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Here I learned a brief overview of anxiety before I started.

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Covid 19 has impacted us all so much, but it was twice as hard for people with anxiety to manage.

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A large share of the U.S. population lives with depression and/or anxiety. Fills for depression/anxiety drugs reached an all-time peak in 2020.

Across the board, COVID-19 has negatively impacted the mental health of people living with depression and/or anxiety: 63% of people living with depression and/or anxiety that we surveyed reported having worse or much worse symptoms since the start of the COVID-19 pandemic.

COVID-19 has also caused disruptions to prescription drug access that may be making it harder for people to fill and take their medications as prescribed. In our survey, 18% to 25% of people reported missing a prescription due to access or cost.

From job loss and isolation, to the fear of contracting a deadly disease, the COVID-19 pandemic continues to play a front-and-center role in our daily lives. But for some, the pandemic may be taking an especially large toll.

Research has linked the COVID-19 pandemic to increases in depression-like symptoms across the country, but how has the pandemic affected those that were already living with anxiety and/or depression? The GoodRx Research team surveyed over 1,000 adults diagnosed with anxiety and/or depression on their experiences with the COVID-19 pandemic, and the results are jarring.

Overall, two themes emerged from respondents. First off, the pandemic is worsening symptoms related to depression and anxiety, like lack of motivation, panic attacks, and even thoughts of self-harm or suicide. Secondly, COVID-19 is making it harder for some to access mental health care and manage symptoms of depression and/or anxiety.

Prescription fill trends for anxiety and depression treatments further underscore the dire effect of the COVID-19 pandemic on mental health. Since 2016, fills for anxiety and depression medications have been increasing, and reached a peak in April 2020, just after the COVID-19 pandemic began in the United States. Though this may be reflective of the overall stockpiling of medications during the pandemic around this time, fill rates in 2020 are still higher than in any previous year. The fill rate in 2020 thus far has been about 9.5% higher on average than 2016.

As the COVID-19 pandemic rages on through the winter, and each new day brings even more cases and tighter lockdowns, it's likely that mental health could suffer even more. But what places someone at higher risk for worsening symptoms, or lack of access to care? And how can we better support those suffering during the pandemic?

Below we share results from our survey of over 1,000 participants diagnosed with anxiety and/or depression, detail certain factors that may lead to serious symptoms, and pose some possible solutions that could extend beyond the pandemic.

COVID-19 and worsening symptoms of anxiety and depression

According to GoodRx's survey, the COVID-19 pandemic has caused a deepening of many symptoms associated with anxiety and depression. And this may not come as a surprise. People with depression/anxiety may be more vulnerable to the negative mental health effects of COVID-19-related events, like loss of health insurance, loss of income, and social distancing measures that require self-isolation.

Overall, respondents overwhelmingly answered that their depression and anxiety symptoms had worsened since the COVID-19 pandemic began in the United States. A total of 62% of people surveyed reported that their symptoms were "worse" or "much worse," versus 28% reporting that symptoms were the "same," and 10% saying symptoms were "better" or "much better."

The most commonly reported experiences related to the COVID-19 pandemic were difficulty with motivation to eat healthy and exercise, reported by almost half of the survey respondents. Eating healthy foods and regular exercise are two factors that are important to alleviating depression and anxiety symptoms.

Additionally, 400 respondents reported an increase in frequency of panic attacks since the COVID-19 pandemic began in the U.S. Participants suggested that fear around what could happen if they contract the disease may be driving some of the reported symptom-worsening. For example, one participant said that "I keep praying I don't get [COVID-19] because I won't make it."Another participant said that in general the pandemic has led to "PTSD-type symptoms."

A small subset of respondents reported increases in frequency of self-harm or suicide, which is cause for concern as the pandemic in the U.S. does not seem to be subsiding anytime soon.

Factors affecting symptoms of depression and anxiety during COVID-19

Overall, trends reflecting worsening of symptoms post-pandemic appear across every demographic group by age, marital status, race/ethnicity, and sexual orientation. However, there are some experiences and characteristics that lead to even worse symptoms of anxiety and depression. Specifically, quarantine measures, employment status, income, and experiences related to the pandemic can affect symptoms.

