Exploring Links Between Depression & Delayed Care Amid COVID-19 Pandemic

Since the start of the SARS-CoV-2 pandemic, regular medical care in the United States has been massively disrupted. Emergency health care use has declined by 10% for hyperglycemic crises, 20% for strokes, and 23% for heart attacks.

Ambulatory visits have also declined by almost 60%.

While pandemic-related fear—often regardless of contextual risk—is part of the picture for patients, another factor may be just as important in explaining their reticence.

According to a recent study published by investigators in the Journal of General Internal Medicine, pervasive anxiety and depression during the COVID-19 pandemic has contributed to this nationwide underutilization of care.

Individuals who experience symptoms of anxiety and depression had higher adjusted relative risk ratios of delayed medical care and not receiving necessary non-COVID medical care, after adjustment for potential confounders.

"The results from our study are alarming given that delaying medical care can have significant adverse short- and long-term health outcomes, depending on the condition," said lead author Kyle T. Ganson, PhD, MSW, assistant professor at the University of Toronto's Factor-Inwentash Faculty of Social Work. "We need to increase access to telehealth, and in the U.S., health insurance policies must be expanded to cover telehealth services that address non-emergency medical concerns."

Investigators looked at data from the US Census Bureau’s Household Pulse Survey of 73,472 people between June-11-June 16, 2020.

The survey was reviewed by independent specialists at the Center for Behavioral Science Methods.

To gather the information, the Household Pulse Survey used the Census Bureau’s Master Address File.

Information on the social impact of COVID-19 among adults in the US was alarming.

Study authors report that individuals who were nervous, anxious, or on edge in the prior 7 days had the highest adjusted relative risk ratio of delayed medical care (1.95, 95% confidence interval 1.83—2.09) and the highest adjusted relative risk ratio of not receiving needed non-coronavirus medical care (2.08, 95% CI 1.93–2.25).

“Our results provide support for accurate and effective translation of knowledge to the public about the risks and benefits of seeking needed medical care during the ongoing COVID-19 pandemic,” study authors wrote.

They also highlighted the importance of expanding telehealth services, as well as their insurance coverage.

While it is beyond the purview of the study what interventions need to be changed to improve the mental health crisis in the US, it is empirically observable that delays in care are in some way linked to a demoralized social populace.