U.S. adults face distress, unequal mental health care access during the COVID-19 era

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According to a study by Columbia University Mailman School of Public Health and Columbia University Irving Medical Center, US adults have experienced substantial psychological distress and adverse mental health effects as a result of the COVID-19 pandemic. The study, based on insurance claims, mental health care provider surveys and electronic health records, also revealed that in-person outpatient mental health visits declined during the acute phase of the epidemic. Results are reported History of Internal Medicine.

The trends and patterns we observed in the United States align with global reports concluding that several mental health problems, including depression and generalized anxiety disorder, have become more prevalent than before the pandemic.

Mark Wolfson, MD, MPH, is Professor of Epidemiology at Columbia Mailman School of Public Health and Endowed Professor of Psychiatry, Medicine, and Law at Columbia University Irving Medical Center.

To identify experiences of emotional distress, determine levels of outpatient mental health care, and describe patterns of in-person versus telemental health care, researchers studied responses of adults from the Agency for Healthcare Research and Quality Component’s Medical Expenditure Panel Survey. , a nationally representative survey of over 85,000 people. Psychological distress was measured with a 6-point scale range and outpatient mental health care utilization was determined by computer-assisted personal interview.

The rate of serious mental distress among adults increased from 3.5 percent to 4.2 percent from 2018 to 2021. While outpatient mental health care overall increased — from 11.2 percent to 12.4 percent, the rate among adults with serious mental health problems dropped from 46.5 percent. at 40.4 percent. Younger adults (ages 18 to 44) significantly increased outpatient mental health care but this pattern was not observed for middle-aged (ages 45 to 64) and older adults (ages 65 and older). Similarly, more engaged adults tended to receive outpatient mental health care. reported health.health care services compared to the unemployed.

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; Percentages of video care were higher for young adults than middle-aged or older adults, women than men, college graduates than adults with less education, severely distressed, low-income, unemployed, and rural patients.

“Thanks to the rapid pivot to telemental health care, the number of adults receiving outpatient mental health care in the United States increased overall during the pandemic. However, the percentage of adults with severe mental health problems receiving outpatient mental health treatment declined significantly. Several groups include older individuals and those with low income and less education. “There was difficulty accessing telemental health care,” Wolfson observed. “These patterns underscore the significant challenges to expanding reach and access to telemental health services through easy-to-use and affordable service options.”

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

“The national profile of older adults who receive outpatient mental health care through telemental health — young adults, working, high-income and privately insured adults — raises concerns about disparities in access to virtual mental health care,” Wolfson said. “Until progress is made in reducing these barriers, primary care physicians will continue to face challenges in connecting their elderly, unemployed, and low-income patients with video-delivered 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.


Journal Reference:

Wolfson, M., etc (2024). Psychological distress in adults and trends in outpatient mental health care in the era of Covid-19. History of Internal Medicine. doi.org/10.7326/m23-2824.

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