Quarantine measures

Not surprisingly, one of the factors most strongly associated with worsening depression and/or anxiety symptoms is stay-at-home orders.

People with depression and/or anxiety often struggle with loneliness, especially older populations. Not being able to see family or friends due to COVID-19 can exacerbate sadness associated with solitude. Being required to quarantine, whether self-imposed or government-mandated, may also result in isolation from support systems, having to skip mental health treatment (such as therapy), and potential job loss.

Those who reported quarantining due to COVID-19 were far more likely to report "worse" or "much worse" symptoms compared to those who did not quarantine.Over 70% of those who reported quarantining for more than one week said their depression and/or anxiety symptoms were "worse" or "much worse." By comparison, only 53% of depression and anxiety patients that quarantined for less than a week reported worse symptoms during the pandemic.

Employment status

Work status is also related to reports of worsening symptoms. Survey respondents were predominantly either employed full-time or part-time, unemployed, or retired. A small subset also worked as caregivers, essential workers, and healthcare workers. Some respondents also reported being on disability.

Compared to unemployed respondents, those that were employed at the time of the survey seemed to be faring much better. Specifically, 57% of respondents with full-time employment reported "worse" symptoms versus 17% reporting "better" symptoms and 26% reporting no change in symptoms. In contrast, 68% of unemployed respondents reported symptoms to be worse, while just 3% reported that their symptoms were better.

Even before the COVID-19 pandemic, unemployed individuals experienced a greater burden of mental health symptoms. Being unemployed intensifies negative mental health; it typically causes feelings of pessimism, anxiety, and stress. Further, having a reduced income can make it more difficult to access and stay in treatment for mental health conditions like depression and/or anxiety. The impacts of the COVID-19 pandemic have likely, and unsurprisingly, increased the negative effects of unemployment.

Income level

When evaluating different income groups, individuals in the highest income category reported being less affected by the COVID-19 pandemic than other income groups. Among respondents reporting an annual household income of more than $200,000, only 34% reported that their symptoms of anxiety and depression were worse, and 36% actually reported that their symptoms were better.

This is in stark contrast to the other income groups, where the percentage of people reporting that symptoms were "worse" or "much worse" ranged from 60% to almost 70%. People with an annual household income of at least $200,000 may have more job security and feel more stable in the pandemic given their income.

Experiences during COVID-19

While the COVID-19 pandemic has negatively impacted day-to-day life for nearly everyone, people living with depression and/or anxiety are especially vulnerable. We asked respondents about their exposure to pandemic-related experiences, including COVID-19 illness and death.

It can be extraordinarily difficult to have a friend or family member diagnosed with COVID-19 during this pandemic, given the uncertainty around the virus, lack of definitive treatment, and inability to visit with a sick loved one. In this sample of individuals, 34% reported having a friend or family member who was diagnosed with COVID-19. About 12% of these individuals had a loved one pass away due to the virus.

On top of that, 19% of respondents also reported either job or income loss, and 47% of respondents reported reduced contact with friends and family. As discussed above, job loss and quarantining were also associated with worse depression/anxiety symptoms.

We found that the more negative COVID-19 related experiences a person had, the more likely they were to report worse depression and/or anxiety symptoms. For those who did not experience any of the events that we asked about, 47% reported "worse" or "much worse" symptoms. For those who experienced just one of the events, 62% reported worsening of symptoms. Of the respondents who reported more than one event related to COVID-19, 72% reported worse or much worse symptoms.

COVID-19 and access to care for anxiety and depression

The COVID-19 pandemic has also caused disruptions to normal access to care. For people who rely on prescription medication to treat their mental health conditions, the direct impacts of COVID-19 may make filling prescriptions more challenging, and they may resort to other unauthorized medications to treat their depression and/or anxiety.

