The impact of COVID-19 lockdowns on mental health patient populations in the United States

Abstract

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 to the presence of the pandemic itself. The effects of the lockdown increased over an extended time to the end of December 2020.

Figure 1

Distributions of mental health patients weighted by regions’ populations in years of 2019 and 2020 in counties (A) and states (B). The total population increase is 22% in 2020.

Figure 2

Mental health patients over time.

Figure 3

Correlation of mental health daily visits and COVID-19 confirmed cases in a log-log plot with an increase of 0.043 mental health visits for each confirmed COVID-19 case in counties (R² = 0.77, p-value < $2\times {10}^{-16}$).

Figure 4

Average number of mental health patients over time (September 2019–December 2020) in counties with stay-at-home orders and without. Vertical lines show the first stay-at-home order on 3/14/2020 and last on 4/07/2020 across United States. Difference-in-differences estimates are included for each population. (Detailed average percentage changes are listed in Table 3). $\ast \ast \ast p<0.01$, $\ast \ast p<0.05$, $\ast p<0.1$.

Figure 5

Average number of mental health ED visits over time (September 2019–December 2020) in counties with stay-at-home orders and without. Vertical lines show the first stay-at-home order on 3/14/2020 and last on 4/07/2020 across United States. Difference-in-differences estimates are included for each population. $\ast \ast \ast p<0.01$, $\ast \ast p<0.05$, $\ast p<0.1$ .