Trends In Outpatient Mental Health Services Use Before And During The COVID-19 Pandemic

Zhu, Jane M.; Myers, Renae; McConnell, K. John; Levander, Ximena A.; Lin, Sunny C.

doi:10.1377/hlthaff.2021.01297

Cited by 53 publications

(40 citation statements)

References 19 publications

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“…Such changes have been reported both in psychiatric care delivered by GPs ( 15 , 16 ) and in specialized open care ( 29 , 30 ). In the US, Zhu et al ( 31 ) found that the declining number of in-person encounters in psychiatric open care was correlated with an increase in telehealth encounters.…”

Section: Discussionmentioning

confidence: 99%

Differential impact of the COVID-19 pandemic on primary care utilization related to common mental disorders in four European countries: A retrospective observational study

Flodin

Wallin²,

Tarantino³

et al. 2023

Front. Psychiatry

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BackgroundThe COVID-19 pandemic is commonly believed to have increased common mental disorders (CMD, i.e., depression and anxiety), either directly due to COVID-19 contractions (death of near ones or residual conditions), or indirectly by increasing stress, economic uncertainty, and disruptions in daily life resulting from containment measure. Whereas studies reporting on initial changes in self-reported data frequently have reported increases in CMD, pandemic related changes in CMD related to primary care utilization are less well known. Analyzing time series of routinely and continuously sampled primary healthcare data from Sweden, Norway, Netherlands, and Latvia, we aimed to characterize the impact of the pandemic on CMD recorded prevalence in primary care. Furthermore, by relating these changes to country specific time-trajectories of two classes of containment measures, we evaluated the differential impact of containment strategies on CMD rates. Specifically, we wanted to test whether school restrictions would preferentially affect age groups corresponding to those of school children or their parents.MethodsFor the four investigated countries, we collected time-series of monthly counts of unique CMD patients in primary healthcare from the year 2015 (or 2017) until 2021. Using pre-pandemic timepoints to train seasonal Auto Regressive Integrated Moving Average (ARIMA) models, we predicted healthcare utilization during the pandemic. Discrepancies between observed and expected time series were quantified to infer pandemic related changes. To evaluate the effects of COVID-19 measures on CMD related primary care utilization, the predicted time series were related to country specific time series of levels of social distancing and school restrictions.ResultsIn all countries except Latvia there was an initial (April 2020) decrease in CMD care prevalence, where largest drops were found in Sweden (Prevalence Ratio, PR = 0.85; 95% CI 0.81–0.90), followed by Netherlands (0.86; 95% CI 0.76–1.02) and Norway (0.90; 95% CI 0.83–0.98). Latvia on the other hand experienced increased rates (1.25; 95% CI 1.08–1.49). Whereas PRs in Norway and Netherlands normalized during the latter half of 2020, PRs stayed low in Sweden and elevated in Latvia. The overall changes in PR during the pandemic year 2020 was significantly changed only for Sweden (0.91; 95% CI 0.90–0.93) and Latvia (1.20; 95% CI 1.14–1.26). Overall, the relationship between containment measures and CMD care prevalence were weak and non-significant. In particular, we could not observe any relationship of school restriction to CMD care prevalence for the age groups best corresponding to school children or their parents.ConclusionCommon mental disorders prevalence in primary care decreased during the initial phase of the COVID-19 pandemic in all countries except from Latvia, but normalized in Norway and Netherlands by the latter half of 2020. The onset of the pandemic and the containment strategies were highly correlated within each country, limiting strong conclusions on whether restriction policy had any effects on mental health. Specifically, we found no evidence of associations between school restrictions and CMD care prevalence. Overall, current results lend no support to the common belief that the pandemic severely impacted the mental health of the general population as indicated by healthcare utilization, apart from in Latvia. However, since healthcare utilization is affected by multiple factors in addition to actual need, future studies should combine complementary types of data to better understand the mental health impacts of the pandemic.

