Mental telehealth use surged as in-person care dropped amid COVID

Online med consultation

Dragos Condrea / iStock

The expansion of mental health telemedicine more than offset the drop in in-person mental health services among more than 5.1 million US adults for some diagnoses during the first year of the pandemic, finds a study published late last week in JAMA Health Forum.

Rand Corp. researchers evaluated county-level data from health benefit manager Castlight Health on the weekly use of mental health services among 5,142,577 commercially insured adults with psychiatric diagnoses in all 50 states from Jan 5 to Dec 21, 2020. The included diagnoses were major depressive disorder (MDD), anxiety disorders, bipolar disorder, adjustment disorders, and posttraumatic stress disorder (PTSD).

The researchers noted the prevalence of mental disorders dramatically increased from 2020 to 2021.

"The pandemic has been associated with decreased social interactions and physical exercise, threats to individuals' employment and economic security, and an escalation in morbidity and mortality—all of which are likely to have contributed to widespread psychological distress," they wrote.

Telehealth uptake low in rural residents, older people

The use of in-person mental health services fell 52% to 57% after Jan 5, 2020 (eg, the average use of services for MDD dropped from 17.0 per 10,000 participants to 7.2 per 10,000, a 57% falloff), a trend that persisted through the end of the study period.

At the same time, the use of telehealth mental health services multiplied 16 to 20 times, or 1,495% to 1,925%, with the lowest increase for bipolar disorder (average, 0.13 to 1.5 per 10,000 adults) and the highest for anxiety (0.20 to 9.3).

After accounting for the drop in in-person services and the rise in telehealth services, the overall use of mental health services rose during the pandemic for MDD, anxiety, and adjustment disorders.

The use of telehealth mental health services multiplied 16 to 20 times, with the lowest increase for bipolar disorder and the highest for anxiety.

People living in rural areas and those older than 46 years were the least likely to use telehealth services. "While this may be partly due to a lower prevalence of certain conditions among older Americans, the consistency of this trend across different diagnosis categories suggests that factors such as lower digital literacy and less comfort with using telehealth also may play a role," lead author Ryan McBain, PhD, MPH, said in a Rand news release.

The study authors said that while it is well known that telehealth services for mental health diagnoses rose during early in the pandemic, theirs was the first to show that the increase was more than enough to make up for the decline in in-person treatment. The pivot to telehealth, they said, was driven by both providers' and patients' hesitance to risk the spread of COVID-19 and the expansion of coverage of telehealth services.

But so much has changed since 2020, the researchers added. "Against the backdrop of these trends, it remains unclear how mental health service utilization for specific conditions at a national level has evolved over the course of the pandemic compared with prepandemic levels," they concluded. 

This week's top reads