• Mark Olfson, Chandler McClellan, Samuel H Zuvekas, Melanie Wall, and Carlos Blanco.
• Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, New York (M.O., M.W.).
• Ann. Intern. Med. 2024 Mar 1; 177 (3): 353362353-362.

BackgroundIn addition to the physical disease burden of the COVID-19 pandemic, concern exists over its adverse mental health effects.ObjectiveTo characterize trends in psychological distress and outpatient mental health care among U.S. adults from 2018 to 2021 and to describe patterns of in-person, telephone, and video outpatient mental health care.DesignCross-sectional nationally representative survey of noninstitutionalized adults.SettingUnited States.ParticipantsAdults included in the Medical Expenditure Panel Survey Household Component, 2018 to 2021 (n = 86 658).MeasurementsPsychological distress was measured with the Kessler-6 scale (range of 0 to 24, with higher scores indicating more severe distress), with a score of 13 or higher defined as serious psychological distress, 1 to 12 as less serious distress, and 0 as no distress. Outpatient mental health care use was measured via computer-assisted personal interviews.ResultsBetween 2018 and 2021, the rate of serious psychological distress among adults increased from 3.5% to 4.2%. Although the rate of outpatient mental health care increased from 11.2% to 12.4% overall, the rate decreased from 46.5% to 40.4% among adults with serious psychological distress. When age, sex, and distress were controlled for, a significant increase in outpatient mental health care was observed for young adults (aged 18 to 44 years) but not middle-aged (aged 45 to 64 years) and older (aged >65 years) adults and for employed adults but not unemployed adults. In 2021, 33.4% of mental health outpatients received at least 1 video visit, including a disproportionate percentage of young, college-educated, higher-income, employed, and urban adults.LimitationInformation about outpatient mental health service modality (in-person, video, telephone) was first fully available in the 2021 survey.ConclusionThese trends and patterns underscore the persistent challenges of connecting older adults, unemployed persons, and seriously distressed adults to outpatient mental health care and the difficulties faced by older, less educated, lower-income, unemployed, and rural patients in accessing outpatient mental health care via video.Primary Funding SourceNone.

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