Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic.
Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic.
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DOI：
10.1001/jamahealthforum.2022.4936
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发表时间：
2023-01-06
期刊：
影响因子：
--
通讯作者：
Whaley, Christopher M.
中科院分区：
文献类型：
--
作者：
McBain, Ryan K.;Cantor, Jonathan;Pera, Megan F.;Breslau, Joshua;Bravata, Dena M.;Whaley, Christopher M.
这项队列研究考察了在新冠肺炎大流行的第一年里，美国所有50个州有商业保险的成年人使用面对面和远程健康心理健康服务的变化。在新冠肺炎大流行的第一年(2020年1月至12月)，美国的精神卫生服务利用情况是否因不同的精神诊断而发生变化？在这项对美国所有50个州的5名 142 577商业保险成年人进行的队列研究中，在新冠肺炎大流行开始后，面对面心理健康服务的每周使用率下降了超过50%，但同时远程健康的增加导致焦虑症的总使用率略有增加，其他障碍的总服务量保持稳定。研究结果表明，大流行扰乱了身临其境的精神卫生保健，但远程保健的扩大使越来越多的患者能够得到护理。新冠肺炎大流行与精神健康疾病的高患病率有关，并扰乱了整个美国的精神卫生保健。调查2020年1月至12月美国成年人对心理健康服务的使用情况。这项队列研究使用了2020年1月5日至12月21日期间美国全国成人(18岁)商业医疗索赔数据库中的县级服务利用数据。所有分析都是在2021年4月和5月进行的。计算每10,000名 受益者每周对5个精神诊断类别的精神卫生服务的使用量：严重抑郁障碍、焦虑症、双相情感障碍、适应障碍和创伤后应激障碍。在2020年3月13日宣布国家公共卫生紧急状态后，对服务利用率的变化进行了全面检查，并按服务方式(面对面与远程医疗)、诊断类别、患者性别和年龄组进行了检查。这项研究包括5名 142名 577名商业保险的成年人。新冠肺炎的流行与面对面精神卫生保健服务使用率下降了50%以上有关。在基准线上，每10,000名 参与者中平均有11.66(118.00)名每周受益者接受MDD服务；这一数字每10,000名 ，参与者每周减少6.44名(β，-6.44；95%CI，-8.33至-4.54)。对于其他障碍，这些比率如下：焦虑症(平均[SD]基线，每10 000名参与者中有12.24[129.40]名受益人；β，-5.28；95%CI，-7.5%至-3.05)；双相情感障碍(平均[SD]基线，每10名 000名参与者中有3.32[60.39]名受益人；β，-1.81；95%CI，-2.75至-0.87)；适应障碍(平均[SD]基线，每10名 000名参与者中有12.14[129.94]名受益人；β，-6.78；95%可信区间，-8.51%至-5.04%)和创伤后应激障碍(平均[SD]基线，每10,000 ，4.93[114.23]受益人；β，-2.00；95%可信区间，-3.98%至-0.02)。在同一时期，远程医疗服务的利用增加了16到20倍；双相情感障碍的增长率最低(平均[SD]基线，每10 000参与者中有0.13[16.72]受益人；β，1.4；95%CI，1.04-1.76)，而焦虑症的增长率最高(平均[SD]基线，每10,000 000参与者中有0.20[9.28]受益人；β，9.12；95%CI，7.32-10.92)。当结合面对面和远程医疗服务利用率时，在此期间观察到MDD、焦虑和适应障碍的护理总体增加。在这项针对美国成年人的队列研究中，我们发现新冠肺炎大流行与精神健康疾病远程医疗服务的快速增加有关，抵消了面对面护理服务的急剧下降，并导致几种精神健康疾病的总体服务利用率高于流行前水平。
This cohort study examines changes in use of in-person and telehealth mental health services among commercially insured adults across all 50 US states during the first year of the COVID-19 pandemic. Did mental health service utilization in the US change for different psychiatric diagnoses during the first year of the COVID-19 pandemic (January to December 2020)? In this cohort study of 5 142 577 commercially insured adults across all 50 US states, the weekly rate of in-person mental health service utilization decreased by more than 50% after the start of the COVID-19 pandemic but concurrent increases in telehealth led to a slight increase in total utilization for anxiety disorders and stability in total volume of service for other disorders. The findings suggest that the pandemic disrupted in-person mental health care but expansion of telehealth enabled care for an increasing number of patients. The COVID-19 pandemic has been associated with an elevated prevalence of mental health conditions and disrupted mental health care throughout the US. To examine mental health service use among US adults from January through December 2020. This cohort study used county-level service utilization data from a national US database of commercial medical claims from adults (age >18 years) from January 5 to December 21, 2020. All analyses were conducted in April and May 2021. Per-week use of mental health services per 10 000 beneficiaries was calculated for 5 psychiatric diagnostic categories: major depressive disorder (MDD), anxiety disorders, bipolar disorder, adjustment disorders, and posttraumatic stress disorder (PTSD). Changes in service utilization rates following the declaration of a national public health emergency on March 13, 2020, were examined overall and by service modality (in-person vs telehealth), diagnostic category, patient sex, and age group. The study included 5 142 577 commercially insured adults. The COVID-19 pandemic was associated with more than a 50% decline in in-person mental health care service utilization rates. At baseline, there was a mean (SD) of 11.66 (118.00) weekly beneficiaries receiving services for MDD per 10 000 enrollees; this declined by 6.44 weekly beneficiaries per 10 000 enrollees (β, –6.44; 95% CI, –8.33 to –4.54). For other disorders, these rates were as follows: anxiety disorders (mean [SD] baseline, 12.24 [129.40] beneficiaries per 10 000 enrollees; β, –5.28; 95% CI, –7.50 to –3.05), bipolar disorder (mean [SD] baseline, 3.32 [60.39] beneficiaries per 10 000 enrollees; β, –1.81; 95% CI, –2.75 to –0.87), adjustment disorders (mean [SD] baseline, 12.14 [129.94] beneficiaries per 10 000 enrollees; β, –6.78; 95% CI, –8.51 to –5.04), and PTSD (mean [SD] baseline, 4.93 [114.23] beneficiaries per 10 000 enrollees; β, –2.00; 95% CI, –3.98 to –0.02). Over the same period, there was a 16- to 20-fold increase in telehealth service utilization; the rate of increase was lowest for bipolar disorder (mean [SD] baseline, 0.13 [16.72] beneficiaries per 10 000 enrollees; β, 1.40; 95% CI, 1.04-1.76) and highest for anxiety disorders (mean [SD] baseline, 0.20 [9.28] beneficiaries per 10 000 enrollees; β, 9.12; 95% CI, 7.32-10.92). When combining in-person and telehealth service utilization rates, an overall increase in care for MDD, anxiety, and adjustment disorders was observed over the period. In this cohort study of US adults, we found that the COVID-19 pandemic was associated with a rapid increase in telehealth services for mental health conditions, offsetting a sharp decline in in-person care and generating overall higher service utilization rates for several mental health conditions compared with prepandemic levels.
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在19日大流行期间，患有严重精神疾病的医疗保险受益人的护理中断。
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