U.S. adults have experienced considerable psychological distress and adverse mental health effects as a result of the COVID-19 pandemic, according to a study from Columbia University Mailman School of Public Health and Columbia University Irving Medical Center. The study further shows that in-person outpatient mental health visits declined during the acute phase of the pandemic, based on insurance claims, mental health care provider surveys and electronic health records.The findings are reported in Annals of Internal Medicine.
The trends and patterns we observed in the U.S. are consistent with global reports concluding that several mental health conditions, including depression and generalized anxiety disorder, have become more prevalent during the pandemic than before. “
Mark Olfson, MD, MPH, is Professor of Epidemiology at Columbia Mailman School of Public Health and Dollard Professor of Psychiatry, Medicine and Law at Columbia University Irving Medical Center.
To describe psychological distress experienced, determine levels of outpatient mental health care, and describe patterns of in-person versus telemental health care, researchers examined responses among adults in a Medical Expenditure Panel survey conducted by the Division of Healthcare Research and Quality. It is a nationally representative survey of more than 85,000 people. Psychological distress was measured using a 6-point scale, and use of outpatient mental health services was determined using a computer-assisted personal interview.
From 2018 to 2021, the rate of severe psychological distress among adults increased from 3.5% to 4.2%. While outpatient mental health care overall also increased, from 11.2% to 12.4%, the rate of severe psychological distress among adults fell from 46.5% to 40.4%. Outpatient mental health care increased significantly among younger adults (18 to 44 years), but this pattern was not observed among middle-aged (45 to 64 years) and older adults (age >65 years). Likewise, more employed adults report outpatient mental health care compared with health treatment care among the unemployed.
In 2021, 33% of mental health outpatients received at least one video visit. The likelihood of receiving in-person, telephone, or video mental health care varies across sociodemographic groups; younger adults than middle-aged and older adults, women versus men, college graduates versus less educated adults, those with severe poverty, those with low incomes , unemployed and rural patients receive video care at higher rates.
“Due to the rapid shift to telemental health care, the number of adults receiving outpatient mental health care in the United States has increased overall during the pandemic. However, the proportion of adults with severe psychological distress receiving outpatient mental health treatment has increased significantly. is declining. Some groups also have difficulty accessing telemental health care, including older adults and those with lower incomes and less education,” Olfson observed. “These models highlight the serious challenges in expanding coverage and access to telemental health services through accessible and affordable service options.”
“Increasing our understanding of outpatient mental health care access patterns, including face-to-face, telephone-administered, and internet-administered outpatient mental health services, can inform ongoing public policy discussions and clinical interventions,” Olfson noted. “Identified Low-cost ways to connect low-income patients to telemedicine should be a priority, along with increased public investment in making high-speed broadband universal.”
“National profiles of adults receiving outpatient mental health care through telemental health—younger, employed, higher-income, and privately insured adults—raise concerns about disparities in access to virtual mental health care,” Olfson said. concerns.” “Unless progress is made in reducing these barriers, primary care clinicians will continue to face challenges in connecting older, unemployed, and low-income patients to video outpatient mental health care.”
Co-authors are Chandler McClellan and Samuel H. Zuvekas, Agency for Healthcare Research and Quality; Melanie Wall, Columbia Mailman School of Public Health; and Carlos Blanco, National Institute on Drug Abuse.
Columbia University Mailman School of Public Health
Olfson, M., et al. (2024). Trends in adult psychological distress and outpatient mental health care in the COVID-19 era. Annals of Internal Medicine. doi.org/10.7326/m23-2824.