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

BackgroundSocial 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 resource usage is lacking. ObjectiveThis 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 mental health facility usage and the prevalence of mental illnesses on the total population, different age and gender groups, and patients of selected mental health diagnoses. MethodsWe 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 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. ResultsBased on common pre-treatment trend assumption of regions, we find that lockdown has significantly and causally increased the usage of mental health in regions with lockdowns in comparison to regions without. In regions with lockdown orders the resource usage increased by 18% compared to 1% decline in regions without a lockdown. Also, female populations have been exposed to a larger lockdown effect on their mental health with 24% increase in regions with lockdowns compared to 3% increase in regions without. While male mental health patients decreased by 5% in regions without lockdowns. Patients diagnosed with panic disorders and reaction to severe stress both were significantly exposed to a significant large effect of lockdowns. Also, 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. Patients older than 80 used mental health resources less in regions with lockdowns. Adults between (21 - 40) years old were exposed to the greatest lockdown effect with increase between 20% to 30% in regions with lockdown. ConclusionAlthough 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.