Patients Experiencing Depression Preferred In-Person Visits During the COVID-19 Pandemic

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Even during times of peak transmission, individuals preferred in-person screening over video or telephone screening for depression.

At the start of the COVID-19 pandemic, health care professionals worldwide were faced with the sudden, urgent need to provide care without human contact. While these professionals were forced to rethink their practices, patients seeking health care were provided with video screenings and telehealth resources as a substitute for in-person medical visits.

Following shutdowns and lockdowns across the globe, individuals were asked to shelter in place until COVID-19 cases decreased locally. Since then, COVID-related health issues have become a new challenge for health care providers—in addition to a worldwide increase in depression that is now affecting millions of patients.

Rates of depression increased during the COVID-19 pandemic. | image credit: kwanchaift - stock.adobe.com

Rates of depression increased during the COVID-19 pandemic. | image credit: kwanchaift - stock.adobe.com

Looking back at the early stages of the COVID-19 pandemic, researchers from the University of California, San Francisco (UCSF), analyzed the likeliness of patients using telephone, video or in-person resources for depression screenings.1 The goal of the study was to identify the leading visit type that patients gravitated towards for treating depression during the pandemic. Results of the study were published in JAMA Network Open.1

What The Research Tells Us

Evaluating data from over 57,000 visits from 37,250 individual patients (60% women, mean age, 52.3±17.9 years; 42% White), screenings were conducted at 6 UCSF primary care practices from June 1, 2020, to September 30, 2021. Data show that, at the beginning of 2020, depression screenings for telephone, video and in-person visits increased across the board, with in-person screenings leading the way. However, these numbers began to plateau around the start of the initial shelter-in-place affecting most countries around the world.

Across the entire 16-month study—which included some of the pandemic’s highest peaks—in-person depression screenings were the most frequently chosen type of primary care visits among patients, followed by video screenings, then telephone screenings, which were the least-frequent screening type.

Key Takeaways

  • Patients preferred in-person depression screenings to video and telephone screenings.
  • Data about the impact of COVID-19 on mental health across the globe are still emerging.
  • Health care providers should remain proactive in addressing disparities by race, ethnicity, language, or age to telehealth access.

Researchers determined key factors that might have influenced these results, specifically age, insurance type and native language.

“While there were no differences in screening by sex or race and ethnicity, patients who preferred Chinese, Spanish, or other languages had lower odds of screening than patients who preferred English,” the authors noted. “Patients older than 75 years had lower odds of being screened than patients aged 18 to 30 years.”

Patients with private insurance were also more likely to participate in a depression screening compared to individuals with Medicaid.

READ MORE: While Telemedicine Decreased After COVID-19 Peak, Mental Health Video Visits Rose

Telehealth Before and After the Pandemic

Although study results indicated that in-person patient visits were the preferred screening method, telehealth services have evolved elsewhere around the world. Considering the urgency of the pandemic’s initial shelter-in-place in 2020, telehealth has come a long way for providing patients with convenient yet efficient services.

“Telemedicine was underused and understudied until the COVID-19 pandemic, during which reduced regulations and increased payment parity facilitated a rapid increase in telemedicine consultation,” according to Julia Shaver, MD, author of a 2022 study evaluating telehealth published in Primary Care: Clinics in Office Practice.2 “Telemedicine literature to date suggests that it holds benefits for patients and health care providers, may result in outcomes not inferior to in-person care, and has cost-saving implications.”

Authors for the UCSF, study noted that the switch to telehealth services was too abrupt for immediate success, but over time, video and telephone screenings have been deemed more likely for patients to utilize.1

Depression Increase Worldwide Correlating with the COVID-19 Pandemic

“The information we have now about the impact of COVID-19 on the world’s mental health is just the tip of the iceberg,” said Tedros Adhanom Ghebreyesus, PhD, Director-General of the World Health Organization, in a news release.3 “This is a wake-up call to all countries to pay more attention to mental health and do a better job of supporting their populations’ mental health.”

Health care professionals around the world continue to adjust to a changing environment created by COVID-19. With the availability of alternative screening methods and rates of worldwide depression increasing at the start of the pandemic, mental health issues and how to address them has become more important than ever.

“Health systems must be vigilant and proactive in addressing emerging disparities by race and ethnicity, language, or age, particularly in the telemedicine setting,” the UCSF authors concluded.1

References
1. Garcia ME, Neuhas J, Livaudais-Toman J, et al. Telemedicine and depression screening after the start of the COVID-19 pandemic. JAMA Netw Open. 2024;7(2):e2355830. doi:10/1001/jamanetworkopen.2023.55830
2. Shaver J. The state of telehealth before and after the COVID-19 pandemic. Prim Care. 2022;49(4):517-530. doi:10.1016/j.pop.2022.04.002
3. COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. News release. World Health Organization. March 2, 2022. Accessed February 15, 2024. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
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