Post by Psychocreature on Apr 10, 2024 3:12:32 GMT -5
During the start of the COVID-19 pandemic in 2020, lockdowns and movement restrictions were thought to negatively impact population mental health, since depression and anxiety symptoms were frequently reported. This study investigates the effect of COVID-19 mitigation measures on mental health across the United States, at county and state levels using difference-in-differences analysis. It examines the effect on mental health facility usage and the prevalence of mental illnesses, drawing on large-scale medical claims data for mental health patients joined with publicly available state- and county-specific COVID-19 cases and lockdown information. For consistency, the main focus is on two types of social distancing policies, stay-at-home and school closure orders. Results show that lockdown has significantly and causally increased the usage of mental health facilities in regions with lockdowns in comparison to regions without such lockdowns. Particularly, resource usage increased by 18% in regions with a lockdown compared to 1% decline in regions without a lockdown. Also, female populations have been exposed to a larger lockdown effect on their mental health. Diagnosis of panic disorders and reaction to severe stress significantly increased by the lockdown. Mental health was more sensitive to lockdowns than the presence of the pandemic itself.
The effects of the lockdown increased over an extended time to the end of December 2020.
As the COVID-19 pandemic began, confirmed cases rose, and mandated policy responses were enacted, mental health concerns started to be alarming1,2,3. The deterioration of mental health was observed during the first few months of the COVID-19 pandemic, March–June 20204,5, especially among women and college students6,7,8. Further, people with preexisting psychiatric disorders9,10 and people that encountered COVID-19 itself4 developed more mental health issues during the pandemic.
In the early stage of the COVID-19 pandemic, people voluntarily stayed at home and limited their trips for weeks before public policy interventions were imposed11. Subsequently, social distancing policies were issued globally as a form of non-pharmaceutical intervention, including limiting people’s gatherings, closing schools, and fully restricting movements by lockdown orders (also called stay-at-home or shelter-in-place orders)12, so as to contain virus spread in light of the increasing number of COVID-19 cases and fatalities.
Given that various intertwined events took place during the COVID-19 pandemic, the cause of mental health deterioration is not clear. One possible explanation is the increased severity of COVID-19 which led to increased anxiety, worry, and depression13. Another explanation is that policy responses to the pandemic, particularly the lockdown orders, contributed to worsening mental health.
Previous studies observing the decline in mental health have faced a challenge in determining possible causes or selecting direct measures. For example, Refs.14,15 found that depression and anxiety symptoms almost quadrupled from 2019 to June 2020, but could not infer causality given the study design. Other studies found that reduced physical activity resulting from restricted mobility led to higher rates of depression during the pandemic, but could not establish causality since they lacked pre-COVID-19 data10,16,17. Two other important studies by Refs.18,19 used Google search data and found that the timing of lockdown policies has been significantly associated with searches of terms related to worry, sadness, and boredom revealing negative feelings. A recent study established causality of the effect of lockdown
restrictions on worsening mental health using a clinical mental health questionnaire in Europe20. Although these studies considered pre-COVID-19 trends and have established causality on the lockdown orders, they lacked measures that reflect the rising need for mental health treatment and lacked a large representative population.
Examining the use of mental health resources and the prevalence of mental illnesses would further help in measuring the actual cost of COVID-19 lockdowns on mental health and inform mental health treatment resource planning for future lockdowns. Mental disorders have been more economically costly than any other disease, in which mental disorders were the leading segment of healthcare spending in the United States21, with the potential cause of a global economic burden22. Mental health has been related to social capital on individual and community levels23,24. Indeed, good social capital plays a role in promoting healthier public behaviors, especially during COVID-1925. The risk of mental health degradation goes beyond to impact the advantage of social capital in the face of viral diseases. Given these consequences of poor mental health on health care systems26, it has been essential to mitigate additional mental degradation and avoid potential future economic and social costs.
In this work, we consider measures that reflect the actual seeking of mental health services covering a large fraction of the United States population. To the best of our knowledge, there is no large-scale study that has investigated the effect of lockdown on the usage of mental health resources across the country. We empirically estimate the causal effect of COVID-19 social distancing policies on mental health across counties and states in the United States by comparing the differences in changes between locked and non-locked down regions using a large-scale medical claims dataset that covers most hospitals in the country. Specifically, we are interested to know whether the increase in mental health patients can be explained by COVID-19 lockdowns. Causal inference gives us the tools to uncover causal relationships rather than correlational relationships27, in order to understand the impact of COVID-19 policies on mental health.
We use the daily number of patients who visit mental health facilities as a measure for the usage of mental health resources, and we consider emergency department (ED) visits for mental health issues as a proxy for the development of new mental diseases, here, so severe that treatment could not be avoided. We consider ED visits to reflect the utilization of hospital resources under the shortage of medical staff. During COVID-19 there were patients with acute conditions reaching ED in which they have not been in regular outpatient visits28. Also, given the shortage in in-patient beds during the pandemic, mental health patients were admitted to ED instead29. Therefore, ED visits were of interest to indicate unmet mental health needs. The usage of mental health resources can further trigger analysis of economic costs borne by health care systems and the country as a whole. Mental health ED treatment visits might further reflect the mental health cost on an individual level.
