Effects of COVID-19 on Patients in Adult Ambulatory Psychiatry: Using Patient-Rated Outcome Measures and Telemedicine

Abstract

Introduction: To examine the effects of coronavirus disease 2019 (COVID-19) on patients in an academic psychiatric ambulatory clinic, data from a measurement-based care (MBC) system were analyzed to evaluate impacts on psychiatric functioning in patients using telemedicine. Psychiatric functioning was evaluated for psychological distress (brief adjustment scale [BASE]-6), depression (patient health questionnaire [PHQ]-9), and anxiety (generalized anxiety disorder [GAD]-7), including initial alcohol (U.S. alcohol use disorders identification test) and substance use (drug abuse screening test-10) screening. Methods: This observational study included MBC data collected from November 2019 to March 2021. Patient-Reported Outcome Measures (PROMs) were examined to determine changes in symptomatology over the course of treatment, as well as symptom changes resulting from the pandemic. Patients were included in analyses if they completed at least one PROM in the MBC system. Results: A total of 2,145 patients actively participated in the MBC system completing at least one PROM, with engagement ranging from 35.07% to 83.50% depending on demographic factors, where completion rates were significantly different for age, payor status, and diagnostic group. Average baseline scores for new patients varied for the GAD-7, PHQ-9, and BASE-6. Within-person improvements in mental health before and after the pandemic were statistically significant for anxiety, depression, and psychological adjustment. Discussion: MBC is a helpful tool in determining treatment progress for patients engaging in telemedicine. This study showed that patients who engaged in psychiatric services incorporating PROMs had improvements in mental health during the COVID-19 pandemic. Additional research is needed exploring whether PROMs might serve as a protective or facilitative factor for those with mental illness during a crisis when in-person visits are not possible.

Patients with affective disorders profit most from telemedical treatment: Evidence from a naturalistic patient cohort during the COVID-19 pandemic

“…Thus, the specific conditions of telepsychiatric assessment and treatment did not impede the validity and reproducibility of diagnostic procedures in the study sample. This corroborates earlier findings that the implementation of patient reported outcome measures via telemedicine is a viable way of assessing psychiatric symptoms and psychosocial functioning as well as monitoring clinical changes in order to improve treatment outcomes ( 23 ).…”

Brief Adjustment Scale–6 for Measurement-Based Care: Psychometric Properties, Measurement Invariance, and Clinical Utility

“…As the data were solely collected during the COVID-19 pandemic for nonclinical samples while the clinical sample’s data were collected before and during the pandemic, there is a possibility that the pandemic affected and increased overall mental health distress in these populations, in line with the growing research of pandemic’s negative influence on mental health (Horigian et al, 2021; Islam et al, 2021; Pierce et al, 2020; Serafini et al, 2020). Furthermore, another study that utilized the BASE-6 for adult psychiatric outpatients showed total scores between 22.71 and 26.38 during the COVID-19, which is higher than the total score of the clinical population in this study (Kablinger et al, 2022). These results imply the impact of the pandemic on clinical populations and suggest that the current study’s clinical sample’s scores could have been even higher if the data were solely collected during the pandemic, rather than before and throughout COVID-19.…”

Social media use for coping with stress and psychological adjustment: A transactional model of stress and coping perspective

“…The current study used the Brief Adjustment Scale-6 ( Cruz et al, 2020 ) to assess respondents’ psychological adjustment (e.g., “To what extent have you felt irritable, angry, and/or resentful this week?”). The Brief Adjustment Scale-6 was previously tested for its validity in the context of COVID-19 ( Kablinger et al, 2022 ). All six items on the scale are scored based on a 5-point scale ranging from 1 (not at all) to 5 (extremely).…”