The Impact of COVID-19 Lockdowns on Mental Health Patient Populations: Evidence from Medical Claims Data

Abstract

Background Social distancing policies were enacted during March 2020 to limit the spread of COVID-19. Lockdowns and movement restrictions increased the potential of negative impact on population mental health, in which depression and anxiety symptoms were frequently reported by different population groups during COVID-19 lockdown. However, the causal relationship of mitigation policies on national-wide mental health treatment is lacking. Objective This study investigates the effect of COVID-19 mitigation measures on mental health across the UnitedStates, on county and state levels. It examines the effect on the total mental health patients, different age and gender groups, and patients of selected mental health diagnoses. Methods We used large-scale medical claims data for mental health patients dated from September 1, 2019 to December31, 2020, with publicly available state- and county-specific COVID-19 cases from first case in January to December 31,2020, and used publicly available lockdown dates data for states and counties. We designed a difference-in-differences(DID) model, which infers the causal effect of a policy intervention by comparing pre-policy and post-policy periods indifferent regions. We mainly focused on two types of social distancing policies, stay-at-home and school closure orders. Results Based on common pre-treatment trend assumption of regions, we find that lockdown has significantly and causally increased seeking medical treatment for mental health across counties and states. Mental health patients inregions with lockdown orders have significantly increased by 18% compared to 1% decline in regions without a lockdown.Also, female populations have been exposed to a larger lockdown effect on their mental health with 24% increase in regions with lockdowns compared to 3% increase in regions without. While male mental health patients decreased by 5% in regions without lockdowns. Patients diagnosed with panic disorders and reaction to severe stress both were significantly exposed to a significant large effect of lockdowns. Also, life management difficulty patients doubled in regions with stay-at-home orders but increased less with school closures. Contrarily, attention-deficit hyperactivity patients declined in regions without stay-at-home orders. The number of mental health patients older than 80 decreased in regions with lockdowns. Adults between (21-40) years old were exposed to the greatest lockdown effect with patient number increasing between 20% to 30% in regions with lockdown. Adolescent patients under 21 increased in regions with school closures. Conclusion Although non-pharmaceutical intervention policies were effective in containing the spread of COVID-19, our results show that mitigation policies led to population-wide increase in mental health patients. Our results suggest the need for greater mental health treatment resources in the face of lockdown policies