Long-Term Trends in Counseling for Stress and Depression Among Adults, 2009–2024, Considering the Impact of COVID-19 Pandemic: A Nationwide Representative Study in South Korea

OBJECTIVE: Despite the impact of the COVID-19 pandemic on global mental health, few studies have examined changes in the demand for mental health counseling over time. This study investigated 16-year national trends in counseling for stress and depression in South Korea, with a focus on the pandemic's impact and evolving population-level risk factors. METHODS: This study analyzed trends in stress and depression counseling using data from 3,195,912 Korean adults in the Korea Community Health Survey (2009-2024). Counseling was defined by self-reported responses. The period was categorized as pre-pandemic (2009-2019), intra-pandemic (2020-2022), and post-pandemic (2023-2024). Weighted logistic regression was used to assess prevalence trends, high-risk groups, and changes in risk patterns over time. RESULTS: The prevalence of counseling for stress steadily increased from 1.54% (2009-2010) to 2.16% (2017-2019), peaked at 3.06% in 2022 during the pandemic, and remained elevated at 2.97% in 2023-2024. Depression counseling showed a similar pattern. Higher rates were consistently observed among young adults, women, those with poor self-rated health, and individuals with sleep <6 or ≥8 hours. Notably, while low education was a key pre-pandemic risk factor, counseling increased more among highly educated individuals during the pandemic. CONCLUSION: The COVID-19 pandemic affected mental health counseling in South Korea and led to the emergence of new at-risk groups. Sustained high counseling rates among young adults and the highly educated highlight the need for targeted, population-specific interventions.