To examine the immediate and long-term effect of the pandemic on clinical encounters in predominantly low-income, racially and ethnically diverse mothers.
Methods:
This is a longitudinal study of 3,073 predominantly low-income, racially, and ethnically diverse mothers in the Boston Birth Cohort. We conducted descriptive and random-effects negative binomial regression to examine the impact of the COVID-19 pandemic on medical and mental health care encounters of the study mothers, using comprehensive electronic health record data before and during the pandemic (January 2019–December 2021). We also conducted a qualitative survey in a subsample (N ∼200) to assess pandemic-related stressors.
Results:
Compared with 2019 (prepandemic), mental health encounter incidence increased by 56% in 2020 (incidence rate ratio [IRR]: 1.56, 95% confidence interval [CI]: 1.29–1.88) and 37% in 2021 (IRR: 1.37, CI: 1.14–1.64). In contrast, primary care and non-mental health subspecialty care decreased in 2020 (IRRs: 0.91 and 0.73, CIs: 0.85–0.97 and 0.67–0.8) and recovered in 2021 (IRRs: 1.24 and 1.48, CIs: 1.17–1.32 and 1.37–1.61), whereas emergency department encounters decreased in both 2020 (IRR: 0.64, CI: 0.57–0.71) and 2021 (IRR: 0.74, CI: 0.67–0.82). Telemedicine was utilized the most for mental health. Consistently, 38.4% of the mothers reported higher levels of stress during the pandemic.
Conclusions:
COVID-19 imposed significant mental distress on this sample of racially and ethnically diverse mothers, with an increase in mental health encounters. Telemedicine was a major modality for mental health services.
Policy Implications:
The study findings draw attention to the profound adverse impact of the pandemic on mental health in racially and ethnically diverse mothers and highlights the need to develop current and long-term strategies for addressing mental distress in this population and for future preparedness.
DeJongC, KatzMH, CovinskyK. Deferral of care for serious non-COVID-19 conditions: A hidden harm of COVID-19. JAMA Intern Med2021;181(2):274; doi: 10.1001/jamainternmed.2020.4016
2.
HuYJ, WakeM, SafferyR. Clarifying the sweeping consequences of COVID-19 in pregnant women, newborns, and children with existing cohorts. JAMA Pediatr2021;175(2):117–118; doi: 10.1001/jamapediatrics.2020.2395
3.
St-DenisX. Sociodemographic determinants of occupational risks of exposure to COVID-19 in Canada. Can Rev Sociol2020;57(3):399–452; doi: 10.1111/cars.12288
4.
AsfawA. Racial disparity in potential occupational exposure to COVID-19. J Racial Ethn Health Disparities2022;9(5):1726–1739; doi: 10.1007/s40615-021-01110-8
MillettGA, JonesAT, BenkeserD, et al.Assessing differential impacts of COVID-19 on black communities. Ann Epidemiol2020;47:37–44; doi: 10.1016/j.annepidem.2020.05.003
7.
BhambhvaniHP, RodriguesAJ, YuJS, et al.Hospital volumes of 5 medical emergencies in the COVID-19 pandemic in 2 US medical centers. JAMA Intern Med2021;181(2):272–274; doi: 10.1001/jamainternmed.2020.3982
8.
BleckerS, JonesSA, PetrilliCM, et al.Hospitalizations for chronic disease and acute conditions in the time of COVID-19. JAMA Intern Med2021;181(2):269–271; doi: 10.1001/jamainternmed.2020.3978
9.
MoynihanR, SandersS, MichaleffZA, et al.Impact of COVID-19 pandemic on utilisation of healthcare services: A systematic review. BMJ Open2021;11(3):e045343; doi: 10.1136/bmjopen-2020-045343
10.
HartnettKP, Kite-PowellA, DeViesJ, et al.Impact of the COVID-19 pandemic on emergency department visits—United States, January 1, 2019–May 30, 2020. MMWR Morb Mortal Wkly Rep2020;69(23):699–704.
11.
XuS, GlennS, SyL, et al.Impact of the COVID-19 pandemic on health care utilization in a large integrated health care system: Retrospective cohort study. J Med Internet Res2021;23(4):e26558; doi: 10.2196/26558
12.