Our results show that extended lockdown measures significantly increase the usage of mental health resources and ED visits. In particular, mental health resource usage in regions with lockdown orders has significantly increased compared to regions without a lockdown. The effect size of lockdowns was not only positive and significant but was also increasing till the end of December 2020. Our results further imply that mental health is more sensitive to policy interventions rather than the evolution of the pandemic itself.
www.nature.com/articles/s41598-024-55879-9
The effects of the lockdown increased over an extended time to the end of December 2020.
As the COVID-19 pandemic began, confirmed cases rose, and mandated policy responses were enacted, mental health concerns started to be alarming1,2,3. The deterioration of mental health was observed during the first few months of the COVID-19 pandemic, March–June 20204,5, especially among women and college students6,7,8. Further, people with preexisting psychiatric disorders9,10 and people that encountered COVID-19 itself4 developed more mental health issues during the pandemic.
In the early stage of the COVID-19 pandemic, people voluntarily stayed at home and limited their trips for weeks before public policy interventions were imposed11. Subsequently, social distancing policies were issued globally as a form of non-pharmaceutical intervention, including limiting people’s gatherings, closing schools, and fully restricting movements by lockdown orders (also called stay-at-home or shelter-in-place orders)12, so as to contain virus spread in light of the increasing number of COVID-19 cases and fatalities.
Given that various intertwined events took place during the COVID-19 pandemic, the cause of mental health deterioration is not clear. One possible explanation is the increased severity of COVID-19 which led to increased anxiety, worry, and depression13. Another explanation is that policy responses to the pandemic, particularly the lockdown orders, contributed to worsening mental health.
Previous studies observing the decline in mental health have faced a challenge in determining possible causes or selecting direct measures. For example, Refs.14,15 found that depression and anxiety symptoms almost quadrupled from 2019 to June 2020, but could not infer causality given the study design. Other studies found that reduced physical activity resulting from restricted mobility led to higher rates of depression during the pandemic, but could not establish causality since they lacked pre-COVID-19 data10,16,17. Two other important studies by Refs.18,19 used Google search data and found that the timing of lockdown policies has been significantly associated with searches of terms related to worry, sadness, and boredom revealing negative feelings. A recent study established causality of the effect of lockdown
restrictions on worsening mental health using a clinical mental health questionnaire in Europe20. Although these studies considered pre-COVID-19 trends and have established causality on the lockdown orders, they lacked measures that reflect the rising need for mental health treatment and lacked a large representative population.
Examining the use of mental health resources and the prevalence of mental illnesses would further help in measuring the actual cost of COVID-19 lockdowns on mental health and inform mental health treatment resource planning for future lockdowns. Mental disorders have been more economically costly than any other disease, in which mental disorders were the leading segment of healthcare spending in the United States21, with the potential cause of a global economic burden22. Mental health has been related to social capital on individual and community levels23,24. Indeed, good social capital plays a role in promoting healthier public behaviors, especially during COVID-1925. The risk of mental health degradation goes beyond to impact the advantage of social capital in the face of viral diseases. Given these consequences of poor mental health on health care systems26, it has been essential to mitigate additional mental degradation and avoid potential future economic and social costs.
In this work, we consider measures that reflect the actual seeking of mental health services covering a large fraction of the United States population. To the best of our knowledge, there is no large-scale study that has investigated the effect of lockdown on the usage of mental health resources across the country. We empirically estimate the causal effect of COVID-19 social distancing policies on mental health across counties and states in the United States by comparing the differences in changes between locked and non-locked down regions using a large-scale medical claims dataset that covers most hospitals in the country. Specifically, we are interested to know whether the increase in mental health patients can be explained by COVID-19 lockdowns. Causal inference gives us the tools to uncover causal relationships rather than correlational relationships27, in order to understand the impact of COVID-19 policies on mental health.
We use the daily number of patients who visit mental health facilities as a measure for the usage of mental health resources, and we consider emergency department (ED) visits for mental health issues as a proxy for the development of new mental diseases, here, so severe that treatment could not be avoided. We consider ED visits to reflect the utilization of hospital resources under the shortage of medical staff. During COVID-19 there were patients with acute conditions reaching ED in which they have not been in regular outpatient visits28. Also, given the shortage in in-patient beds during the pandemic, mental health patients were admitted to ED instead29. Therefore, ED visits were of interest to indicate unmet mental health needs. The usage of mental health resources can further trigger analysis of economic costs borne by health care systems and the country as a whole. Mental health ED treatment visits might further reflect the mental health cost on an individual level.
Our results show that extended lockdown measures significantly increase the usage of mental health resources and ED visits. In particular, mental health resource usage in regions with lockdown orders has significantly increased compared to regions without a lockdown. The effect size of lockdowns was not only positive and significant but was also increasing till the end of December 2020. Our results further imply that mental health is more sensitive to policy interventions rather than the evolution of the pandemic itself.
www.nature.com/articles/s41598-024-55879-9
