Did Therapy for Mental Health Increase During COVID?

Summary: Yes, overall rates for therapy for mental health showed an increase during COVID, with the exception of specific demographic groups. Variation in increases appeared in the type of treatment received, socioeconomic status, and location.

Key Points:

• Psychotherapy use, including via telehealth/phone, increased across all age groups between 2018 and 2021
• Gender influenced magnitude of increase
• Age influenced magnitude of increase
• Level of education influenced magnitude of increase
• Psychotherapy use decreased for unemployed people and people living in rural areas

New Research Examines Increase in Therapy During COVID

When the coronavirus pandemic arrived in the U.S. five years ago, mental health experts warned about the potential negative consequences of the various public health measures adopted by various cities and states, and endorsed by the CDC. But with all those warnings about the impact on mental health, did therapy for mental health increase during COVID?

And if so, for whom did it increase?

At the beginning of the pandemic, mental health experts warned that worry about getting sick combined with the stress associated with public health measures such as business closures, shelter-in-place guidelines, social distancing, virtual school, virtual school, and other unforeseen consequences would cause an increase in psychological and emotional disorders such as depression and anxiety.

Now, five years later, all the final data are in, confirmed, vetted, and have been analyzed by mental health experts and health science statisticians in countless ways. Researchers published one of those analyses this year, called “Trends in Outpatient Psychotherapy Among Adults in the US,’ which focused on answering this research question:

How [did] US psychotherapy use patterns changed between 2018 and 2021?

To answer this question, the research team collected data on 89,619 patients from a public resource called the Medical Expenditure Panel Surveys (MEPS). Here’s what MEPS is:

“The Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States. MEPS is the most complete source of data on the cost and use of health care and health insurance coverage.”

Therefore, MEPS is a resource we can trust: it includes data on patients from a wide range of ages, demographic groups, and types of insurance coverage, as well as data on the type of therapy patients used most often.

Let’s take a look at what they found.

Before and After 2020: Did Rates of Therapy Use Increase or Decrease During COVID

First, let’s review the overall rates of psychotherapy use during the period immediately before, during, and after the most intense part of the pandemic. These results describe the changes reported among various demographic categories, such as gender, age, education, income, and location.

Psychotherapy Use/Therapy Increase Around COVID: 2018-2021

Between 2018 and 2021, psychotherapy use increased more for:

• Females compared to males:
  • Females: 7.7% to 10.5%
  • Males: 5.2% to 6.3%
• Younger adults compared to older adults
  • 18-34: 8% to 11.9%
  • ≥65: 3.6% to 4.6%
• College graduates compared to non-high school graduates:
  • With college degree: 7.6% to 11.4%
  • Without high school diploma: 5.5% to 7.0%
• Adults with private insurance compared to adults with public insurance:
  • Private insurance: 6.1% to 8.9%
  • Public insurance: 8.8% to 8.8%
• Adults with income at 2 to 4 times above poverty level compared to adults with income below the poverty level:
  • Income 2-4 times above poverty level: 5.7% to 8.2%
  • Income below the poverty level: 9.7% to 10.0%
• Employed people under age 65 compared to unemployed people under age 65:
  • Employed: 5.7% to 8.9%
  • Unemployed: 10.8% to 10.5%
• People living in urban areas compared to people living in rural areas:
  • Urban residents: 6.5% to 8.7%
  • Rural residents: 6.4% to 5.9%

Next, let’s review a set of data from 2021, a period that includes both the time before the arrival of the COVID vaccine and the time when we settled into our new, post-COVID normal. This set of data describes the relative use of telehealth services for mental health among various demographic groups.

Teletherapy Use: 2021

In 2021, use of telehealth for mental health therapy was significantly higher among:

• Younger adults (18-34) compared to middle-aged or older (≥65) adults:
  • Younger compared to middle aged: 3.7% higher
  • Younger compared to older: 6.5% higher
• Females compared to males:
  • Females: 1.9% higher
• Unmarried people compared to married people:
  • Unmarried: 2.9% higher
• College graduates compared to non-high school graduates:
  • College graduates: 4.9% higher
• People with higher income (400% above poverty level) compared to people with lower income (below poverty level):
  • Higher income: 2.3% higher
• Adults with private insurance compared to adults with public insurance:
  • Private insurance: 2.5% higher
• People living in urban areas compared to people living in rural areas:
  • Urban residents: 2.7% higher

We’ll discuss both these sets of data below.

How This Information Helps

When we consider the data above, what stands out most are the differences related to income and education, and how those factors impacted the therapy use: they led to an increase for some but decreases for other during COVID.

We’re already familiar with data that indicates women and younger people engage in therapy at higher rates than men and older people. The reasons for higher rates among these groups are well-understood. In most cases, they’re a function of socialization and generation: in general, women are more willing to talk about mental health and emotions because of our gender norms, and older people are less willing to talk about mental health because of broader, older norms that consider talking about mental health a weakness, rather than a way to resolve clinical medical conditions, such as mental health disorders.

The study authors concur with our analysis. Here’s how they describe their results:

“This study found that psychotherapy use increased significantly faster among several socioeconomically advantaged groups and that inequalities were evident in teletherapy access. These trends and patterns highlight a need for clinical interventions and health care policies to broaden access to psychotherapy including teletherapy.”

The data are clear: disparities exist, and we can work to bring equity to mental health care. If we increase access to all forms of mental health treatment, including telehealth services for mental health, we can improve the lives of people who need treatment, but experience barriers to care: offering support where it’s needed most helps us all.