CortezC, MansourO, QatoDM, et al.Changes in short-term, long-term, and preventive care delivery in US office-based and telemedicine visits during the COVID-19 pandemic. JAMA Health Forum2021;2(7):e211529; doi: 10.1001/jamahealthforum.2021.1529
AtherlyA, Van Den Broek-AltenburgE, HartV, et al.Consumer reported care deferrals due to the COVID-19 pandemic, and the role and potential of telemedicine: Cross-Sectional analysis. JMIR Public Health Surveill2020;6(3):e21607; doi: 10.2196/21607
15.
SaundersNR, KurdyakP, StukelTA, et al.Utilization of physician-based mental health care services among children and adolescents before and during the COVID-19 pandemic in Ontario, Canada. JAMA Pediatr2022;176(4):e216298; doi: 10.1001/jamapediatrics.2021.6298
16.
WongSYS, ZhangD, SitRWS, et al.Impact of COVID-19 on loneliness, mental health, and health service utilisation: A prospective cohort study of older adults with multimorbidity in primary care. Br J Gen Pract2020;70(700):e817–e824; doi: 10.3399/bjgp20X713021
17.
ToulanyA, VigodS, KurdyakP, et al.New and continuing physician-based outpatient mental health care among children and adolescents during the COVID-19 pandemic in Ontario, Canada: A population-based study. Front Psychiatry2023;14:1063203; doi: 10.3389/fpsyt.2023.1063203
18.
MannDM, ChenJ, ChunaraR, et al.COVID-19 transforms health care through telemedicine: Evidence from the field. J Am Med Inform Assoc2020;27(7):1132–1135; doi: 10.1093/jamia/ocaa072
19.
OsulaV, RuskS, HaoL, et al.Prospective cohort study of emergency department visit frequency and diagnoses before and during COVID-19 pandemic in Urban, low-income, US- and Foreign-Born Mothers in Boston, MA. West J Emerg Med2023;24(6):1117–1127; doi: 10.5811/westjem.59639
20.
SilvermanME, BurgosL, RodriguezZI, et al.Postpartum mood among universally screened high and low socioeconomic status patients during COVID-19 social restrictions in New York City. Sci Rep2020;10(1):22380; doi: 10.1038/s41598-020-79564-9
21.
NguyenLH, Anyane-YeboaA, KlaserK, et al.The mental health burden of racial and ethnic minorities during the COVID-19 pandemic. PLoS One2022;17(8):e0271661; doi: 10.1371/journal.pone.0271661
22.
BastainTM, KnappEA, LawA, Environmental Influences on Child Health Outcomes Program Collaborators. et al.; COVID-19 pandemic experiences and symptoms of pandemic-associated traumatic stress among mothers in the US. JAMA Netw Open2022;5(12):e2247330; doi: 10.1001/jamanetworkopen.2022.47330
23.
LukV, LaytonH, SavoyC, et al.Healthcare utilization before and during the COVID-19 pandemic among mothers and birthing parents with elevated levels of postpartum depression symptoms. Women Health2024;64(2):175–184; doi: 10.1080/03630242.2024.2308516
24.
AdamsSH, SchaubJP, NagataJM, et al.Young adult anxiety or depressive symptoms and mental health service utilization during the COVID-19 pandemic. J Adolesc Health2022;70(6):985–988; doi: 10.1016/j.jadohealth.2022.02.023
25.
RacineN, EirichR, CookeJ, et al.When the bough breaks: A systematic review and meta-analysis of mental health symptoms in mothers of young children during the COVID-19 pandemic. Infant Ment Health J2022;43(1):36–54; doi: 10.1002/imhj.21959
26.
PearsonC, BartellT, WangG, et al.Boston birth cohort profile: Rationale and study design. Precis Nutr2022;1(2):e00011.
27.
PearsonC, BartellT, WangG, et al.Boston birth cohort profile: Rationale and study design. Precis Nutr2022;1(2):e00011; doi: 10.1097/pn9.0000000000000011
28.
PatridgeEF, BardynTP. Research Electronic Data Capture (REDCap). Jmla2018;106(1):142.
29.
ShoreJH, SchneckCD, MishkindMC. Telepsychiatry and the coronavirus disease 2019 pandemic—current and future outcomes of the rapid virtualization of psychiatric care. JAMA Psychiatry2020;77(12):1211–1212; doi: 10.1001/jamapsychiatry.2020.1643
30.
