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The Need for Adult Mental Health Help Continues to Rise Amidst COVID-19

  • Authors: News Author: Megan Brooks; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 12/3/2021
  • Valid for credit through: 12/3/2022
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Target Audience and Goal Statement

This activity is intended for primary care clinicians, psychiatrists, nurses, pharmacists, and other clinicians who care for patients at risk of mental health disorders.

The goal of this activity is to assess the use of treatment for mental health disorders in the United States in 2020.

Upon completion of this activity, participants will:

  • Analyze trends in the prevalence of elevated depressive symptoms during the COVID-19 pandemic
  • Assess variables associated with increased use of treatment for mental health disorders in 2020
  • Outline implications for the healthcare team


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News Author

  • Megan Brooks

    Freelance writer, Medscape


    Disclosure: Megan Brooks has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine


    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/CME Reviewer/Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC


    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.

CE Reviewer

  • Esther Nyarko, PharmD

    Director, Accreditation and Compliance
    Medscape, LLC


    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.

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The Need for Adult Mental Health Help Continues to Rise Amidst COVID-19

Authors: News Author: Megan Brooks; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 12/3/2021

Valid for credit through: 12/3/2022


Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to COVID-19 vaccines may be provided in this activity to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

The COVID-19 pandemic has changed the epidemiology and management of multiple illnesses, including mental illness. A recent study by Ettman and colleagues, which was published in Lancet Regional Health, Americas[1] on October 4, 2021, compared rates of symptoms of depression in 2020 and 2021. Overall, rates of having depressive symptoms were 27.8% in 2020 and 32.8% in 2021 (P = .0016). The average number of depressive symptoms had increased in both 2020 and 2021 compared with a sample from 2017 to 2018.

The increase in depressive symptoms was most profound among adults between ages 18 and 39 years. Increased self-reported stress, particularly lower income, was significantly associated with a higher number of depressive symptoms. In contrast, educational attainment, marital status, and household savings did not significantly affect rates of elevated depressive symptoms in 2021.

The pandemic has also caused serious disruptions for routine care, including the care of mental health disorders. Current data by the Centers for Disease Control and Prevention (CDC) assess trends in mental health care in the United States in 2020.

Study Synopsis and Perspective

In 2020, amid the COVID-19 pandemic, about 1 in 5 (20.3%) US adults received mental health treatment, up slightly from 19.2% in 2019, data from the CDC showed.[2]

Compared with 2019, the pandemic year of 2020 also saw an uptick in adults receiving prescription medication for a mental health problem (from 15.8% to 16.5%) or counseling or therapy from a mental health professional (from 9.5% to 10.1%), the CDC said.

The percentage of adults who had received mental health treatment in the prior year decreased with age, from 20.9% among people aged 18 to 44 years to 20.5% among individuals aged 45 to 64 years to 18.7% among persons aged 65 years and older.

Women were more likely than men to have received any mental health treatment (25.6% vs 14.6%), according to an analysis of 2020 data from the National Health Interview Survey (NHIS).[3]

This is consistent with their higher prevalence of common mental health conditions, including anxiety and depression, and their greater willingness to seek out mental health care, Emily Terlizzi, MPH, and Tina Norris, PhD, with the CDC's National Center for Health Statistics (NCHS), noted in their data brief published in October.

Non-Hispanic White adults (24.4%) were more likely than non-Hispanic Black (15.3%), Hispanic (12.6%), and non-Hispanic Asian (7.7%) adults to be treated with a mental health issue.

The percentage of adults treated for a mental health problem increased as their place of residence became more rural, from 19.3% for persons living in large urban areas to 21.7% among those residing in nonmetropolitan areas.

Social and Emotional Support

Despite rising mental health care needs, more than 3 in 4 US adults (77.5%) indicated that they always or usually received the social and emotional support they needed during the pandemic period of July to December 2020, also according to NHIS data.

Social and emotional support is associated with well-being and a reduced risk for early death, NCHS researchers Peter Boersma, MPH, and Anjel Vahratian, PhD, MPH, noted in their data brief[3]; however, social and emotional support varies by age and race/ethnicity.

Groups with lower levels of social and emotional support are Hispanic, non-Hispanic Black, and non-Hispanic Asian adults; adults neither married nor living with a partner; adults without another adult in the home; adults with less than a high school education; and adults with disability.

"While most adults always or usually had the emotional support they needed, 1 in 10 adults rarely or never received the social and emotional support they needed," the authors reported.

As reported by Medscape Medical News, 2020 data from the National Academies of Sciences, Engineering, and Medicine (NAS)[4] show social isolation in older adults is a major public health concern that contributes to heart disease, depression, and premature death.

The report implored healthcare systems to take urgent action to address social isolation and loneliness in older adults and proposed a series of recommendations for addressing social isolation.

One recommendation was to improve awareness by including measures of social isolation and loneliness in health surveys, such as the NHIS, which began asking about perceived social and emotional support in July 2020.

Study Highlights

  • Researchers derived study data from the 2020 NHIS. This study is designed to create a nationally representative sample. The study, conducted in 2020, used a mix of telephone and in-home based interviews.
  • 20.3% of US adults had received any mental health treatment in 2020, which was increased from 19.2% in 2019.
  • Rates of medication use for mental health and talk therapy in 2020 were 16.5% and 10.1%, respectively.
  • Rates of mental health treatment declined among adults at age 65 years and older. This was particularly true for talk therapy. Rates of any mental health treatment in 2020 among adults from age 18 to 44 years, 45 to 64 years, and ≥ 65 years were 20.9%, 20.5%, and 18.7%, respectively.
  • Rates of receiving any mental health treatment among women and men in 2020 were 25.6% and 14.6%, respectively. The degree of sex-based differences in the use of medication and talk therapy were similar.
  • Rates of mental health treatment in 2020 based on race/ethnicity were
    • 24.4% for White persons
    • 15.3% for Black persons
    • 12.6% for Hispanic persons
    • 7.7% for Asian persons
  • Living in a nonmetropolitan area was associated with a higher rate of mental health treatment in 2020 (21.7%) vs living in a metropolitan area (19.3%). Higher use of medications by residents of more rural areas accounted for this difference. The rates of talk therapy among residents in metropolitan and nonmetropolitan areas were 10.9% and 7.6%, respectively.

Clinical Implications

  • Rates of increased depressive symptoms increased in a cohort of US adults between 2020 and 2021. Depressive symptoms were more common during these COVID-19 pandemic years compared with 2017 to 2018.
  • One-fifth (20.3%) of US adults received treatment for mental health disorders in 2020. Variables associated with receiving such treatment included White race, being a woman, living in a nonmetropolitan area, and younger age.
  • Implications for the healthcare team: The healthcare team should be screening for mental health diagnoses such as depression and ensure that patients with a positive screen receive treatment.


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