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. 2021 Oct 23;11(10):1947-1956.
doi: 10.1093/tbm/ibab030.

Trends in mental health symptoms, service use, and unmet need for services among U.S. adults through the first 9 months of the COVID-19 pandemic

Rebekah Levine Coley  1 , Christopher F Baum  2
Affiliations

Trends in mental health symptoms, service use, and unmet need for services among U.S. adults through the first 9 months of the COVID-19 pandemic

Rebekah Levine Coley et al. Transl Behav Med. .

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Abstract

The COVID-19 pandemic has led to rising morbidity, mortality, and social and economic disruption, likely impairing mental health. The purpose of this study was to track trends in mental health symptoms, use of services, and unmet need for services among U.S. adults and to delineate variation across demographic strata. Data were drawn from the 2020 U.S. Household Pulse Survey from repeated cross-sectional online surveys collected between April 23 and November 23, 2020 from 1,483,378 US adults, weighted to represent the U.S. population. Survey respondents self-reported their symptoms of anxiety and depression, use of medication, counseling services, and unmet need for services. Reports of probable anxiety and depression rose significantly through the study period, to prevalence rates of 50% and 44%, respectively, by November 2020, rates six times higher than early 2019 U.S. norms. Use of prescription medication, counseling services, and unmet need for mental health services also rose significantly. Prevalence rates of probable mental health disorders were highest among young, less educated, single, female, Black and Hispanic respondents, with age and education disparities growing over cohorts. Young, female, and moderately educated respondents also reported higher unmet needs for services. Disparities in estimates of mental health disorders and mental health treatment indicate a striking disequilibrium between the potential need for and the use of mental health services during the COVID-19 pandemic. Rising mental health challenges are being borne largely by young, less advantaged people of color and women, with the potential for expanded interruptions to optimal functioning and societal recovery from COVID-19.

Keywords: Anxiety; COVID-19; Depression; Disparities; Mental health treatment.

Plain language summary

The myriad stressors imposed by the COVID-19 pandemic have impaired mental health and well-being. Although evidence from early in the pandemic revealed elevated rates of mental health conditions, research has not documented whether psychological disorders have continued to rise as the pandemic has persisted. In this research, we assess data from nearly 1.5 million U.S. adults who participated in cross-sectional surveys each week from April through November 2020 to track trends in mental health disorder symptoms and services. Our results show that reports of anxiety and depression rose significantly from April to November 2020 to rates six times higher than in 2019. We also found evidence of growing unmet need for mental health services. Rising mental health challenges are being borne largely by young, less advantaged people of color and women. Growing disparities in mental health disorders and treatment raise concerns for psychological, social, and economic recovery from COVID-19.

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Figures

Fig 1
Fig 1
| Adjusted prevalence (with 95% confidence intervals) of anxiety and depression, AprilNovember 2020.
Fig 2
Fig 2
| Adjusted prevalence (with 95% confidence intervals) of prescription use, use of counseling services, and unmet need for counseling among full sample (A) and subsample screening for anxiety and/or depression (B), AugustNovember 2020.
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