"In 2024, a diagnosis of a mental disorder was documented in two out of five adults. Mental health impairments therefore play a considerable role in outpatient care. Since 2012, the administrative prevalence of mental disorders has continued to rise almost every year." "Possible explanations for this development include that people may be increasingly seeking help for mental disorders, also due to their destigmatisation." "However, the increase in the administrative prevalence is attributable to a rise in newly diagnosed cases only for specific mental disorders in age groups up to the mid-30s (Kohring et al. 2025; Grobe et al. 2025) and may therefore primarily reflect an increase in the duration of diagnosis or treatment."

In the time course, the administrative prevalence of mental disorders increased between 2012 (35.0%) and 2024. The strongest increase compared to the previous year occurred in 2014. After a comparatively fluctuating trend in the years 2018 to 2022, increases were again observed in 2023 and 2024. In 2024, increases were more pronounced in men than in women and were observed in all age groups, with stronger absolute increases in the age groups from 60 years onwards. As causes of the development, it is discussed that people are increasingly making use of help due to mental disorders, also in the course of their destigmatization.

Ambulatory diagnoses of mental disorders… share of adults with diagnosis of a mental disorder, observed values 2012: 35.0% … 2023: 40.4%. Duration diagnoses. Prevalence 2007–2022: +29%. Incidence 2007–2022: +9%. + Indications of a changed way of dealing with mental health in younger cohorts. Possibly higher mental health literacy, less stigmatization of mental disorders, possibly…

"In addition, a renewed increase in the administrative prevalence of depression and anxiety disorders among adults with statutory health insurance in outpatient care was recorded for both 2023 and 2024 [21, 51], after diagnoses had previously developed differently." "Another possibility in debate is that cultural shifts are resulting in a misconstrual of mild distress as a mental health problem. However, it is unlikely that these developments have been so significant over the past five years that they alone can explain the observed trends." "These trends were also not confined to an increase in mild cases [26], further suggesting that a rise in morbidity may have occurred."

Current figures from Mental Health Surveillance (MHS) based on nationwide statutory health insurance billing data show that the proportion of adults with a diagnosis of a mental disorder in outpatient care rose from 35.0% in 2012 to 40.4% in 2023. Further indications of an increase in mental stress in the population in Germany in recent years can be found in diagnostic prevalence and in health insurance billing data. However, the report also refers to discussions that rising diagnostic prevalence may partly reflect increased help-seeking and reduced stigma rather than only a true increase in disorders.

"As part of its health monitoring activities, the Robert Koch Institute (RKI) continuously collects key indicators that describe the health of the population in Germany as well as health determinants and care. This article presents the design of a panel study..." "The panel design allows the analysis of trends and causal relationships in health indicators, including outpatient diagnoses registered in administrative data."

Background: Analyses of health insurance funds show an increase in diagnostic prevalence of mental disorders, the level and extent of which vary. Within the framework of Mental Health Surveillance, trends are to be described across health insurance funds and differentiated according to various diagnostic groups, sex and age as well as before and during the COVID-19 pandemic. Rising diagnostic prevalence can be influenced both by changes in morbidity and by changes in help-seeking behaviour, diagnostic practice and stigma surrounding mental illness.

"Outpatient mental health services and telehealth are becoming more available, though access remains uneven." "These findings underscore the urgent need for sustained investment, stronger prioritization, and multi-sectoral collaboration to expand access to mental health care, reduce stigma, and tackle the root causes of mental health conditions." "The reports serve as critical tools to inform national strategies and shape global dialogue ahead of the 2025 United Nations High-Level Meeting on Mental Health."

Over the period 2012–2022, the percentage of people with outpatient diagnoses of mental disorders rose from 33.4% to 37.9% (a relative increase of 13.4%). For example, medical and psychotherapeutic diagnoses of mental disorders rise when, as a result of destigmatization and patient education or a cultural shift in dealing with mental health combined with an expansion in SHI-authorized care, more people seek outpatient help and more health professionals are more likely to identify and document mental disorders appropriately—or overdiagnose them. Analyses of nationwide outpatient claims data show that diagnoses of mental disorders are continuously being documented for more than one in three people and thus significantly shape outpatient diagnostic reality in Germany.

"This narrative review aims to provide an overview of the structure, financing models, and challenges of the German mental healthcare system for adults." "Studies indicate that increased public awareness and reduced stigma may contribute to rising service utilization, including outpatient care, although supply-side factors and changes in coding practices also play a role."

Results: From 2012 to 2022, the proportion of persons with outpatient diagnoses of mental disorders increased from 33.4% to 37.9% (+13.4%). The increase in diagnostic prevalence over time can be due to a real rise in mental disorders but also to changes in diagnostic and treatment practices, help-seeking behaviour, and reduced stigma surrounding mental illness. The article discusses destigmatization and improved awareness as contributing factors to more people seeking professional help, which in turn raises recorded diagnostic prevalence.

In addition, a renewed increase in the administrative prevalence of depression and anxiety disorders among adults with statutory health insurance in outpatient care was recorded for both 2023 and 2024, after diagnoses had previously developed differently from symptoms. Furthermore, it cannot be ruled out that survey participants’ response behaviour may have changed due to greater public awareness of mental health issues and growing health literacy, as well as a decline in the stigmatisation of mental disorders. As a result, mental distress may now be reported more accurately and underreported to a lesser extent. Another possibility in debate is that cultural shifts are resulting in a misconstrual of mild distress as a mental health problem. However, it is unlikely that these developments have been so significant over the past five years that they alone can explain the observed trends.