CantorJH, McBainRK, HoP-C, et al.Telehealth and in-person mental health service utilization and spending, 2019 to 2022. JAMA Health Forum2023;4(8):e232645; doi: 10.1001/jamahealthforum.2023.2645
31.
Villas-BoasS, KaplanS, WhiteJS, et al.Patterns of US mental health–related emergency department visits during the COVID-19 pandemic. JAMA Netw Open2023;6(7):e2322720; doi: 10.1001/jamanetworkopen.2023.22720
32.
BrunetA, Rivest-BeauregardM, LonerganM, et al.PTSD is not the emblematic disorder of the COVID-19 pandemic; adjustment disorder is. BMC Psychiatry2022;22(1):300; doi: 10.1186/s12888-022-03903-5
33.
BourmistrovaNW, SolomonT, BraudeP, et al.Long-term effects of COVID-19 on mental health: A systematic review. J Affect Disord2022;299:118–125; doi: 10.1016/j.jad.2021.11.031
34.
EkmanB, ArvidssonE, ThulesiusH, et al.Impact of the Covid-19 pandemic on primary care utilization: Evidence from Sweden using national register data. BMC Res Notes2021;14(1):424; doi: 10.1186/s13104-021-05839-7
35.
FloresM, MullinB, CreedonT, et al.Racial/Ethnic and language disparities in telepsychiatry during the COVID‐19 pandemic: Results from an Urban safety‐net hospital system. Health Serv Res2021;56(S2):63–64.
36.
AdepojuOE, ChaeM, OjinnakaCO, et al.Utilization gaps during the COVID-19 pandemic: Racial and ethnic disparities in telemedicine uptake in federally qualified health center clinics. J Gen Intern Med2022;37(5):1191–1197; doi: 10.1007/s11606-021-07304-4
37.
LitchfieldI, ShuklaD, GreenfieldS. Impact of COVID-19 on the digital divide: A rapid review. BMJ Open2021;11(10):e053440; doi: 10.1136/bmjopen-2021-053440
38.
ChangJE, LaiAY, GuptaA, et al.Rapid transition to telehealth and the digital divide: Implications for primary care access and equity in a Post-COVID Era. Milbank Q2021;99(2):340–368; doi: 10.1111/1468-0009.12509
39.
EylemO, de WitL, van StratenA, et al.Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis. BMC Public Health2020;20(1):879; doi: 10.1186/s12889-020-08964-3
40.
MüllerF, AbdelnourAM, RutaremaraDN, et al.Association between sociodemographic factors, clinic characteristics and mental health screening rates in primary care. PLoS One2024;19(3):e0301125; doi: 10.1371/journal.pone.0301125
41.
MembrideH. Mental health: Early intervention and prevention in children and young people. Br J Nurs2016;25(10):552–554; doi: 10.12968/bjon.2016.25.10.552
42.
LiangJ, MathesonBE, DouglasJM. Mental health diagnostic considerations in racial/ethnic minority Youth. J Child Fam Stud2016;25(6):1926–1940; doi: 10.1007/s10826-015-0351-z
43.
SnowdenLR, CordellK, BuiJ. Racial and ethnic disparities in health status and community functioning among persons with untreated mental Illness. J Racial Ethn Health Disparities2023;10(5):2175–2184; doi: 10.1007/s40615-022-01397-1
44.
SchnyderN, PanczakR, GrothN, et al.Association between mental health-related stigma and active help-seeking: Systematic review and meta-analysis. Br J Psychiatry2017;210(4):261–268; doi: 10.1192/bjp.bp.116.189464
45.
O’HaraMW, EngeldingerJ. Treatment of postpartum depression: Recommendations for the clinician. Clinical Obstetrics and Gynecology2018;61(3):604–614.
46.
MezzinaR, SashidharanS, RosenA, et al.Mental health at the age of coronavirus: Time for change. Soc Psychiatry Psychiatr Epidemiol2020;55(8):965–968.
47.
PercudaniM, CorradinM, MorenoM, et al.Mental health services in lombardy during COVID-19 outbreak. Psychiatry Res2020;288:112980.
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