A detailed analysis of mental health treatment trends during the COVID-19 pandemic found a 7% increase in visits during the initial shelter-in-place period in 2020, compared with the same 3-month period in 2019.
The study, published in The Journal of Clinical Psychiatry March 3, examined patient visits for psychiatric diagnoses among members of Kaiser Permanente in Northern California.
The greatest increases in visits were for substance use (up 51%), adjustment disorder (up 15%), anxiety (up 12%), bipolar disorder (up 9%), and psychotic disorder (up 6%). Adjustment disorder is diagnosed when someone responds to a stressful life event with symptoms such as sadness and hopelessness.
"The increases we found in patients seeking care for substance use and anxiety are consistent with other data showing the pandemic and shelter-in-place orders were difficult for many people," said lead author Kathryn Erickson-Ridout, MD, a psychiatrist with Kaiser Permanente in Northern California and a member of the Physician Researcher Program with the Kaiser Permanente Northern California Division of Research. "These findings reflect what I experienced with my patients who sought out care."
The analysis focused on a period when Kaiser Permanente pivoted to virtual visits by video and telephone to ensure that patients continued to have access to care when shelter-in-place orders were implemented. "COVID-19 has created huge psychosocial disruption," Dr. Erickson-Ridout said. "It's impacting people's ability to work, socialize, and have relationships, and that is having mental health consequences. We were able to respond to that with a robust telehealth system, to reach those patients and give them good care."
The study was a retrospective observational analysis comparing 165,696 psychiatric outpatient contacts between March 9 and May 31, 2019, with 181,015 during the same period in 2020, an increase of 7%. The researchers also confirmed the shift away from in-person visits, tallying a 264% increase in telephone and video visits from the year before. Kaiser Permanente clinicians also offer mental health support by secure email message, but this study did not count those.
The study found 42% more addiction clinic visits than the same period in 2019. This could be related to patients having more difficulty coping with the pandemic, but it could also reflect existing patients having good connections with their addiction medicine providers, said study senior author Esti Iturralde, PhD, a research scientist with the Division of Research. "They may have been able to seek care more easily from the health system because of the strong connections and supports Kaiser Permanente provides, including case management," she said.
The results also suggest some people did not immediately adjust to the new virtual visit format. Visits with new patients declined by 42%, as did visits by children and adolescents (down 23%), and older adults (down more than 5%).
The authors said these results may reflect which patients were most comfortable reaching out for telehealth care, at least during the first few months of the pandemic. Reliance on caregivers to facilitate visits, or healthcare avoidance during this time, may be behind these changes. Future research may reflect how patients adjusted to virtual visits past May 2020.
To increase use of virtual visits by these groups, and people with new mental health symptoms, the authors suggested outreach through collaborative care, such as getting referrals from primary care providers and other clinicians patients see for physical health concerns.
The research was supported by The Permanente Medical Group Delivery Science and Applied Research Initiative and Physician Researcher Program.
Other coauthors were Constance Weisner, DrPH, MSW, Cynthia Campbell, PhD, MPH, and Mubarika Alavi, MS, of the Division of Research; Samuel J. Ridout, MD, PhD, Maria T. Koshy, MD, Inderpreet Dhillon, MD, and Sameer Awsare, MD, of The Permanente Medical Group; and Brooke Harris, PhD, of the Kaiser Permanente Oakland Medical Center.
Journal of Clinical Psychiatry