"Stigma toward depression has declined among the overall US adult population; from 1996 to 2018, there were statistically significant decreases in desire for social distance, a standard measure of public stigma, from people with depression in work, socializing, friendship, and marriage." "In addition, digital mental health approaches can remove the barrier of stigma; for example, when you participate in mental health treatment via videoconference from your living room, you do not have to worry about a neighbor seeing your car in the mental health clinic parking lot."

"Together, this scientific foundation demonstrates that policies restricting mental health care access are likely to increase mental health burdens, healthcare costs, and societal impacts while failing to achieve stated policy objectives." "The evidence strongly indicates that full mental health parity implementation leads to improved health outcomes without significantly increasing overall healthcare costs." "Destigmatization efforts, along with parity enforcement, are among the policy tools that can improve help-seeking and access to care."

In outpatient care alone, 40.4% of adults in Germany received a mental health diagnosis in 2023. The paper notes that the prevalence of mental disorders in the population has long been high and that administrative prevalence has risen from around one quarter of adults in 2012 to over two fifths by 2023. It references RKI Mental Health Surveillance findings and mentions that increased utilization of services and reduced stigma may contribute to the observed rise in diagnoses, alongside possible changes in actual morbidity.

"Stigma and increased out-of-pocket costs will continue to hinder patients’ ability to access behavioral health services." "Because telebehavioral health offers additional privacy when speaking with a provider, potential barriers associated with stigma may also be overcome." "Peer providers have been shown to have a positive effect in reducing stigma associated with behavioral health treatment, increasing awareness of behavioral health resources, improving treatment engagement, and allowing licensed behavioral health providers to focus on more complex behavioral health services."

The Mental Health Surveillance (MHS) aims at systematic and continuous reporting of selected core indicators of mental health over time. Among others: ‘Psychische Störungen: Administrative Prävalenz (ab 18 Jahre)’. Diagnostic frequencies of mental disorders in care are observed in cooperation with the Central Institute for Statutory Health Insurance Physicians. Building on an investigation of trends in administrative prevalence of various diagnostic groups 2012–2022, these are reported annually for depression, anxiety disorders and mental disorders overall on the web portal. Analyses consider that trends may reflect not only changes in morbidity but also factors such as help-seeking behaviour and destigmatization.

Statistics show a marked increase in depression diagnoses in health care. In contrast, studies do not show a corresponding increase in depression in the population. This suggests that changes in diagnostic behaviour, help-seeking and the social perception of mental health (including destigmatization) play a role. The report highlights that communication about mental health and mental disorders, and thus their destigmatization, is part of national strategies for prevention and resilience strengthening.

"National data for 2024 was available for six of the 17 measures: ‘Adults with any mental illness (AMI) in the past year,’ ‘Adults with substance use disorder (SUD) in the past year,’ and others." "Many youth and adults report not receiving needed mental health treatment because of cost, lack of availability, or stigma-related fears; for example, nearly half (46.20%) of youth reported that they did not get treatment because they were afraid of being committed to a hospital or forced into treatment against their will."

In 2024 an estimated 22% of adults had depressive symptoms (PHQ‑9 ≥ 10) and 14% had anxiety symptoms (GAD‑7 ≥ 10); overall, 25.1% had either depressive or anxiety symptoms. These self-report data from the RKI Panel are used alongside administrative prevalence from health insurance billing data. Differences between symptom prevalence and diagnostic prevalence suggest that increasing diagnoses over time cannot be attributed solely to changes in population mental health but may also be influenced by greater willingness to seek help and reduced stigma.

A fact sheet on mental health of adults in Hochsauerlandkreis notes that only a small proportion of people with mental disorders are treated in inpatient settings, while 16% use outpatient treatment according to a 2014 nationwide survey.[2] It also states: "Despite growing openness in dealing with psychological stress, the stigmatization of mental illness remains a relevant issue."[2] The fact sheet suggests that increasing openness coexists with persistent stigma but does not directly connect this to national RKI data on rising outpatient diagnoses.[2]

"In addition, it appears to be essential to continually destigmatize and educate about mental illnesses in neighboring disciplines." "Respondents highlighted that stigma and lack of knowledge about psychiatric disorders among non-psychiatric professionals remain barriers to appropriate referral and treatment."

The state report on mental health in Schleswig-Holstein notes that many people suffer from mental illness during their lifetime and that stigma influences whether they seek help.[9] It emphasizes that improved public awareness and destigmatization can encourage affected individuals to make use of support services.[9] Although not an RKI document, it reflects a broader public health perspective that destigmatization can increase help‑seeking and thus recorded diagnoses.[9]

The RKI web page on "Mental disorders: administrative prevalence" is part of the German health monitoring system and functions as an interpretive report of routinely collected outpatient diagnosis data. It states explicitly that "possible explanations for this development include that people may be increasingly seeking help for mental disorders, also due to their destigmatisation," indicating that increasing help‑seeking linked to destigmatization is framed as one key explanatory factor for rising outpatient diagnoses alongside changes in duration of diagnosis or treatment and coding practices.

Approximately one-third of the participants reported having received treatment for mental health problems in the past. This rate is notably higher than the 24.5% reported in previous population-based surveys. The authors suggest that increasing openness toward mental health treatment and reduced stigma may be contributing factors to higher rates of service use, which can affect observed outpatient diagnosis prevalence.

Survey: 46% of Gen Z has a mental health diagnosis—yet optimism is rising. The report notes that younger generations are more likely to talk openly about mental health and to seek professional help. It argues that destigmatization and increased mental health literacy have contributed to higher reported rates of diagnoses, particularly in outpatient clinical settings.

According to the report, independent clinicians collectively delivered 113.6 million sessions of mental health care over the course of the year. The analysis cites increasing demand for mental health services and greater willingness to seek care as key drivers, noting that reduced stigma and wider public discourse around mental health have encouraged more people to pursue outpatient treatment.