Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic

Abstract

ImportanceThe COVID-19 pandemic has been associated with an elevated prevalence of mental health conditions and disrupted mental health care throughout the US.ObjectiveTo examine mental health service use among US adults from January through December 2020.Design, Setting, and ParticipantsThis cohort study used county-level service utilization data from a national US database of commercial medical claims from adults (age >18 years) from January 5 to December 21, 2020. All analyses were conducted in April and May 2021.Main Outcomes and MeasuresPer-week use of mental health services per 10 000 beneficiaries was calculated for 5 psychiatric diagnostic categories: major depressive disorder (MDD), anxiety disorders, bipolar disorder, adjustment disorders, and posttraumatic stress disorder (PTSD). Changes in service utilization rates following the declaration of a national public health emergency on March 13, 2020, were examined overall and by service modality (in-person vs telehealth), diagnostic category, patient sex, and age group.ResultsThe study included 5 142 577 commercially insured adults. The COVID-19 pandemic was associated with more than a 50% decline in in-person mental health care service utilization rates. At baseline, there was a mean (SD) of 11.66 (118.00) weekly beneficiaries receiving services for MDD per 10 000 enrollees; this declined by 6.44 weekly beneficiaries per 10 000 enrollees (β, –6.44; 95% CI, –8.33 to –4.54). For other disorders, these rates were as follows: anxiety disorders (mean [SD] baseline, 12.24 [129.40] beneficiaries per 10 000 enrollees; β, –5.28; 95% CI, –7.50 to –3.05), bipolar disorder (mean [SD] baseline, 3.32 [60.39] beneficiaries per 10 000 enrollees; β, –1.81; 95% CI, –2.75 to –0.87), adjustment disorders (mean [SD] baseline, 12.14 [129.94] beneficiaries per 10 000 enrollees; β, –6.78; 95% CI, –8.51 to –5.04), and PTSD (mean [SD] baseline, 4.93 [114.23] beneficiaries per 10 000 enrollees; β, –2.00; 95% CI, –3.98 to –0.02). Over the same period, there was a 16- to 20-fold increase in telehealth service utilization; the rate of increase was lowest for bipolar disorder (mean [SD] baseline, 0.13 [16.72] beneficiaries per 10 000 enrollees; β, 1.40; 95% CI, 1.04-1.76) and highest for anxiety disorders (mean [SD] baseline, 0.20 [9.28] beneficiaries per 10 000 enrollees; β, 9.12; 95% CI, 7.32-10.92). When combining in-person and telehealth service utilization rates, an overall increase in care for MDD, anxiety, and adjustment disorders was observed over the period.Conclusions and RelevanceIn this cohort study of US adults, we found that the COVID-19 pandemic was associated with a rapid increase in telehealth services for mental health conditions, offsetting a sharp decline in in-person care and generating overall higher service utilization rates for several mental health conditions compared with prepandemic levels.

Prescription Drug Dispensing and Patient Costs After Implementation of a No Behavioral Health Cost-Sharing Law

“…However, this limitation is unlikely to substantially affect the results because the intervention and comparison groups were similarly affected by the pandemic, and patterns of MH and SUD treatment had largely stabilized by 2021. 29 Fourth, we found a small but statistically significant differential trend in the volume of dispensed MH/SUD prescriptions in the 12 months prior to the policy change, although this is unlikely to alter our conclusion that there was no overall association of NCS with the volume of dispensed MH/SUD prescriptions in the first 6 months after the law's implementation. Fifth, we only observed dispensed prescriptions and have no information on prescriptions that were written but not dispensed or whether patients took dispensed medications.…”

“…Third, the 2021 to 2022 study period happened during the COVID-19 pandemic, likely affecting trends in MH/SUD treatment. However, this limitation is unlikely to substantially affect the results because the intervention and comparison groups were similarly affected by the pandemic, and patterns of MH and SUD treatment had largely stabilized by 2021 . Fourth, we found a small but statistically significant differential trend in the volume of dispensed MH/SUD prescriptions in the 12 months prior to the policy change, although this is unlikely to alter our conclusion that there was no overall association of NCS with the volume of dispensed MH/SUD prescriptions in the first 6 months after the law’s implementation.…”

A Nationally Representative Summary of 2020 Changes in the Use of Health Care in the United States

“…The percent of the population with any medical visit declined by at least one-third in April 2020 for all specialties examined except psychiatry, which increased 1.6% ( P < .001) (Table 2). Psychiatrists, who before the pandemic were far more likely to offer telehealth services than other specialties, were in the best position to rapidly switch from in-person to telehealth visits (McBain et al, 2023; Weinfield et al, 2023; Zhu et al, 2022). The percent with any visit to an ophthalmologist declined by 71% from April 2019 to April 2020.…”

Correlates of and Disparities in Cancellations or Delays of Prenatal Visits During the Covid-19 Pandemic: Emphasis on Racial/Ethnic Minorities and Persons with Low Socioeconomic Status

“…Approximately 7% to 20% of women during pregnancy suffer clinically relevant symptoms of depression, making it one of the most critical health concerns for mothers [ 29 – 31 ]. Recent studies found that many women with mental health conditions during the COVID-19 pandemic missed or avoided doctor visits, losing the opportunity to effectively manage their conditions [ 32 , 33 ]. Consistent with previous reports, the current study found that women with depression compared to those without it tended to have greater difficulties receiving prenatal care for reasons such as facility closures, COVID-19-related reasons, and family care.…”