Nearly two-thirds of survey respondents reported taking a prescription to manage their depression and/or anxiety/depression. While the majority of these patients reported no changes to their medication regimen, a number of people reported disruptions to their prescription medication management.

Stopping, starting, and adjusting medications

Of the respondents that were taking a prescription for depression and/or anxiety, almost a quarter reported that they had altered the quantity, strength, or type of an existing medication due to the pandemic. These regimen changes included trying out a different antidepressant, or going on higher or lower dosages. Almost a quarter of people with a regimen change also reported that they started a new prescription for depression/anxiety management, and 20% reported that they stopped taking a prescription due to the COVID-19 pandemic.

Some respondents reported a combination of all of the above, likely trying to find a good balance of strength and type of medication. For example, 6% of people taking a prescription reported more than one change to their medication regimen, whether that was starting a new medication, altering the strength of an existing medication, and/or switching medications.

Pandemic-related barriers to accessing medications

The COVID-19 pandemic has impacted all components of the healthcare system, and we found that people using medication to treat their depression/anxiety have experienced barriers to accessing medication.

One challenge respondents noted is issues with doctor visits that prevented them from getting the medication they needed. One person wrote that "[my] doctor changed and [the prescription] never got sent," and others wrote that "my doctor won't refill" or "I cannot afford to see a doctor to get a new prescription." For one person, their doctor's office abruptly closed without warning.

Of all the people taking a prescription for depression or anxiety, 37% reported at least one issue related to administration of the medication. Participants reported delays in picking up or receiving medication; needing to change the pharmacy where they typically pick up the prescription; missing, skipping, or rationing prescriptions; or having issues with the pharmacy refilling the prescription. In addition, 15% of respondents reported using a prescription medication to treat depression/anxiety that was not prescribed to them.

Sadly, our analyses also revealed that cost is a barrier to care. Of respondents taking prescription medications for depression/anxiety, nearly 20% of respondents who take a prescription for depression/anxiety reported that they were unable to afford one of their prescription medications.

Reliance on drugs and alcohol

While drinking alcohol may appear to be a benign way of easing symptoms of anxiety or depression, it can actually have the opposite effect. In our survey, 18% of people reported increasing consumption of alcohol or drugs to treat depression/anxiety. This may be reflective of people self-medicating with alcohol and/or drugs because they can't access prescription medications. For those who are taking prescriptions, this is also concerning because alcohol can interact with anxiety and depression medications in a dangerous way.

Summing it all up

Clearly, the COVID-19 pandemic has worsened mental health conditions like depression and anxiety. The upcoming holiday season may make it even more difficult to manage depression and anxiety and exacerbate feelings of isolation amidst not being able to travel to see loved ones.

Untreated impacts of depression and anxiety compound over time, causing health effects that are physical, behavioral, and emotional. Some of these effects include extreme social isolation, attempted suicide or self-harm, and excess weight gain (which can lead to illnesses like cardiovascular disease, diabetes, etc.).

During this pandemic, our findings confirm what other studies have found: The most vulnerable populations during this pandemic include low-income populations who are more susceptible to job insecurity and who may not be able to afford mental healthcare. Drug discount coupons can help these people afford medications that they might otherwise need to forego due to cost.

Most importantly, if you do suffer from depression or anxiety, please know that there are support systems designed to help that are completely free and available 24/7. You can access a virtual appointment to meet with a doctor for refills for your prescription anxiety medications, and you can rely on discount sites like GoodRx if you have trouble affording a prescription.

In addition to applying discounts for savings on prescription drugs, support groups and crisis response lines are also available to provide assistance. If you are in crisis, please do not hesitate to contact a crisis care center or 911, or go to your local emergency room. You can also call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255) to be connected with a trained counselor (available 24/7). For mental health support over text messaging, you can text 741-741 to connect with a crisis counselor at the Crisis Text Line from anywhere in the U.S. These services are all free and confidential.

