Trends in mental health care in Brazilian Primary Health Care before, during, and after COVID-19: an ecological interrupted time-series study (2018-2023).

OBJECTIVE: To evaluate the temporal evolution of mental disorder-related visits in Primary Health Care (PHC) within the Brazilian Unified Health System (SUS) and estimate the effects of social distancing, the Covid-19 pandemic, and the post-pandemic period. METHODS: This is a national ecological interrupted time-series study using data from the Primary Health Care Information System (SISAB/DATASUS). Monthly proportional and population incidence rates of mental disorder-related visits (ICD-10 F00-F99) in PHC were analyzed. Segmented regression models with negative binomial distribution and autoregressive structure were fitted. RESULTS: A total of 38.7 million PHC visits were analyzed. In the pre-pandemic period, the share of mental disorder-related visits increased (exp(β)Trend=1.011; 95%CI 1.008-1.014). During social distancing, the proportion of these visits increased abruptly (exp(β)Level=1.241; 95%CI 1.149-1.339), largely associated with a reduction in the total volume of PHC visits. During the rest of the pandemic, the proportional increase plateaued. We observed regional heterogeneity (p<0.001), with greater level increase in the Northeast. In the post-pandemic period, growth resumed in both the proportion and the population incidence of mental disorder-related visits; increases were notable for anxiety, neurodevelopmental and child and adolescent disorders. CONCLUSION: The share of mental disorder-related visits in Brazilian PHC increased over the study period. Social distancing resulted in an abrupt proportional increase in the context of reduced overall visits, followed by heterogeneous recomposition across regions and diagnostic groups. These findings indicate a recent increase in demand for mental health care in PHC.