According to a study from the Columbia University Mailman School of Public Health and the Columbia University Irving Medical Center, adults in the United States experienced significant psychological distress and negative mental health effects as a result of the COVID-19 pandemic. The investigation, based on insurance claims, surveys of psychiatric care providers, and electronic health records, also found a decrease in in-person, outpatient psychiatric visits during the acute phase of the pandemic. The results are reported in the Annalen der Inneren Medizin.
„The trends and patterns we observed in the United States are consistent with reports worldwide that have concluded that several mental health problems, including depression and generalized anxiety disorders, were more common during the pandemic than before,“ said Mark Olfson, MD, MPH, professor of epidemiology at the Columbia Mailman School of Public Health and Dollard Professor of Psychiatry, Medicine, and Law at the Columbia University Irving Medical Center.
To characterize the experienced psychological distress, determine the degree of outpatient mental health care, and describe patterns between personal and physical health care, the researchers examined the responses of adults from the Medical Expenditure Panel Surveys of the Agency for Healthcare Research and Quality Component, a nationally representative survey of over 85,000 people. The psychological distress was measured using a 6-point scale, and the use of outpatient mental health care was determined through computer-assisted personal interviews.
The rate of severe psychological distress in adults increased from 3.5 percent in 2018 to 4.2 percent in 2021. While overall outpatient mental health care also increased – from 11.2 percent to 12.4 percent – the rate among adults with severe psychological distress decreased from 46.5 percent to 40.4 percent. Young adults (aged 18 to 44) significantly increased their outpatient psychiatric care, but this pattern was not observed in middle-aged (45 to 64) and older adults (>65). Similarly, more employed adults reported outpatient psychiatric care compared to the unemployed. In 2021, 33 percent of outpatient psychiatric patients received at least one video visit. The likelihood of receiving in-person, telephone, or video psychiatric care varied by sociodemographic group. The proportion of video care was higher for younger adults, women, college graduates, people with disabilities, low-income earners, the unemployed, and rural patients.
„Thanks to the rapid transition to telemental health care during the pandemic, there was an overall increase in the number of adults receiving outpatient mental health care in the United States. However, the proportion of adults with severe psychological distress receiving outpatient mental health treatment decreased significantly,“ said Olfson. „Several groups also encountered difficulties in accessing telemental health care, including older adults and people with lower incomes and education,“ Olfson observed. „These patterns underscore the critical challenges in extending the reach and access to telemental health services through user-friendly and affordable service options.“
„A better understanding of the patterns we observed in access to outpatient mental health care, including in-person, telephone, and internet-based outpatient mental health services, could contribute to ongoing policy discussions and clinical interventions,“ noted Olfson. „Finding cost-effective ways to connect low-income patients with telemental health should be a priority, as should increasing public investments to expand high-speed broadband access for all.“
„The nationwide profile of adults receiving outpatient mental health care via telemental health – younger adults, employed, higher-income, and privately insured adults – raises concerns about inequalities in access to virtual mental health care,“ said Olfson. „As long as no progress is made in overcoming these barriers, primary care physicians will continue to face the challenge of connecting their older, unemployed, and lower-income patients to outpatient psychiatric care via video.“
Co-authors include 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.
Mailman School of Public Health, Columbia University
Olfson, M., et al. (2024). Trends in psychological distress and outpatient mental health care among adults during the COVID-19 era. Annalen der Inneren Medizin. doi.org/10.7326/m23-2824.