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Co-contributors: Amanda Nguyen, PhD, Tori Marsh, MPH
Methodology: Survey data was collected via Qualtrics from November 1 to November 10, 2020. Participants were eligible if they were adults diagnosed with depression and/or anxiety prior to the COVID-19 pandemic. A total of 1,042 eligible individuals completed the survey. All participants were based in the United States and had received a diagnosis of depression and/or anxiety prior to the COVID-19 pandemic hitting the U.S. The sample of participants we surveyed is representative (based on age, race/ethnicity, and educational attainment) of the population in the United States with depression, based on the National Survey on Drug Use and Health (from the To calculate trend-lines for depression/anxiety fills, we used a representative sample of U.S. prescription fills, and assigned conditions to the drug filled on the claims. Then, we compared the average number of fills for depression and anxiety drugs to the total number of fills for all other conditions. Substance Abuse and Mental Health Data Archive).

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COVID-19 Has Made Managing Anxiety and Depression Harder - GoodRx

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In a GoodRx survey, 63% of respondents living with depression and/or anxiety said their symptoms have gotten worse since the start of the COVID-19 pandemic. The pandemic also may be making it harder for people to fill or afford their medications.

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This specific article kind of compares January-June 2019 vs January 2021. Lots of adults report symptoms of anxiety during the virus.One in Four Older Adults Report Anxiety or Depression Amid the COVID-19 Pandemic

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Note: This brief was updated on March 20, 2023 to incorporate the latest available data.

Concerns about mental health and substance use remain elevated three years after the onset of the COVID-19 pandemic, with 90% of U.S. adults believing that the country is facing a mental health crisis, according to a recent KFF/CNN survey. The pandemic has affected the public's mental health and well-being in a variety of ways, including through isolation and loneliness, job loss and financial instability, and illness and grief.

Over the course of the pandemic, many adults reported symptoms consistent with anxiety and depression, with approximately four in ten adults reporting these symptoms by early 2021, before declining to approximately three in ten adults as the pandemic continued (Figure 1). Additionally, drug overdose deaths have sharply increased - largely due to fentanyl - and after a brief period of decline, suicide deaths are once again on the rise. These negative mental health and substance use outcomes have disproportionately affected some populations, particularly communities of color and youth. As the end of the declaration of the public health emergency nears - on May 11, 2023 - many people continue to grapple with worsened mental health and well-being and face barriers to care.

This brief explores mental health and substance use during, and prior to, the COVID-19 pandemic. We highlight populations that were more likely to experience worse mental health and substance use outcomes during the pandemic and discuss some innovations in the delivery of services. We analyze and present findings using the most recent data available at the time of this publication - including the Household Pulse Survey and the CDC WONDER database. Key takeaways include:

Symptoms of anxiety and depression increased during the pandemic and are more pronounced among individuals experiencing household job loss, young adults, and women. Adolescent females have also experienced increased feelings of hopelessness and sadness compared to their male peers.

Deaths due to drug overdose increased sharply across the total population coinciding with the pandemic - and more than doubled among adolescents. Drug overdose death rates are highest among American Indian and Alaska Native people and Black people.

Alcohol-induced death rates increased substantially during the pandemic, with rates increasing the fastest among people of color and people living in rural areas.

After briefly decreasing, suicide deaths are on the rise again as of 2021. From 2019 to 2021, many communities of color experienced a larger growth in suicide death rates compared to their White counterparts. Additionally, self-harm and suicidal ideation has increased faster among adolescent females compared to their male peers.

Several changes have been implemented in the delivery of mental health and substance use services since the onset of the pandemic, including the utilization of telehealth, steps to improve access to treatment for opioid use disorders, expansion of school-based mental health care, and the rollout of the 988 crisis line. As the public health emergency declaration comes to an end, it is possible that some of these changes will be interrupted.

Prevalence of Mental Illness and Substance Use During the Pandemic

Anxiety and depression

The pandemic was associated with a high prevalence of anxiety and depression symptoms in adults. Research suggests that these symptoms increased during the pandemic, but the extent of this increase is unclear. Throughout the pandemic, symptoms of anxiety and depression have been more pronounced among several populations.

