significant rise in anxiety disorders and depressive disorders, particularly during peaks in contamination and the implementation of strict containment measures. A decrease was observed in 2022, with anxiety and depressive disorders affecting less than 20% of the population overall. It should be noted that in 2022, despite the announcement of the end of the COVID-19 crisis, other major crises emerged, such as the war in Ukraine and its economic consequences.

Up to June 2022, data come from the COVID-19 Health Surveys. As of October 2022, the same group of people were followed in the BELHEALTH survey to assess the evolution of anxiety and depressive disorders in time and the potential risk and protective factors involved. 

The data collected from 2023 onwards indicate a gradual decline in these problems among the participants. However, anxiety and depressive disorders rose again slightly in the winter (November 2023 and March 2024) to decrease in June 2024 to 17% and 15% respectively.  

Throughout the entire period, anxiety disorders consistently had a higher prevalence compared to depressive disorders.

Anxiety and depressive disorders tend to decrease with age for both genders

In Belgium, the groups most at risk of experiencing anxiety and depression disorders include women, young adults, people with lower education, people living alone and as single parents, and residents of the Walloon Region.

Young adults, aged between 18 and 29, are particularly vulnerable to anxiety and depressive disorders, with a higher prevalence among women. Several factors specific to this life phase—including the transition to higher education, entry into the job market, and the pursuit of financial independence—coupled with the changes imposed by the pandemic and the heightened sensitivity of young people to social issues, contribute to their increased vulnerability to these disorders [17].

Regarding the peaks that are linked to the COVID-19 pandemic, the two youngest age categories (18-49 years) appear to be particularly affected, showing a more significant increase in cases. In contrast, individuals over the age of 50 exhibit a more stable trend throughout this period, with less pronounced variations.

From 2022 on, the prevalence of anxiety and depressive disorders is more stable. However, anxiety disorders remain high among the working-age population as of November 2023, especially compared to those aged 65+ and older. Among women, a clear age-related gradient persists for anxiety disorders. Depressive disorders showed an increase in November 2023 for individuals aged 30-49 and men aged 50-64, and in March 2024 for both genders in the 18-29 group. 

3. The prevalence of anxiety and depression in 2018

Women present more often anxiety and depressive disorders compared to men

Based on these psychometrics questionnaires, in 2018, 11.2% of the Belgian population aged 15 and over presented an anxiety disorder and 9.4% presented a depressive disorder. For both disorders, women had a higher prevalence (14.2% for anxiety and 10.7% for depression) than men (7.9% for anxiety and 8% for depression).

The trend shows that anxiety remains high over time, while depression returns to its pre-2013 level

The prevalence of anxiety disorders increased among people of both sexes in 2013 compared with previous years, and this increase was maintained in 2018.

The prevalence of depressive disorders also increased in 2013 among people of both sexes. Subsequently, in 2018, the pre-2013 figures were repeated, with a clearer drop among women than among men between these two years. It should be noted, however, that the questionnaires used to assess the presence of anxiety and depression were different in 2018 than in previous surveys. Consequently, trends should be interpreted with caution.

The Walloon Region and the Brussels-Capital Region have a higher prevalence compared to the Flemish Region

The Walloon Region had a higher prevalence of anxiety and depressive disorders compared to the Brussels Capital Region and the Flemish Region and the Brussels Capital Region had a higher prevalence compared to the Flemish Region.

Between 2008 and 2013, the prevalence of anxiety disorders increased in all regions. Between 2013 and 2018, it continued to rise in the Walloon region, especially among women but also among men, whereas this was not the case in the other regions.

Since 2001, depressive disorders among women have been less frequent in the Flemish Region than in the Brussels-Capital Region and the Walloon Region. This trend has also been observed among men since 2008. 

People in the group with the lowest level of education were more likely to have an anxiety or depressive disorder

There is a strong socio-economic gradient in the prevalence of mental health disorders. After age-adjustment, anxiety disorders were 2.3 times more frequent in people from the lowest educational group compared to the highest educational group. Depressive disorders were 3 times more frequent in people from the lowest educational group compared to the highest educational group.

4. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

COVID-19 survey interactive app

BELHEALTH interactive tool

If you are in distress or in need of emotional/psychological support, do not hesitate to call 02 648 40 14 for the community help service helpline, or visit the Community Help Service online.

Background

Mental health is the capacity of each of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections, and personal dignity [18]. Due to the high frequency of mental problems in Western societies and the significance of their costs in human, social, and economic terms, mental health is now regarded as a public health priority. Mental health particularly deteriorated during the COVID-19 crisis [19].

