COVID-19, One Year Later

Examining the behavioral health impact of a yearlong pandemic

During the COVID-19 pandemic, behavioral health issues in people of all ages have been steadily increasing. Cases of anxiety and depression are on the rise. Even children have not escaped the impact. Between March and April 2020, total mental health claims for children ages 13 and 18 doubled compared to 2019, according to an analysis released March 2 by the not-for-profit, transparency advocacy group FAIR Health. During the same period, use of healthcare services for physical conditions declined by more than 50% compared to the same period of 2019 due to widespread restrictions on non-emergency medical care as well as ongoing patient hesitancy to access care even after restrictions were relaxed.

The Kaiser Family Foundation has similar findings. During the pandemic, about 4 in 10 adults in the U.S. have reported symptoms of anxiety or depressive disorder, a share that has been largely consistent, up from 1 in 10 adults who reported these symptoms from January to June 2019. And in a survey from June 2020, 13% of adults reported new or increased substance use due to coronavirus-related stress, and 11% of adults reported thoughts of suicide in the past 30 days.

Mental distress during the pandemic is occurring against a backdrop of high rates of mental illness and substance use that existed prior to the current crisis. Prior to the pandemic, 1 in 10 adults reported symptoms of anxiety and/or depressive disorder. Nearly 1 in 5 U.S. adults (47 million) reported having any mental illness.

In a recent survey, the Association of American Medical Colleges found that nationwide, half of physicians report feeling anxious due to COVID-19-related concerns. Nearly 60% report experiencing burnout — a significant leap from 40% two years ago. But a key question in leaders’ minds has been whether staff would avoid the services given the long-standing stigma surrounding mental health care. One study, for example, found that 73% of emergency physicians expect stigma at work for seeking treatment.

Within our ONEcare networks, we practice the “4 C’s.” Catch, Care, Connect, and Collaborate. Simple in phrase yet critically important in gluing a care team together around a patient. To Catch the disease early, we encourage and support ongoing and routine dialogue between the primary care physician and the patient beyond the stilted administration of a PHQ-9 or similar screening tool. With behavioral health conditions co-occurring alongside chronic illness 40% of the time, the trusted primary care physician can shift the perspective from “if” to “when” behavioral health symptomology appears. This simple conversation helps educate the patient that they will likely experience some form of mental health and/or substance use condition within their life, even if episodic, as is completely natural and expected. This begins to reduce disease stigma, increases self-awareness, and empowers the patient to actively monitor and discuss symptoms before they become acute and disruptive. For those healthcare providers assuming upside or downside financial risk in patient care, I will leave you one more statistic born of the over 1M clinical records that we analyze annually. . .patients with a chronic health condition and a corresponding untreated behavioral health disorder have a medical loss ratio 3.6Xhigher than those without. In 2021, I encourage our healthcare community to move to a proactive, rather than reactive, stance regarding rising behavioral health rates and severity. . .let’s work together to Catch the disease sooner.