For example, individuals experiencing household job loss were more likely than their counterparts to report symptoms of anxiety and/or depression (53% vs. 30%) in February 2023 (Figure 2). Job loss and unemployment - which have long been associated with adverse mental health outcomes - increased substantially early on in the pandemic.

Fifty percent of young adults (ages 18-24) reported anxiety and depression symptoms in 2023, making them more likely than older adults to experience mental health symptoms (Figure 2). Young adults have experienced a number of pandemic-related consequences - such as closures of universities, transitioning to remote work, and loss of income or employment - that may contribute to poor mental health. Additionally, young adults in college settings may encounter increased difficulty accessing treatment.

Symptoms of anxiety and/or depression were also elevated among women (36%) compared to men (28%) in February 2023 (Figure 2). Even before the pandemic, women were more likely than men to report mental health disorders, including serious mental illness.

Concerns about youth mental health further increased with the onset of the pandemic and the recent uptick in gun violence. In a recent KFF/CNN survey, roughly half of parents (47%) said the pandemic had a negative impact on their child's mental health, including 17% who said it had a "major negative impact". Poor mental health has been more pronounced among adolescent females in particular. As shown in Figure 3, the gap in the share of adolescent females and males reporting feelings of hopelessness and sadness - symptoms indicative of depressive disorder - widened from 2019 (47% vs. 27%, respectively) to 2021 (57% vs. 29%, respectively). Many female adolescents also reported adverse experiences in 2021, which can negatively impact mental health.

Substance use and deaths

The pandemic has coincided with an increase in substance use and increased death rates due to substances. In 2021, there were over 106,600 deaths due to drug overdose in the U.S. - the highest on record. This spike in deaths has primarily been driven by substances laced with synthetic opioids, including illicitly manufactured fentanyl.

Further, the overall drug overdose death rate rose by 50% during the pandemic (Figure 4), but varied across states. While drug overdose death rates increased across all racial and ethnic groups, the increases were larger for people of color compared to White people. White people continue to account for the largest share of deaths due to drug overdose per year, but people of color are accounting for a growing share of these deaths over time. In 2021, the highest drug overdose death rates were among American Indian Alaska Native (AIAN) people (56.6 per 100,000), Black people (44.2 per 100,000), and White people (36.8 per 100,000) (Figure 4). Differences in drug overdose deaths by sex were also exacerbated during the pandemic. As shown in Figure 4, the gap in the drug overdose death rates between males and females increased from 2019 (29.6 vs. 13.7 per 100,000, respectively) to 2021 (45.1 vs. 19.6 per 100,000, respectively).

Research suggests that substance use among adolescents has declined, yet drug overdose deaths have sharply increased among this population, primarily due to fentanyl-laced substances. Among adolescents, drug overdose deaths have more than doubled from 2019 (282 deaths) to 2021 (637 deaths) following a period of relative stability. Male, Black, and Hispanic youth have experienced the highest increases in deaths due to drug overdose.

During the pandemic, excessive drinking increased along with alcohol-induced deaths. Alcohol-induced death rates increased by 38% during the pandemic, with rates the highest and increasing the fastest among AIAN people. AIAN people died of alcohol-induced causes at a rate of 91.7 per 100,000 in 2021, six times more than the next highest group - Hispanic people at a rate of 13.6. Black people also experienced significant increases in alcohol-induced deaths during COVID, with rates increasing more than 45% (Figure 5). Both rural and metropolitan areas experienced an increase in alcohol-induced deaths during the pandemic, but rural areas saw the largest increase (46% increase compared to 36%).

Suicidal ideation and deaths

Concerns about suicidal ideation and suicide deaths have also grown during the pandemic. Notably, self-harm and suicidal ideation has increased among adolescent females. Thirty percent of adolescent females seriously considered attempting suicide in 2021 compared to 14% of their male peers (Figure 6). Other analyses found that as the pandemic progressed, emergency department visits for suicide attempts increased among adolescents, primarily driven by females.

