Study of social disparities in the impact of the pandemic and SARS-CoV-2 infection on use of the mental health care system in the general population in France

Since the onset of the COVID-19 pandemic, the mental health care system has faced new challenges, including 1) a significant increase in mental health disorders in the general population, but particularly among people with a low socioeconomic status or with previous mental health disorders, and 2) an increase in the use of psychotropic medications since 2020. While several international studies indicate a decrease in consumption or a change in the modalities of mental health care since the beginning of the health crisis, few have investigated the social disparities in the use of the mental health care system during the pandemic. Moreover, in addition to the stress generated by the health measures implemented to combat the spread of SARS-CoV-2 and their consequences (lockdown, social distancing, job insecurity, etc.), having had COVID-19 was found to be associated with a deterioration in psychiatric and mental health. Studying the use of the mental health care system during the pandemic according to the presence or absence of COVID-19 could make it possible to distinguish the specific effect of SARS-CoV-2 infection within the pandemic context. In addition, a new nosological entity emerged during the pandemic, called covid-long or post-covid-19 syndrome, which is the presence of defined persistent symptoms (according to WHO) for a period of time. The presence of persistent and long-lasting symptoms can have a significant impact on mental health. Using data from the EpiCoV (Epidemiology and Living Conditions) survey, which is representative of the French general population and linked with data from the French national health data system (SNDS), this post-doctoral fellowship will aim 1) to study trends of the level of the utilization of the mental health care system (consumption of care and medical prescriptions) since the pre-pandemic period, according to the occurrence of a COVID-19 ; 2) to identify the social factors associated with the utilization of the mental health care system, according to the SARS-CoV-2 infection status ; 3) to study the utilization of the mental health care system among persons with a mental health disorder during the pandemic, according to their social characteristics and SARS-CoV-2 infection status; 4) to characterize the utilization of the mental health care system among persons with a post-COVID-19 syndrome; 5) to study changes in the level of utilization of the mental health care system among healthcare workers since the pre-pandemic period and the role of SARS-CoV-2 infection. The EpiCov cohort is constituted of three waves of data collection with 134,391 in wave 1, 107,759 in wave 2 and 85,074 in wave 3. A 4th wave is scheduled in September 2022. The data collected by web-questionnaire contain, among other data, characteristics on social situation, physical and mental health. The utilization of the health care system will be measured using data from the SNDS on the level of consumption of care and medical prescriptions for mental health. This work will provide a rare opportunity to compare the social determinants of mental health with a part of the real and not self-reported consumption of care and medical prescriptions among a representative sample of the French population before and after the pandemic. This work will also allow to specify the role of SARS-COV-2 infection on mental health and also, the consequences of persistent symptoms following the infection (post-covid-19 syndrome), on the utilization of the mental health care system. The results of this work will contribute to the improvement of access to care and mental health management of the French population in this pandemic context, and in particular of the most vulnerable social groups.