A recent health insurance report indicates that cases of depression have surged dramatically over the past year in Germany.

The frequency of mental illness diagnoses is on the rise each year, yet this increase is particularly remarkable: last year, there was a notable increase of 50 percent in the number of workdays missed due to depression among DAK policyholders.

Yesterday, the health insurance company DAK-Gesundheit made this announcement. In 2024, for every 100 employees, there were 183 days absent, a notable increase from the 122 days recorded in 2023, amidst a total of 2.4 million policyholders.

What on earth is happening? Frank Jacobi from the Berlin School of Psychology cautions against hasty conclusions, stating, “We certainly do not find ourselves facing a sudden epidemic of depressive illnesses.” Jacobi’s research delves into the prevalence of mental illnesses, examining both the risk factors and the protective elements that may influence them.

The expert expresses doubt

He recommends exercising prudence in the interpretation of the DAK data. While there is a notable rise in the number of workdays lost to depression, it concurrently reveals a decline in instances of other mental health conditions. There was a notable decline of 32 percent in sick notes attributed to “adjustment disorders,” which encompass responses to stress and traumatic experiences, over the same timeframe. The analysis revealed a notable decline in anxiety disorders and other neurotic disorders.

“It may be the case that the alterations in diagnostics are more systemic in nature, suggesting that a significant increase in the number of individuals diagnosed with depression may not be warranted,” remarks Jacobi. At present, a discussion is unfolding among therapists regarding the potential overdiagnosis of adjustment disorders. Historically, there have been numerous trends concerning the selection of disease codes for mental health conditions.

A spokesperson for DAK remarked on the matter when queried: “We are unable to provide any conclusive statements regarding coding practices.” DAK suggests that one reason for the notable rise in depression may be attributed to the fact that mental illnesses, particularly depression, frequently require an extended period of treatment. “A modest uptick in cases leads to a significant surge in the number of days absent.”

Altered conditions?

Jacobi cautions against rapid conclusions: “At times, such figures are interpreted too swiftly and too simplistically in political contexts.” Nonetheless, there is a distinct lack of evidence to suggest that social conditions have undergone such a dramatic transformation within the span of a single year that they could account for these fluctuations.

The DAK data indicates that the overall rise in days absent due to mental health issues was relatively modest. The tally of absence days per 100 insured individuals has risen from 323 to 342 days, marking an approximate increase of six percent.

While the significant surge in depression rates may be largely a product of measurement issues, the consistent long-term rise in mental illness diagnoses raises important concerns among researchers. The DAK report reveals that in 2024, there was a staggering 45 percent increase in days absent due to mental illness compared to 2014. A rise from 237 to 342 days of absence for every 100 insured employees.

Reduced stigma

Nonetheless, Jacobi contends that this does not imply a corresponding rise in the number of individuals suffering from mental illnesses. There are additional elements contributing to the rise in diagnoses, such as the diminishing stigma surrounding mental illnesses in contemporary society.

“Individuals exhibiting mental health symptoms are seeking help more promptly these days, resulting in swifter diagnoses,” remarks the psychologist and therapist. Historically, individuals with mental health issues were frequently classified as unwell based on physical ailments.

It is essential that treatment is also taken into consideration. Health insurance will only cover outpatient psychotherapy if a patient maintains their classification as mentally ill. It is essential to ensure that a diagnosis is coded for each instance of psychotherapeutic or medical billing. “These diagnosis codes frequently endure for numerous quarters and years, even when the diagnostic criteria may no longer be satisfied,” remarks Jacobi. When symptoms arise, general practitioners frequently opt for a mental health condition on the sick note. “At times, the individual may not even be cognizant of it.”

Repercussions of the Pandemic

Simultaneously, Jacobi remarks, “That cannot possibly account for everything; the rise in diagnoses appears far too significant for that.” In the aftermath of the coronavirus pandemic, we have witnessed a significant rise in mental health issues. This increase can be attributed either directly to the fatigue experienced post-infection or indirectly due to factors such as isolation and the myriad challenges posed by the pandemic.

Mental illnesses in Germany are, quite possibly, on the increase. However, the extent remains elusive to determine. “It must be acknowledged that we are in the dark—we simply do not possess adequate representative studies,” remarks Jacobi.

The Risks of Overdiagnosis

A survey conducted by the Robert Koch Institute reveals that the incidence of depressive symptoms among individuals has nearly doubled since 2019. “However, these are not classified as diagnosed illnesses; rather, they are symptoms evaluated through questionnaires,” states Jacobi. “Determining whether the rise in depression among the populace, impacting individuals to varying degrees, correlates with genuinely severe mental health conditions is a complex challenge.”

The circumstances surrounding the investigation into the causes are decidedly intricate. Although it is acknowledged that factors such as loneliness, stress, or poverty are commonly linked to depression, “even in this context, it is frequently ambiguous whether the relationship is genuinely causal,” remarks Jacobi.

Jacobi believes that the heightened awareness surrounding mental illness brings with it a mix of benefits and drawbacks. “One encouraging aspect is that mental illnesses are no longer so readily dismissed.” Concurrently, there exists the peril of overdiagnosis: “Certain hardships inherent to life are hastily categorized as ailments.”