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Section: Discussionmentioning

confidence: 99%

Differential impact of the COVID-19 pandemic on primary care utilization related to common mental disorders in four European countries: A retrospective observational study

Flodin

Wallin²,

Tarantino³

et al. 2023

Front. Psychiatry

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“…However, this particular finding of increased needs of seeking help among 2SLGBTQI+ young adults experiencing mental health challenges presents an opportunity for timely intervention. In addition to increased prevalence of mental health issues [ 6 ], making virtual mental health visits became more common during the pandemic [ 57 ]. Hence, 2SLGBTQI+ young adults can be encouraged to leverage these services, seek help and access urgent online supports at the time of mental health emergency.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to increased prevalence of mental health issues [6], making virtual mental health visits became more common during the pandemic [57]. Hence, 2SLGBTQI+ young adults can be encouraged to leverage these services, seek help and access urgent online supports at the time of mental health emergency.…”

Section: Plos Onementioning

confidence: 99%

Correlates of wanting to seek help for mental health and substance use concerns by sexual and gender minority young adults during the COVID-19 pandemic: A machine learning analysis

Kundu

Fu²,

Grace³

et al. 2022

PLoS ONE

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The COVID-19 pandemic has worsened the mental health and substance use challenges among many people who are Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, and intersex (2SLGBTQI+). We aimed to identify the important correlates and their effects on the predicted likelihood of wanting to seek help among 2SLGBTQI+ young adults for mental health or substance use concerns during the pandemic. A cross-sectional survey was conducted in 2020–2021 among 2SLGBTQI+ young adults aged 16–29 living in two Canadian provinces (Ontario and Quebec). Among 1414 participants, 77% (n = 1089) wanted to seek help for their mental health or substance use concerns during the pandemic, out of these, 69.8% (n = 760) reported delay in accessing care. We built a random forest (RF) model to predict the status of wanting to seek help, which achieved moderately high performance with an area under the receiver operating characteristic curve (AUC) of 0.85. The top 10 correlates of wanting to seek help were worsening mental health, age, stigma and discrimination, and adverse childhood experiences. The interactions of adequate housing with certain sexual orientations, gender identities and mental health challenges were found to increase the likelihood of wanting to seek help. We built another RF model for predicting risk of delay in accessing care among participants who wanted to seek help (n = 1089). The model identified a similar set of top 10 correlates of delay in accessing care but lacked adequate performance (AUC 0.61). These findings can direct future research and targeted prevention measures to reduce health disparities for 2SLGBTQI+ young adults.

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“…

The COVID-19 pandemic prompted increased demand for behavioral health services. 1 These conditions introduced significant stressors on the behavioral health workforce, which already experienced high rates of burnout and turnover before the COVID-19 pandemic that contributed to shortages in many areas of the country. 2,3 This study examined the association between the COVID-19 pandemic and the US behavioral health workforce.Methods | This study used an employment census to describe trends in behavioral health employment before and during the COVID-19 pandemic.

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confidence: 99%

“…These differential trends may be driven in part by greater ease of telehealth implementation in outpatient relative to intensive settings and sustained concern about COVID-19 transmission risks in in-person IOP, inpatient, and residential treatment programs. 1,5 Fewer than half of US adults with behavioral health conditions receive any treatment, and pandemic stressors have increased behavioral health care need. 6 Slow recovery of the intensive behavioral health services workforce may exacerbate the treatment gap.…”

mentioning

confidence: 99%

Employment in Office-Based and Intensive Behavioral Health Settings in the US, 2016-2021

Eisenberg

Eddelbuettel

McGinty

2022

JAMA

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Trends In Outpatient Mental Health Services Use Before And During The COVID-19 Pandemic

Cited by 53 publications

References 19 publications

Differential impact of the COVID-19 pandemic on primary care utilization related to common mental disorders in four European countries: A retrospective observational study

Differential impact of the COVID-19 pandemic on primary care utilization related to common mental disorders in four European countries: A retrospective observational study

Correlates of wanting to seek help for mental health and substance use concerns by sexual and gender minority young adults during the COVID-19 pandemic: A machine learning analysis

Employment in Office-Based and Intensive Behavioral Health Settings in the US, 2016-2021

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