Suicide deaths in the U.S. began to increase in 2021 after briefly slowing in 2019 and 2020, although some research suggests that some suicides may be misclassified as drug overdose deaths since it can be difficult to determine whether drug overdoses are intentional. From 2019 to 2021, many communities of color experienced a larger growth in suicide death rates compared to their White counterparts. In 2021, suicide deaths by firearm accounted for more than half ( 55%) of all suicides in the U.S., but varied greatly across states.

The pandemic has also raised concerns about mental illness, suicide, and substance use among other populations. Essential workers and people with chronic health conditions may have experienced worsened mental health due to increased risk of contracting or becoming severely ill from COVID-19. Many of these individuals, particularly those with chronic conditions, were already at-risk of experiencing poor mental health outcomes prior to the pandemic. LBGT+ people have historically faced mental health problems at higher rates than their non-LGBT+ peers. The pandemic has continued to negatively impact LBGT+ people's mental health in disproportionate ways. In addition, people experiencing prolonged COVID-19 symptoms, or long COVID, may be more likely to develop new mental health conditions or to experience worsening of existing ones.

Changes in the Delivery of Mental Health and Substance Use Disorder Services

Leading up to the pandemic, many people faced barriers accessing mental health and substance use disorder services for reasons including costs, not knowing where to obtain care, limited provider options, and low rates of insurance acceptance. Young adults, Black adults, men, and uninsured people were less likely to receive services compared to their peers.

In recent years, access to care barriers may have worsened due to pandemic disruptions and closures, workforce shortages, and increased demand for services. In response to growing need, some policies and strategies were implemented to address access challenges, such as growth of telehealth, improved access to opioid use disorder treatment, the expansion of school-based mental health services, and the rollout of 988; however, challenges remain.

The delivery of mental health and substance use disorder services via telehealth grew sharply during the pandemic. By 2021, nearly 40% of all mental health and substance use disorder outpatient visits were delivered through telehealth. These behavioral health services via telehealth have also been more utilized in rural areas than urban areas during the pandemic. This underscores the role telehealth can play in improving access to behavioral health services in rural areas, which often face additional provider and resource shortages. Further, community health centers - which serve low-income and medically underserved communities, including communities of color and those in rural areas - experienced a large increase in behavioral health visits in 2021, largely driven by telehealth. During the pandemic, many state Medicaid programs expanded coverage of behavioral health telehealth services. This includes broadening the range of behavioral health services offered virtually and allowing for more provider types to be reimbursed for telehealth services. Many state Medicaid programs reported that telehealth has helped maintain and expand access to behavioral services during the pandemic. Some private payers have also improved coverage for mental health and substance use services by removing pre-pandemic telehealth coverage restrictions. Although telehealth can broaden access to care, in-person care may be necessary or preferred for some or for those experiencing challenges with technology and digital literacy.

As opioid-related overdose deaths have sharply increased, measures to improve access to treatment have been implemented. Following the onset of the pandemic, the federal government allowed for new flexibilities in opioid use disorder (OUD) treatment to ease access barriers, for example allowing for take-home methadone doses and covering telehealth treatment, and the Biden administration has proposed making these flexibilities permanent. Further, the 2023 Consolidated Appropriations Act eliminated the X-waiver requirement for prescribing buprenorphine, which substantially increases the number of providers who are authorized to prescribe buprenorphine to treat OUD. Voluntary guidelines for providers have also been issued to help reduce opioid overprescribing and misuse. At the same time, the Drug Enforcement Agency recently proposed returning to previous rules that required in-person visits before prescribing controlled substances to patients via telehealth, though there are some exceptions.

