Simply put, you can’t have “health” without mental health. Yet mental health conditions remain an ongoing challenge to prevent, diagnose, and treat successfully. It is estimated that nearly 1 in 5 adults in the United States (51.5 million in 2019) live with a mental illness. However, only approximately half of those people are actively receiving care for their condition.
Like many other chronic diseases, mental health conditions were increasing in prevalence even before the pandemic. However, unlike most other chronic conditions, mental health conditions were most prevalent among younger adults, with the highest prevalence rate among those aged 18 to 25. This youngest adult cohort also has the most rapidly increasing prevalence rate, surpassing all other age cohorts in year-over-year increases. This is not just an issue affecting the older cohorts of your population (like many other chronic conditions); instead, this is affecting the youngest, otherwise healthiest employees, as well as dependents of your older employees. While part of this could be explained by the fact that younger generations may be more likely to seek help for mental health issues, researchers also point to the concurrent rise in social media as a likely contributor. In addition to being less likely to interact face-to-face, those who use social media frequently are also more likely to be involved with cyber-bullying, which has been linked to depression, self-harm, and suicidal thoughts.
Anxiety Disorders Top the Charts
According to data from the National Institute of Mental Health (NIMH), the most common mental health condition category among adults is Anxiety Disorders, which includes panic disorder, generalized anxiety disorder, phobias, social anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and separation anxiety disorder. Women are far more likely than men to report experiencing anxiety disorders.
Major Depression, which often co-exists with anxiety disorders, is the second-most common mental health condition among adults, although considerably less prevalent than Anxiety Disorders. Other even less-common mental health conditions in the adult population include bipolar and other mood disorders, as well as schizophrenia and personality disorders.
Among adolescents, Anxiety Disorders also represent the top-most reported mental health condition, with Attention Deficit and Hyperactivity Disorder (ADHD) and Major Depression appearing next, although at a much lower prevalence rate.
The Impact of COVID-19
All the facts above represent the state of mental health conditions before the pandemic. The mental and emotional stress that has accompanied the COVID-19 pandemic have led many experts to predict increased mental health needs across the country – at a time when mental health needs were already at all-time highs. It’s as if COVID-19 is adding dry wood to an already out-of-control fire.
Early indicators have been reported that support this prediction, including a reported 1000% increase in calls to the national Disaster Distress Helpline, increases in the proportion of emergency department visits related to suicide attempts, and increases in calls to domestic violence hotlines. Simultaneously, new logistical challenges in accessing care (due to shutdowns and fear of exposure) have made it more difficult for individuals to seek care.
Specific studies have identified concerning trends. According to a Kaiser Family Foundation poll, 53% of U.S. adults have reported that their mental health had been negatively impacted by the virus. A CDC survey reported that as of June of 2020, U.S. adults were reporting considerably elevated adverse mental health conditions associated with the circumstances brought on by the pandemic. In November, a team of MIT and Harvard University researchers used machine learning to analyze the text of more than 800,000 Reddit posts. They found changes in the tone and content of language that people used between January and April of 2020, including an overall increase in discussion about anxiety and suicide.
In addition to the effect of COVID-19 on the majority of the population, its impact on specific subgroups’ mental health is likely to be much more pronounced. Healthcare workers in particular are reporting record rates of burnout and exhaustion. Essential workers, who are required to perform their jobs despite the health risks involved in doing so, might feel the pandemic’s impact differently from those who can work from home.
Patients who have themselves had severe cases of COVID-19, or who have had family members who did, may experience post-traumatic stress disorder that is not uncommon after life-threatening or other traumatic experiences as demonstrated in past pandemics. A recent study published in The Lancet suggests that during the months after a severe COVID-19 infection, individuals who had pre-existing mental health conditions are more likely to require additional mental health care. And even individuals that did not have a pre-existing mental health condition are more likely to experience one in the months following a serious infection.
Finally, a recent Canadian study suggests that women, especially younger women, are suffering more impact from the pandemic in a mental health context than other cohorts. The main hypotheses for this pattern are that women often experience added responsibilities of homeschooling and ensuring their children follow safety protocols, especially since they are more likely to sacrifice their work (as they often earn less than their male partners).
How Might This Affect Your Population?
Our Springbuk book of business allows us to provide insights into the impact of COVID-19 on mental health treatment for privately insured individuals under 65. While examining just those being treated represents only a portion of people with conditions, treatment trends are likely to also reflect overall trends in need.
