More on Patient Engagement

Anxiety and depression are associated with medical care avoidance during the COVID-19 pandemic

This has bottom-line impacts for hospitals, especially as they look to recover financially from the worst of the pandemic.

Jeff Lagasse, Associate Editor

Since the start of the COVID-19 pandemic, there have been empirical and anecdotal reports of declines in both emergency and ambulatory medical visits, but little has been known about why these declines have occurred. New research in the Journal of Internal Medicine now shows a strong association between mental health symptoms and medical care avoidance.

Among a sample of over 73,000 U.S. adults from the Household Pulse Survey – a weekly survey conducted by the U.S. Census Bureau that aims to collect data on the social and economic impacts of COVID-19 – adults who experienced four common symptoms of anxiety and depression have upwards of two times greater risk of delaying medical care or of not receiving needed non-coronavirus medical care during the public health crisis.

What makes these results particularly alarming are the significant adverse health outcomes, both short-term and long-term, that can result from delayed medical care, depending on the condition. Increased access to telehealth has helped somewhat, but the authors said health insurance policies should be expanded to cover telehealth services that address nonemergency medical concerns.


For hospitals, the findings are concerning because consumers' avoidance of medical care has bottom-line impacts, especially as hospitals and health systems look to recover financially from the worst of the pandemic. Elective procedures have tentatively resumed in many areas of the country, but the healthcare industry cannot make a full recovery until consumer confidence is restored and patients resume seeking needed care.

In the four weeks prior to participating in the survey in June, 41% of the sample delayed medical care. In addition, nearly one third of those surveyed did not receive necessary non-coronavirus medical care.

That's problematic for those with chronic medical conditions or new symptoms, which highlights the need for them to have access to accurate and updated information regarding the risks and benefits of seeking medical care.

The study also found that symptoms of anxiety and depression were overwhelmingly common among the sample. In the seven days prior to the survey, 65% reported being nervous, anxious or on edge, 56% reported not being able to stop or control worrying, 53% reported having little interest or pleasure in doing things, and 52% reported feeling down, depressed or hopeless.

These symptoms of anxiety and depression can often be addressed through telepsychiatry and telemedicine mental health services, authors said, and should be utilized to help medical professionals, social workers and clinicians help clients work through symptoms and find the medical care they need.


Anxiety and depression aren't the only factors preventing patients from seeking care. A July survey showed that almost half of consumers have avoided care due to difficulty finding, accessing and paying for healthcare.

More than two-thirds of consumers said every step of the healthcare process is a chore. Most said they don't know how much a treatment or visit costs until months later, and nearly all said they want shopping for healthcare to be as easy as shopping for other common services – including using it as a fully connected digital experience.

What this means, in effect, is that the effort required to access and pay for care has in itself become a social determinant of health. Consumers want a simpler system that's less fragmented, which opens up an opportunity for payers and providers. If they offer a more streamlined experience, they'll in turn gain a competitive market advantage.

Twitter: @JELagasse
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