Disconnect between increased stress and diagnoses rates from Cheryl Perkins from Beacon Health

People in America have shared that the pandemic has negatively affected their mental health. However, in spite of the many additional stressors that they felt in 2020, including social unrest, a tumultuous election and a declining economy, there wasn’t a corresponding increase in people seeking mental health treatment, according to the inaugural State of the Nation’s Mental Health report. Children and adults older than 75 appeared to have the largest overall downturn with both groups reporting significantly fewer mental health diagnoses in 2020 compared to 2019. Younger adults, meanwhile, had a smaller than expected increase in mental health diagnoses for the full year of 2020. Further, in spite of the overall downturn, there were two conditions for which diagnoses and treatment grew in 2020: anxiety and PTSD for adults.

These findings, part of a new State of the Nation’s Mental Health report based on 27 million Anthem, Inc.-affiliated health plan claims, show the pandemic disconnect between feeling stressed and depressed and being diagnosed and seeking treatment.

National context

In this century, we have become more comfortable seeking mental health services. In 2002, the percentage of adults aged 18 and older receiving mental health services was 13 percent, according to the Substance Abuse and Mental Health Services Administration. By 2019, that percentage grew to a little more than 16 percent.

In 2020, the pandemic strained our mental health. A recent study revealed that four in 10 adults reported symptoms of anxiety or depression during the pandemic, up from one in 10 in 2019. Further, 42 percent of people younger than 30 are experiencing symptoms of anxiety and depression, according to a CDC survey from August 2020 through February 2021. Not surprisingly, the social distancing and quarantining recommended to protect our physical health is the very thing that paradoxically can have a damaging effect on our mental health. In contrast to the reported increase in mental distress, Anthem’s 2020 data for its affiliated health plan members show little change in the rate of diagnoses: the rate was flat from 2019-2020, compared to an increase in 2018-2019. A conclusion to be drawn is that, regardless of the pandemic’s effect on individuals’ mental health, the pandemic is the likely explanation for the flat rate of diagnoses in 2020.

Indeed, the pandemic has disrupted people’s patterns of care in spite of increased need. For example, specific to mental health, the World Health Organization reports that the pandemic disrupted mental health services in 93 percent of countries.

Youngest, oldest are the outlier groups

The youngest and oldest members of the population were the only two groups to show a decline in diagnoses in 2020. The State of the Nation’s Mental Health report revealed that there was a 10 percent drop in the rate of young children and a 5 percent drop for adolescents treated for mental health diagnoses compared to 2019. At the opposite end of the age spectrum, people older than 75 – also known as the Silent Generation – showed a 5 percent drop. The conditions that showed the greatest drops were ADHD for children (-13%) and adolescents (-8%) and dementia for the Silent Generation (-8%). Interestingly, anxiety and depression emerged in the top three diagnoses for all age groups, except for depression among children 12 and younger.

An Anthem-commissioned survey of behavioral health specialists and primary care physicians supports the State of the Nation’s Mental Health report’s findings. For example, respondents reported that children and adolescents have experienced the most significant short- and long-term impacts on their mental health due to the pandemic. Additionally, the survey confirmed anxiety and depression as top diagnoses, with providers reporting that they have been treating anxiety (90%) and depression (95%) more frequently than before the pandemic’s onset.

Additional Anthem data from IngenioRx, its pharmacy benefits manager, supports the report’s finding that people didn’t access treatment in 2020 at as high of a rate as they did in 2019, in spite of the rising need. For example, while the overall utilization for medications to treat depression was up in 2020, much of that increase can be attributed to existing users being more adherent to their dosing regimens, according to IngenioRx medication-adherence data. New users of these medications in 2020 increased at the same rate as 2019.

Lessons learned

The COVID-19 pandemic has changed the world as we knew it. How long those changes will last or whether some of them may be permanent remains to be seen. However, healthcare has learned important lessons, one of which is the growing acknowledgement of mental health as essential to overall health and wellbeing. That acknowledgment starts with the providers themselves. Nine out of 10 of those surveyed said that COVID-19 has made them more aware of the mental health conditions their patients are facing. Further, their patients are opening up about mental health concerns: 70 percent of surveyed providers said their patients have been more willing to proactively bring up mental health during appointments.

We need to be ahead of the curve as our nation’s mental health unfolds post-pandemic. Based on the report’s findings that people aren’t accessing services when they need them the most, a call to action emerges: we must be proactive about identifying those individuals and connecting them to care.