Disconnect between increased stress and lower diagnoses rates raises concerns

Pandemic leads to decrease in mental healthcare over 2020 calendar year for children and older adults, says State of the Nation’s Mental Health report

While people in America have shared that the pandemic and other stressors like social injustice, elections, and the economy negatively impacted their mental health in 2020, there wasn’t a corresponding increase in people seeking mental health treatment, according to the inaugural Anthem, Inc. State of the Nation’s Mental Health report.

However, diagnoses and treatment for anxiety and PTSD for adults were among the few mental health diagnoses that grew in 2020. Children and older adults appeared to have the largest overall downturn, 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.

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

Recent studies have shown that many more adults reported symptoms of anxiety or depression. Further, 42 percent of people under 30 years old were experiencing anxiety and depression symptoms, according to a CDC survey from August 2020 through February 2021.

“What this says to us is that there are many people who may benefit from mental health services, especially children and older adults, who either aren’t being identified or aren’t reaching out to get the help they might need,” said Anthem Chief Health Officer Shantanu Agrawal, M.D. “This is a call out for all of us. We don’t hesitate to help others get the COVID-19 vaccine to protect themselves from the virus and we shouldn’t hesitate to help people find the mental health services they need as they cope with the pandemic, which is equally important to their overall health. That’s why we are dedicated to increasing our focus on whole health.”

The results of the study are supported by other Anthem data from IngenioRx, its pharmacy benefits manager. 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 increased at the same rate as 2019.

The State of the Nation’s Mental Health report showed the following drops in 2020 rates for those treated for mental health diagnoses compared to those treated in 2019:

• 10 percent overall drop for young children
• 5 percent overall drop for adolescents
• 5 percent overall drop for adults older than 75
• 13 percent drop for young children diagnosed with ADHD
• 8 percent drop for adolescents diagnosed with ADHD
• 8 percent drop in adults older than 75 diagnosed with dementia, and a
• 3 percent drop for both Baby Boomers and adults older than 75 diagnosed for depression.

“While we don’t know for sure why children and older adults had fewer diagnoses, we speculate that they weren’t interacting as often with people in our communities who have increasingly become the starting point for mental health diagnoses,” said Agrawal. “Children involved in distance learning had less face time with teachers, who often recommend testing for mental health or attention concerns, and older adults may not have been able or were more reluctant to see their primary care provider in 2020, which may play a role in the decrease in dementia diagnoses, and perhaps, decreased diagnoses for depression.”

Nearly three out of four mental health specialists and primary care doctors estimated in an Anthem commissioned survey that mental health repercussions from the virus will last up to three years or longer and almost two-thirds believe their patients’ mental health declined in the second half of the pandemic (September 2020-February 2021) compared to the first half (March-August 2020).

“When people encounter more stress, it’s logical to expect trends for mental health diagnoses to increase. However, for many, such as children who may be learning virtually and isolated seniors — that hasn’t been the case,” said Agrawal. “This subsequent ‘mental health’ pandemic could have impacts for years to come, reinforcing the need for mental health and physical health to be addressed equally and simultaneously.”

On a positive note, nine out of 10 healthcare professionals surveyed said that COVID-19 has made them more aware of the mental health conditions their patients are experiencing. Seventy percent of healthcare professionals said their patients have been more willing to proactively bring up mental health concerns during appointments.

A majority of healthcare professionals said that patients who were already seeking therapy or in a support group prior to the start of the pandemic have more successfully coped with their mental health concerns. And, many noted they are seeing an increased emphasis in patient self-care and better work/life flexibility.

“People in general and young people in particular should not be reluctant to seek mental health help when they need it,” said Paul Gionfriddo, President and CEO of Mental Health America, the nation’s largest mental health advocacy organization. “We know from the millions of help-seeking people who have reached out to us this past year that more people than ever are in need of help, and we want them to know that it is a show of strength, not weakness, to seek that help as early as possible, and the first step on the pathway to recovery.”

Information about how to recognize the signs and symptoms of mental health conditions is available at the State of the Nation’s Mental Health report web site and the Mental Health America web site.

Survey and Claims Methodology

The State of the Nation’s Mental Health report is based on claims data from 27 million members in Anthem affiliated individual, employer-sponsored, Medicare and Medicaid health plans in all states. Prevalence of behavioral health diagnoses each year (2019 and 2020) was determined by the number of individuals with at least one claim containing a behavioral health diagnosis during the calendar year divided by the number of members enrolled in the plans.

The Anthem online survey was conducted among a national sample consisting of 552 healthcare professionals, broken out into 285 behavioral health specialists and 267 primary care physicians/general practitioners living in the United States, with an oversample of 100 rural healthcare professionals. The sample includes a diverse set of respondents across key demographics (age, gender, region, race/ethnicity) and experience as a physician (time spent in practice, type of practice, size of practice). The margin of error for the total sample at the 95 percent confidence level is +/- 4 percentage points.

About Anthem, Inc.

Anthem is a leading health benefits company dedicated to improving lives and communities, and making healthcare simpler. Through its affiliated companies, Anthem serves more than 116 million people, including more than 43 million within its family of health plans. We aim to be the most innovative, valuable and inclusive partner. For more information, please visit www.antheminc.com or follow @AnthemInc on Twitter.

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