In response to growing mental health concerns among youth, integration of mental health services in school-based settings became a priority. Recent legislation aims to expand mental health care in schools - a setting that is easily accessible by children and adolescents. Specifically, legislation provides funding to expand and train mental health providers in schools; implement suicide, drug, and violence prevention programs; and provide trauma support services, among others. Further, recognizing Medicaid's importance in covering and financing behavioral health care for children, CMS is now required to provide updated guidance on how to support and expand school-based behavioral health services. The recently passed Consolidated Appropriations Act (CAA) continues to build on prior pandemic-era legislation that promotes access to behavioral health care for children. For example, to ensure more stable coverage for low-income children the CAA requires states to provide 12 months of continuous eligibility for children in Medicaid and CHIP.

An easy-to-remember number for the suicide and behavioral health crisis hotline, 988, was launched in 2022. On July 16, 2022, the federally mandated crisis number, 988, became available to all landline and cell phone users, providing a single three-digit number to access a network of over 200 local and state funded crisis centers where those in need may receive crisis counseling, resources and referrals. After 988 implementation, national answer rates increased alongside increases in call volume. Long-term sustainable funding of local 988 crisis call centers remains uncertain in many states. In addition to 988, some states are developing behavioral health crisis response systems, such as mobile crisis or crisis stabilization units, which will enable a specialized behavioral health response for behavioral health crises that require intervention. The CAA included provisions aimed at strengthening and evaluating 988 and the developing behavioral health crisis continuum.

Despite steps taken to improve the delivery of mental health and substance use services, challenges remain. Provider workforce challenges are widespread, with nearly half of the U.S. population ( 47%) living in a mental health workforce shortage area. Shortages may contribute to access challenges and contribute to increases in psychiatric boarding in emergency rooms. Additionally, provider network directories are often outdated, further contributing to access challenges. While recent legislation has taken steps in response - including funding for at least 100 new psychiatry residency positions, grants for mental health peer support providers, and improvements to provider directories through the CAA - these are relatively small measures in the face of big access challenges. The lack of a diverse mental health care workforce may contribute to limited mental health treatment among people of color. Separately, even with insurance coverage, individuals with mental health needs face challenges accessing care. While Medicaid enrollees have limited out-of-pocket costs there is variation in who is eligible and the range of services covered across states. Additionally, the end of Medicaid's continuous enrollment provision - on March 31, 2023 - could result in millions of disenrollments over the next year which could disrupt access to behavioral health services. Among private insurance enrollees, enrollees, with mental illness face high out-of-pocket costs; and these costs vary substantially across states. While most adults with mental illness have private insurance, rates of mental illness and substance use disorders are most prevalent among nonelderly adults with Medicaid.

Looking Ahead

Although steps have been taken to address negative mental health impacts stemming from the pandemic, mental health and substance use concerns remain elevated. Heightened racism and increasing gun violence may also contribute to poor mental health outcomes. Further, negative mental health impacts have been more pronounced among several populations, including communities of color, young adults and children - populations which have historically experienced increased barriers to care. Additionally, despite renewed discussions and new federal grants for state parity enforcement under the CAA, challenges with mental health parity persist - including lack of clarity on specific protections, low compliance rates, and slow federal enforcement. Finally, the COVID-19 public health emergency will end in May 2023, which may at least partially unravel steps taken toward delivering mental health services via telehealth and improving access to substance use disorder services.

History has shown that the mental health impact of disasters outlasts the physical impact, suggesting today's elevated mental health needs will continue well beyond the coronavirus outbreak itself. As we emerge from the COVID-19 pandemic and the federal public health emergency draws to an end, it will be important to consider how the increased need for mental health and substance use services may persist long term, even as new cases and deaths due to COVID-19 hopefully subside.

This work was supported in part by Well Being Trust. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

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The Implications of COVID-19 for Mental Health and Substance Use | KFF

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This brief explores mental health and substance use during, and prior to, the COVID-19 pandemic. We highlight populations that were more likely to experience worse mental health and substance use outcomes during the pandemic and discuss some innovations in the delivery of services.

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Huge shoutout to Dr. Lepofsky! (The school psychologist.) She has been the best at answering all my questions. She is like a supercomputer, she can basically answer all my questions.

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Since I have anxiety I was able to not use as many websites because I knew a lot about it because I had it. SO that was a very good thing.