Mortality Due to Mental and Behavioral Disorders Before, During, and After the COVID-19 Public Health Emergency in Espírito Santo, Brazil: A Population-Based Ecological Time-Series Study
TL;DR
Mortality from mental and behavioral disorders showed a marked increase during the COVID-19 emergency followed by a subsequent decline, which reinforces the importance of continuous mortality surveillance and maintaining access to mental health and substance use disorder care during periods of health-system disruption.
Abstract
Background: Public health crises may disrupt mental health care and alter mortality patterns. We analyzed temporal patterns in mortality from mental and behavioral disorders in Espírito Santo, Brazil, from 2010 to 2024, encompassing the pre-pandemic, COVID-19 emergency, and subsequent periods. Methods: We conducted a population-based ecological time-series study using data from the Brazilian Mortality Information System from 2010 to 2024. We included deaths among residents of Espírito Santo whose underlying cause was coded as F00–F99 in the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Monthly mortality rates were analyzed using a continuous segmented Prais–Winsten regression of log10-transformed rates, with prespecified transitions in March 2020 and June 2022 and adjustment for calendar-month seasonality. Segment-specific annual percent changes (APCs) and 95% confidence intervals were estimated. Results: We identified 4256 deaths. Males accounted for 79.0% of deaths, and alcohol dependence syndrome accounted for 68.0% of deaths. Mortality decreased during the pre-pandemic period (APC, −4.99%; 95% CI, −6.63% to −3.32%; p < 0.001), increased markedly during the COVID-19 emergency period (APC, +42.00%; 95% CI, 30.24% to 54.81%; p < 0.001), and decreased during the subsequent period (APC, −29.27%; 95% CI, −36.73% to −20.93%; p < 0.001). Alcohol dependence remained the predominant underlying cause, while disorders related to multiple drug use and cocaine gained relative importance. Conclusions: Mortality from mental and behavioral disorders showed a marked increase during the COVID-19 emergency followed by a subsequent decline. These findings reinforce the importance of continuous mortality surveillance and maintaining access to mental health and substance use disorder care during periods of health-system disruption.