In Belgium, the Health Interview Survey (HIS) is one of the main sources of systematic data on mental health indicators in the general population. During the COVID-19 crisis, online health surveys were organized at regular time intervals to follow the evolution of the mental health of the population. Data were collected between April 2020 and June 2022. From October 2022, the BELHEALTH cohort follows up mental health and wellbeing in the population every 4 months. While the COVID-19 Health Survey used a mixed longitudinal and cross-sectional approach (addressing the same participants and recruiting new ones at each data collection point), BELHEALTH uses a longitudinal approach (follow-up of the same cohort of participants throughout data collection points). Cross-sectional data of BELHEALTH were used here. In order to achieve a representativeness of the general population, data are? weighted for age, with a different methodology between the two surveys. 

Among the various dimensions of mental health that are monitored in this survey, we focus on the following two disorders:

• Prevalence of anxiety disorders based on the self-report psychometric instruments GAD-7
• Prevalence of depressive disorders based on the self-report psychometric instruments PHQ-9.

However, it should be noted that the evaluation of mental health problems in the population through a health survey has a number of limitations. These are mainly related to the fact that the estimates are based on screening instruments for psychological problems and thus are not obtained by clinical diagnostic tools, which may be more nuanced. Nevertheless, the results of general population health surveys are generally in line with the findings of specific mental health surveys.

More serious mental health disorders like schizophrenia and bipolar disorders are not presented here. Indeed, health interview surveys are not a valid instrument to capture such complex conditions. Moreover, information about suicidal behaviors can be found on a specific page.

Definitions

GAD-7: General Anxiety Disorder 7-item

The GAD-7 is a screening tool for general anxiety disorder (GAD). Participants aged 15 and older (for HIS) and 18 and older (for other surveys) are asked to evaluate the frequency, if ever, of experiencing 7 core anxiety symptoms in the last 2 weeks. The total score obtained allows to evaluate anxiety severity. [20]

Anxiety disorders

Participants aged 15 and older (for HIS) and 18 and older (for other surveys)  with a score of 10 or over out of 21 in the GAD-7 tool were considered to have an anxiety disorder. 

PHQ-9: Patient Health Questionnaire 9-item depression scale

The PHQ-9 is a screening tool for major depressive disorder and other depressive disorders. Participants aged 15 and older (for HIS) and 18 and older (for other surveys) are asked to evaluate the frequency of 9 symptoms in the last 2 weeks. [21]

Depressive disorders

Participants aged 15 and older (for HIS) and 18 and older (for other surveys) with a combination of answers meeting the criteria specific for major depressive disorder and other depressive disorders for the PHQ-9 were considered to have a depressive disorder.

References

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11. Health Interview Survey, Sciensano, 1997-2018. https://www.sciensano.be/en/projects/health-interview-survey
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14. Belgian Health and Well-being Cohort (BELHEALTH) - Bulletin 3, Brussels: Sciensano; 2023. https://www.sciensano.be/en/biblio/bulletin-ndeg3-belhealth-fr 
15. Belgian Health and Well-being Cohort (BELHEALTH) - Bulletin 4, Brussels: Sciensano; 2024. https://www.sciensano.be/en/biblio/bulletin-ndeg4-belhealth-fr 
16. Belgian Health and Well-being Cohort (BELHEALTH) - Bulletin 5, Brussels: Sciensano; 2024. https://www.sciensano.be/en/biblio/bulletin-ndeg5-belhealth-fr 
17. Youthtalks, Higher  Education for Good Foundation. 2023. https://youth-talks.org/mental-health-issues-rise-young-people/
18. Governement of Canada, 2014. Mental health promotion. https://www.canada.ca/en/public-health/services/health-promotion/mental-health/mental-health-promotion.html
19. United Nations, 2020. Policy Brief: COVID-19 and the need for action on Mental Health. https://unsdg.un.org/sites/default/files/2020-05/UN-Policy-Brief-COVID-19-and-mental-health.pdf 
20. Spitzer RL, Kroenke K, Williams JBW, Löwe B. 2022 A brief measure for assessing generalized anxiety disorder: the GAD-7. 
21. Manea L, Gilbody S, McMillan D.  2012. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9).

Please cite this page as: Sciensano. Mental Health: Anxiety and depression, Health Status Report, 25 Nov 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mental-health/anxiety-and-depression