At the highest level, while mental health care decreased slightly at the onset of the pandemic, it was not lowered to the same extent as some other conditions. This is not surprising since most mental health care can be delivered remotely and does not depend on in-person physical contact to the same degree as other conditions. When we look at telemedicine care, we see a considerable portion of mental health care transitioned to this delivery mode early in the pandemic. But what happened as the pandemic continued to affect society?
A deeper dive shows an increasing volume of patients being treated for Anxiety Disorders, specifically females, starting around June of 2020, with treatment rates meeting or exceeding pre-pandemic levels. The trend is most pronounced among 18-39-year-old women, with similar but less prominent trends among women in older age groups. A similar spike among 18-25-year-old women is seen for Adjustment Disorders (generally shorter-term conditions brought on by a stressful event), starting a little later in the summer.
Similar increases were not noted in treatment for Major Depression in women, or in other less prevalent conditions, with the exception of Bipolar/Other Mood Disorders. Despite the much lower prevalence of these conditions as compared to Anxiety Disorders, the treatment for these disorders show a similar upward pattern among younger women starting in the summer timeframe.
Men have not shown similar upward trends for any of the mental health conditions we measured.
This data supports the survey-based information described above that an increase in mental health needs is happening now, and it is most prevalent among younger women. If your population includes healthcare workers and/or other essential workers, you may see a more pronounced trend across more cohorts.
How Can Employers Help?
As employers, we have a vested interest in both our employees’ physical and mental health as well as that of their families. Studies have shown that employees’ mental health conditions can decrease productivity, increase absenteeism, and increase risk for other physical disorders. For example, research suggests that Depression interferes with a person’s ability to complete physical job tasks about 20% of the time and reduces cognitive performance about 35% of the time. It is also reasonable to assume that family members’ mental health issues also impact an employee’s effectiveness. Regarding physical illnesses, associations have been shown to exist between mental health conditions and a higher risk of many chronic diseases, including asthma, arthritis, heart disease, and diabetes.
So what can employers do to provide support to employees and their families, especially during this challenging time?
While many employers are offering additional support during the pandemic, a November 2020 study by PwC revealed that only a third of employees (31%) strongly agree that their company has successfully addressed employee well-being, including mental health and morale (although 84% of CFOs believe that they are successfully addressing these items). Among remote workers, that number is only 27%. It’s even lower among female employees, with 26% of women aged 18-34 and 22% of women aged 35-44 saying they strongly agree.
Although Employee Assistance Programs have become a staple of many benefit plans, a 2014 survey of workers performed by Workplace Options found that 42% of Americans said their employers had no support structures or programs in place to help employees deal with mental health issues like stress, anxiety, or depression. Just 47 percent said their employers had any kind of emotional well-being support available, while 11% had no idea what their employer offered.
One fundamental first step: if you do not already offer mental health programs such as an EAP, do so. If you already do, ensure that your employees know and understand the benefits they are being offered and take advantage of them. Simply reminding them infrequently that the program exists is not the same as an integrated communications effort that ensures the program is well-understood across the organization.
In addition to traditional programs, there are many other low-cost opportunities for employers to step up their efforts to support their employee’s mental health. Some companies, including Google and Starbucks, have implemented “mental health” days for staff to ensure that their employees take needed time off. Other companies are upping their provision of childcare and caregiver leave for employees. Still others provide free access to mindfulness/meditation apps such as Headspace.
The CDC has emphasized the importance of promoting mental health and stress management awareness, even before the pandemic.They highlight that the workplace has established communication structures and support networks that can easily enable this type of communication. Employers can also offer incentives to reinforce healthy behaviors and use data to track progress and measure the effects of these efforts.The CDC goes on to provide specific tips to improve mental health in the workplace, including making mental health self-assessment tools available to all employees. They also suggest offering free or subsidized clinical screenings for mental health conditions and providing managers with training to recognize signs and symptoms of mental health issues in team members.
The pandemic has brought new complexity to the already challenging issue of mental health conditions in the United States. In particular, young women seem to be emerging as the “canary in the coal mine” in regards to increased mental health needs. Employers can be significantly impacted by the mental health of their workforce, and are also uniquely positioned to have a positive effect on their employees and their families through a variety of approaches. Employers who initiate proactive strategies to assist employees during these times are more likely to be able to mitigate some of the significant impacts mental health conditions can have on productivity and wellness.