US Adults Face Distress, Unequal Access to Mental Health Care During the Era of COVID-19

U.S. adults have experienced significant psychological stress and adverse mental health consequences as a result of the COVID-19 pandemic, according to a study by Columbia University Mailman School of Public Health and Columbia University Irving Medical Center. Based on insurance claims, surveys of mental health providers, and electronic health records, the study further revealed a decline in in-person outpatient visits for mental health patients during the acute phase of the pandemic. The findings are reported in Annals of Internal Medicine.

The trends and patterns we observed in the United States are consistent with reports worldwide, which conclude that several mental health problems, including depression and generalized anxiety disorder, have become more prevalent during than before the pandemic.”

Mark Olfson, MD, MPH, 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 characterize the psychological distress experienced, determine the level of outpatient mental health care, and describe patterns of in-person versus telemental health care, researchers examined responses of adults from the Agency for Healthcare Research’s Medical Expenditure and Quality Component Panel Surveys. nationally representative survey of over 85,000 people. Psychological distress was measured with a 6-point range scale, and use of outpatient mental health care was determined by computer-assisted personal interviews.

The rate of serious psychological distress among adults increased from 3.5 percent to 4.2 percent from 2018 to 2021. While outpatient mental health care also increased overall, from 11.2 percent to 12.4 percent, the rate among adults with serious psychological distress decreased from 46.5 percent to 40.4 percent. Young adults (aged 18 to 44 years) significantly increased outpatient mental health care, but this pattern was not seen in middle-aged (aged 45 to 64 years) and older adults (aged >65 years). Similarly, more employed adults reported receiving outpatient mental health care compared to unemployed adults.

In 2021, 33 percent 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; video care rates were higher for younger adults than for middle-aged or older adults, women compared to men, college graduates compared to adults with less education, severe disabilities, lower income, unemployed and rural patients.

“Thanks to the rapid shift to telehealth, there was an overall increase during the pandemic in adults receiving outpatient mental health care in the United States. However, the percentage of adults with severe psychological distress who received outpatient mental health treatment declined significantly. “Several groups also had difficulty accessing telehealth care, including older adults and those with lower incomes and less education,” Olfson noted. “These models highlight the critical challenges of expanding coverage and access to telehealth services through easy-to-use and affordable service options.”

“Increasing our understanding of the patterns we observed regarding access to outpatient mental health care, including in-person, telephone-administered, and Internet-administered outpatient psychiatric services, can inform ongoing public policy discussions and clinical interventions,” noted Olfson. . “Identifying low-cost means of connecting lower-income patients to telehealth should be a priority, as should increasing public investment to make access to high-speed broadband universal.”

“The national profile of adults receiving outpatient mental health care through telehealth—younger adults, working, higher-income, and privately insured adults—raises concerns about disparities in access to virtual mental health care,” said Olfson. . “Unless progress is made in reducing these barriers, primary care clinicians will continue to face challenges in connecting their older, unemployed, and lower-income patients to outpatient mental health care delivered by via video.’

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.