Psychological distress in US increased during pandemic, barriers to telehealth persist

Key takeaways:

• Older, middle-aged and unemployed adults were less likely to have outpatient mental health care.
• These groups could be impacted by barriers to telehealth, like low digital literacy.

The rate of serious psychological distress among adults rose over the course of the COVID-19 pandemic, and their access to outpatient mental health care decreased, researchers found.

Mark Olfson, MD, MPH, an Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law at Columbia University, and colleagues noted the mental health fallout from the pandemic.

“Several factors, including fear and grief, COVID-19-related morbidity, social restrictions and isolation, financial uncertainty, and work and school disruptions, may have contributed to increasing psychological distress,” they wrote in the Annals of Internal Medicine. However, “data are lacking.”

Although telehealth visits for mental health increased during the pandemic, “concern has developed that some patient groups have difficulty accessing these services.”

Olfson and colleagues analyzed trends in psychological distress and outpatient mental health care by analyzing data from the Medical Expenditure Panel Surveys conducted by the Agency for Healthcare Research and Quality. Their study focused on 86,658 adults, from 2018 to 2021.

They found that the rate of serious psychological distress among adults increased from 3.5% in 2018 to 4.2% in 2021.

Meanwhile, although the rate of outpatient mental health care increased from 11.2% to 12.4% overall during the study period, the rate decreased from 46.5% to 40.4% among adults with serious psychological distress.

According to the researchers, 33.4% of mental health outpatients had at least one video visit in 2021 — a disproportionate number of whom were young, college-educated, higher income, employed and urban adults.

Younger adults and employed adults saw substantial increases in outpatient mental health care over the study period, but not older, middle-aged and unemployed adults — groups that might face barriers like:

• a lack of broadband access;
• social isolation;
• lower digital literacy; and
• a lack of support networks to help with technology difficulties.

The findings raise “previously anticipated concerns about disparities in access to virtual mental health care,” the researchers wrote.

Several interventions have been recommended to improve access to virtual health care, including education and training to teach digital literacy skills, offering video visits to all patients who can be treated in such a manner and addressing financial barriers.

Ultimately, “unless progress is made in reducing these barriers, primary care physicians will continue to encounter challenges in connecting their older, unemployed, low-income, uninsured, and more psychologically distressed patients to video-delivered outpatient mental health care,” Olfson and colleagues concluded.