The Impact of COVID-19 Lockdowns on Mental Health Patient Populations: Evidence from Medical Claims Data

Background Social distancing policies were enacted during March 2020 to limit the spread of COVID-19. Lockdowns and movement restrictions increased the potential of negative impact on population mental health, in which depression and anxiety symptoms were frequently reported by different population groups during COVID-19 lockdown. However, the causal relationship of mitigation policies on national-wide mental health treatment is lacking.Objective This study investigates the effect of COVID-19 mitigation measures on mental health across the United States, on county and state levels. It examines the effect on the total mental health patients, different age and gender groups, and patients of selected mental health diagnoses.Methods We used large-scale medical claims data for mental health patients dated from September 1, 2019 to December 31, 2020, with publicly available state- and county-specific COVID-19 cases from first case in January to December 31, 2020, and used publicly available lockdown dates data for states and counties. We designed a difference-in-differences (DID) model, which infers the causal effect of a policy intervention by comparing pre-policy and post-policy periods in different regions. We mainly focused on two types of social distancing policies, stay-at-home and school closure orders.Results Based on common pre-treatment trend assumption of regions, we find that lockdown has significantly and causally increased seeking medical treatment for mental health across counties and states. Mental health patients in regions with lockdown orders have significantly increased by 18 female populations have been exposed to a larger lockdown effect on their mental health with 24 life management difficulty patients doubled in regions with stay-at-home orders but increased less with school closures. Contrarily, attention-deficit hyperactivity patients declined in regions without stay-at-home orders. The number of mental health patients older than 80 decreased in regions with lockdowns. Adults between (21 textendash 40) years old were exposed to the greatest lockdown effect with patient number increasing between 2001 increased in regions with school closures.Conclusion Although non-pharmaceutical intervention policies were effective in containing the spread of COVID-19, our results show that mitigation policies led to population-wide increase in mental health patients. Our results suggest the need for greater mental health treatment resources in the face of lockdown policies.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis work was supported in part by NSF grant ECCS-2033900 and by the Center for Pathogen Diagnostics through the ZJU-UIUC Dynamic Engineering Science Interdisciplinary Research Enterprise (DESIRE)Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:There is a Research Data Access and Services Agreement between Change Healthcare Operations, LLC and the Board of Trustees of the University of Illinois. Change Healthcare granted us access and the University of Illinois Urbana-Champaign Institutional Review Board declared this work to be exempt from review.All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.Yes1. Medical claims data is confidential, provided by Change Healthcare, LLC 2. NYTimes COVID-19 data (publicly available) 3. COVID-19 government responses data (publicly available) https://github.com/nytimes/covid-19-data https://github.com/covidvis/covid19-vis/tree/master/data