US outpatient care for serious mental health issues declined during COVID-19


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A study today in the Annals of Internal Medicine shows that while telemedicine helped some groups seeking mental health care during the COVID-19 pandemic, Americans with serious mental health symptoms suffered from a decline in in-person outpatient mental health visits that has persisted.

Moreover, this lack of outpatient care for those with significant mental illness was seen mostly in patients with lower incomes and education levels.

In a related study, fewer Swedish teens sought care for mental health issues during COVID-19, but their mental health appeared to improve during the pandemic.

Drop in outpatient mental health treatment

"Thanks to a rapid pivot to telemental health care, there was an overall increase during the pandemic of adults receiving outpatient mental health care in the United States," said Mark Olfson, MD, MPH, of Columbia University, first author of the Annals study, in a university press release

"However, the percentage of adults with serious psychological distress who received outpatient mental health treatment significantly declined."

The study was based on trends seen in participants in the Medical Expenditure Panel Survey Household Component, given from 2018 to 2021 to 86,658 adults. Respondents were asked how frequently in the previous 30 days they had felt so sad that nothing could cheer them up, nervous, restless or fidgety, hopeless, that everything was an effort, or worthless (all, most, some, a little, or none of the time). Responses were scored from 0 to 4, with a score of 13 or higher defining serious psychological distress, the authors said.

During the study period, the rate of serious psychological distress among adults increased from 3.5% to 4.2%, the authors said, likely due to the pandemic and subsequent lockdowns, stress, job loss, and school disruptions.

The rate of outpatient mental health care increased from 11.2% to 12.4% overall from 2018 to 2021. But the rate decreased from 46.5% to 40.4% among adults with serious psychological distress.

Instead, people with higher education degrees, more moderate ranking of mental illness, and younger adults were more likely to use telemental care. Adults over the age of 45 did not see the same increase in telemental care, nor did those seeking care for bipolar disorder or schizophrenia.

By 2021, the authors wrote, approximately one third of adults who received outpatient mental healthcare had received one or more mental health video visits.

"Several groups also had difficulty accessing telemental health care including older individuals and those with lower incomes and less education," observed Olfson. "These patterns underscore critical challenges to extend the reach and access of telemental health services via easy-to-use and affordable service options."

Swedish students’ mental health improved

In a new study from Sweden, researchers show that secondary school students who did distance learning in the pandemic were less likely to seek out mental health services than peers who stayed in person, but overall mental health appeared to improve in this age-group.

During the first months of the pandemic, from mid-March to mid-June 2020, Swedish upper secondary school students (ages 17 to 19) were taught remotely.

Care for psychiatric conditions, particularly depression and anxiety, decreased by 4.4% in this group compared to secondary school students aged 14 to 16 who continued to attend school, and the difference remained 21 months into the pandemic.

Contrary to other studies on school closures, the findings from Sweden suggest that distance learning benefited older teens.

"If young people were not accessing healthcare through normal channels, such as school health services, we should be seeing that they are more likely to seek emergency or unplanned care. Instead, we are seeing the opposite," said study author Helena Svaleryd, PhD, of Uppsala University, in a university press release.

The researchers suggest several possible explanations for this mental illness decrease, including reduced stress, more flexible schedules, reduced social pressure, and a reduction in the perceived demands of academic performance.

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