Impact of the COVID-19 Pandemic on Healthcare Resource Utilization in Individuals with Major Depressive Disorder

Abstract

Objective To estimate the impact COVID-19 pandemic on healthcare resource utilization (HCRU) among individuals with major depressive disorder (MDD). Method A retrospective cohort study was conducted to compare HCRU in the twelve months prior to and six months following pandemic onset among 1,318,709 individuals with MDD and propensity-score matched controls. Outcomes were monthly rates of all-cause and MDD-specific outpatient, inpatient, and prescription medication HCRU. Piecewise random effects models were used to adjust for patient-level clustering, trends over time, and pre-pandemic factors. Results In the first month following onset, outpatient HCRU declined with primary care visits down 25.1%. Following this initial decline, outpatient HCRU increased, exceeding pre-pandemic rates within three months. By April 2020, three quarters of all psychotherapy sessions were delivered by telehealth, followed by psychiatry (62.3%), and primary care visits (30.1%). The use of telehealth remained highest for psychotherapy and psychiatry (representing 67.6% and 54.2% of visits, respectively, in September 2020). All-cause partial-day hospitalizations declined 50.5% and remained depressed through July 2020 (down 18.3%). Beginning in the first month post-onset, prescription medication HCRU increased for all antidepressant and antipsychotic medication classes: serotonin modulators ( + 11.8%), bupropion ( + 10.4%), SSRIs ( + 9.0%), SNRIs ( + 8.6%), and atypical antipsychotics ( + 7.5%). Conclusions Following pandemic onset, individuals with MDD realized an immediate, but short-lived, reduction in primary care HCRU. Telehealth use remained elevated through the first six months. The most significant and sustained reduction in HCRU was noted for partial-day hospitalizations and all-cause ED visits.

Impact of COVID-19 pandemic on depression incidence and healthcare service use among patients with depression: an interrupted time-series analysis from a 9-year population-based study

“…Despite the rising incidence, we found that the pandemic substantially reduced the use of inpatient and outpatient services among both newly diagnosed and pre-existing patients. This is consistent with the previous studies in South Africa, South Korea, the United States, and the UK, which estimated 15% to 51% reductions in healthcare resource utilization depending on diagnosis settings [ 15 , 17 , 45 , 46 ]. Most of them were conducted during the early phase of the pandemic with a focus on lockdowns.…”

“…In the ITS analysis to evaluate changes in depression incidence, we further stratified the analysis into three age groups: adolescents (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), adults (25-64), and the older population (65 +) to explore whether these population subgroups were differentially susceptible to a new depression diagnosis as a result of the pandemic.…”

“…Conversely, other studies reported that the pandemic reduced the risk of depression and self-harm because of the emotional security provided by timely government intervention, but these findings were confounded by increased barriers to seek medical help [12][13][14]. In the emergency phase of the pandemic, it was reported that lockdowns significantly reduced healthcare service use for both outpatient and inpatient services [15][16][17]. Studies also found an elevated risk of depression relapse and use of antidepressants [18,19].…”

Impact of COVID-19 pandemic on major depressive disorder in acute psychiatric inpatients

“…Indeed, the COVID-19 pandemic overwhelmed the healthcare system of many countries, nearly 20% of mental health centers were closed and 25% introduced limited opening hours during the COVID-19 emergency, an issue further exacerbated by the high percentage of healthcare workers affected by COVID-19 and by the patients' fear of contagion (Heymann and Legido-Quigley, 2022 ). Only urgent psychiatric interventions and mandatory treatments have remained unchanged, while all other activities have been somewhat reduced (Carpiniello et al, 2020 ; Liberman et al, 2022 ). These difficulties in maintaining or obtaining an engagement with psychiatric services could therefore have delayed the treatment of outpatients with MDD.…”

Biopsychosocial Response to the COVID-19 Lockdown in People with Major Depressive Disorder and Multiple Sclerosis

“…Although there is a large body of literature on the psychological effects of COVID-19, most of it has selected convenient samples and has used non-standardized instruments for the diagnosis [ 18 ]. There is also limited information on the impact on individuals that suffer from depression or other chronic conditions; COVID-19 might have exacerbated pre-existing clinical symptoms in people with MDDs and MS. Another study found an increase in depression severity in patients with MDDs caused by the pandemic, supported by a higher number of hospitalizations of patients with MDDs at a short-term acute care hospital, and all-cause inpatient hospitalizations at a psychiatric facility increased following the pandemic onset and remained elevated throughout the first six months [ 27 ].…”