The Impact of COVID-19 Lockdowns on Mental Health Patient Populations: Evidence from Medical Claims Data

Abstract

Background

Social distancing policies were enacted during March 2020 to limit the spread of COVID-19. Lockdowns and movement restrictions increased the potential of negative impact on population mental health, in which depression and anxiety symptoms were frequently reported by different population groups during COVID-19 lockdown. However, the causal relationship of mitigation policies on national-wide mental health resource usage is lacking.

Objective

This study investigates the effect of COVID-19 mitigation measures on mental health across the United States, on county and state levels. It examines the effect on mental health facility usage and the prevalence of mental illnesses on the total population, different age and gender groups, and patients of selected mental health diagnoses.

Methods

We used large-scale medical claims data for mental health patients dated from September 1, 2019 to December 31, 2020, with publicly available state- and county-specific COVID-19 cases from first case in January to December 31, 2020, and used publicly available lockdown dates for states and counties. We designed a difference-in-differences (DID) model, which infers the causal effect of a policy intervention by comparing pre-policy and post-policy periods in different regions. We mainly focused on two types of social distancing policies, stay-at-home and school closure orders.

Results

Based on common pre-treatment trend assumption of regions, we find that lockdown has significantly and causally increased the usage of mental health in regions with lockdowns in comparison to regions without. In regions with lockdown orders the resource usage increased by 18% compared to 1% decline in regions without a lockdown. Also, female populations have been exposed to a larger lockdown effect on their mental health with 24% increase in regions with lockdowns compared to 3% increase in regions without. While male mental health patients decreased by 5% in regions without lockdowns. Patients diagnosed with panic disorders and reaction to severe stress both were significantly exposed to a significant large effect of lockdowns. Also, life management difficulty patients doubled in regions with stay-at-home orders but increased less with school closures. Contrarily, attention-deficit hyperactivity patients declined in regions without stay-at-home orders. Patients older than 80 used mental health resources less in regions with lockdowns. Adults between (21 – 40) years old were exposed to the greatest lockdown effect with increase between 20% to 30% in regions with lockdown.

Conclusion

Although non-pharmaceutical intervention policies were effective in containing the spread of COVID-19, our results show that mitigation policies led to population-wide increase in mental health patients. Our results suggest the need for greater mental health treatment resources in the face of lockdown policies.

SciScore for 10.1101/2021.05.26.21257598: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

NIH rigor criteria are not applicable to paper type.

Table 2: Resources

No key resources detected.

Results from OddPub: Thank you for sharing your code and data.

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

A main limitation of our study that impacts representativeness of results is that our medical claims data does not cover Medicare and Medicaid health insurance programs. Medicare covers most aged and disabled population across the US, while Medicare covers a wider range of population including low-income beneficiaries covering 30% of US population [25]. Hence, our data misses some population groups in the US. Despite the limitation of the data, our findings provide important policy implications. There is a significant mental health cost for non-pharmaceutical interventions, especially interventions that are extended to a long duration of time with no expected time for lifting. Our results suggest that policymakers should take into consideration the mental health cost and ensure mental health treatment capacity. Furthermore, we showed that number of patients had dropped right after lockdowns and then progressively increased in June and July 2020, which suggest that people with mental health afflictions did not have the ability to seek care directly during restrictive lockdowns. Our results suggest that policy interventions should be accompanied with strategies that allow seeking psychiatric help despite restrictive lockdowns, in order to avoid the exacerbated effect of delayed mental health treatment.

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

Results from scite Reference Check: We found no unreliable references.

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