Recent Trends in Psychological Distress- Are Outpatient Utilization Patterns Changing?

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Mental health has been in the news with higher frequency in the last few years. Is that due to an increase in reporting? Better measures? Or, because there’s an increase in people reporting in the outpatient care setting?. It is likely all three, a recent study by Mark Olfson and colleagues from the Columbia University in New York, published in the November 28, 2018 issue of JAMA Psychiatry sheds light on these trends.

The Study

The authors examined survey data from the Medical Expenditures Panel Surveys (MEPS) a nationally representative survey administered to US households over 2004-2005, 2009-2010, and 2014-2015. The study reported findings for adults (18 and older), so we don’t know how the adolescent landscape has been changing based on this data set. The survey looked at the mix of outpatient services accessed by the 138, 862 adults who had a mental health diagnosis. Services included: psychotherapy, medication use, and the type of medication prescribed. The study population was also stratified by level of psychological distress as denoted by a score of >13 on the Kessler 6 scale. The study sample was 51% female, and 66% were white.

The Findings

The most interesting trend to emerge was the highest absolute increase in outpatient utilization was seen in patients without serious psychological distress comparing 2004-2005 to 2014-2015 revealed a jump from 21.4% to 28.57%. Older adults with less or no psychological distress reported the highest relative increase in outpatient services. Conversely, those seeking care with high levels of psychological distress were likely to be younger.

Another interesting finding is the number of people with severe psychological distress declined in the same study period (4.82% to 3.71%), Women were more likely to experience the highest levels of psychological distress across all measured timeframes. Older adults were also more likely to report higher levels than their younger counterparts.

In recent times much work has been done to reduce the pervasive stigma around mental health which may account for those experiencing lower levels of distress seeking care. What is clear is the great need to develop new models of care that can meet emerging needs or augment ongoing care. Since the last survey 2014-2015 the digital mental health space has seen tremendous growth in the development of solutions to support individuals in their moment of need with a variety of approaches including cognitive behavioral therapy, mindfulness, meditation, and chatbots.

Many of these products are consumer-facing and can go some way to engaging the general public self-care and compassion if they are experiencing low levels of psychological distress, that is not meeting a threshold for a diagnosis. It is also clear given these study results that a one size fits all approach won’t be sufficient to meet the diverse population needs. What someone needs in their early adulthood may differ from what they need in elderhood, and new models of care that apply human-centered approaches to tease out specific needs will be essential and digital health gains more footing in health care.

Thanks for reading – Trina
(Opinions are my own)



JAMA Psychiatry Study on Trends in Psychological Distress

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