A collective case study of mental health systems’ response to COVID-19: Impact on patterns of care provision for depression and anxiety in two comparable regions of Southern Europe

Background and Objectives: COVID-19 pandemic has affected the mental health system (MHS) globally, although signi cant geographical variation was found, particularly for depression and anxiety. The understanding of its impact at the regional level of the context of care is limited when compared to national evaluations. Methods: Collective case study comparing the prior pattern of care with the rst 11 months of COVID-19 in two sites: Gipuzkoa (Spain) and Friuli Venezia Giulia - FVG (Italy). Information from both sites derive from administrative data of MHS in the two regions harmonized for comparison. Data included prevalence of psy- chiatric diagnoses (ICD-10 F30-F39 and F40-F49 codes), number of hospitalisations, mean and range of psy- chiatric and psychological interventions. Signi cance of time-period and location difference was assessed using the Chi-square and the T-statistics for prevalence and count data, respectively. Results: MHS is community-based in both sites. The prevalence of anxiety decreased in FVG, while a decrease in hospitalisations was found in Gipuzkoa. Both sites registered an increase in psychiatric visits for anxiety and depression. In both periods, FVG showed signi cant lower prevalence of diagnoses, but higher mean number of psychiatric interventions. Conclusions: : The COVID-19 outbreak is a paradigmatic example of complex dynamic systems in public health and illustrates the importance of considering its local context and time dependency. The Standard mapping and coding of local MHS provision is essential to allow comparison and reduce ambiguity. This study highlights the importance of ecosystem research to better interpret epidemiological data and support the development of evidence-informed policymaking.