The Expected and the Unexpected: Observations from Tele-Behavioral Health in the COVID-19 Era

When it became apparent that the coronavirus pandemic was in fact escalating rapidly, many of us were concerned about the impact on mental health knowing the impact that social isolation can have on overall mental health and recognizing the emotional impact of likely financial devastation for many. Not to mention the emotional toll of mandated physical distancing programs. People need people. People need jobs. People need certainty. Many have lost all those things right now. 

We were eager to understand what we expected would be a widespread and profound impact on mental health. What could all this mean for the patients engaging in our tele-behavioral health treatment? What could we learn about the impact that a global traumatic event such as this one might have on our patients? So we turned to our data to find out. And as an example of the best feature of scientific pursuit, some of our findings were expected and some were definitely not. Here are some of the AbleTo Clinical Research team’s questions and answers we unearthed.

Question #1: How Are Hospital Employees Doing? 

As a physician myself and with a husband on the front lines treating COVID-19 patients in the ICU, I have been worried about the mental health impact of the pandemic on our front-line hospital workers. Are they more stressed, more anxious, or experiencing greater levels of burnout than before? 

What we found confirmed our suspicion, that indeed the employees at a large hospital system are suffering. A higher proportion of today’s COVID-era hospital employees participating in our digital program are focused on generalized anxiety (39% compared to only 23.3% in the pre-COVID era). Corresponding to this finding, we saw that the employees participating in the COVID-era had significantly higher anxiety symptom scores (average GAD-7 score 14.1 compared to 8.8 in the pre-COVID time period). And a greater proportion of these employees reported elevated levels of burnout (64% vs. 50.7% in the prior era). 

Our hospital system workers are indeed suffering. 

Question #2: Are Older Adults Lonelier?

Loneliness has been a recent focus for public health experts given the significant impact loneliness and social isolation are known to have on health outcomes and risk of mortality. In fact, nearly 22% of adults in the US report feeling lonely, with rates of loneliness much higher among older adults and particularly those with complex physical health conditions. Now, given mandated social distancing protocols in most states, would greater physical isolation lead to greater levels of loneliness? What we found surprised us! 

The older adults that participate in our program tend to be very lonely. Among members of a large national Medicare Advantage plan who participated in our tele-behavioral health program last year, nearly 60% endorsed a feeling of loneliness. We expected this number to be the same or higher, but what we discovered was the exact opposite. In fact, older adults participating in AbleTo programs in the COVID-19 era were less likely to be lonely. Still lonely, but less so, with only 54% reporting moderate or severe loneliness. When we dug in a little further, we discovered that overall loneliness scores are down and that the reduction was primarily driven by a decrease in the component of the score for social loneliness (as opposed to emotional loneliness). We also found that anxiety scores were slightly lower in this group compared to those who participated in the pre-COVID time period.

What could possibly have driven these results? We aren’t sure, but we have some theories. Maybe it’s that we are all calling our parents or grandparents more regularly, orchestrating Zoom video-conferences, and sending handwritten notes and care packages. Maybe it’s that neighbors are finally meeting one another as they step outside each night to cheer for our front-line healthcare workers. Or maybe it’s that one person’s isolation doesn’t seem so dire when everyone else around them has also been asked to stay home. Either way, it seems to have taken a pandemic to remind us of what’s important. That people need people. That connection matters. That a little effort goes a long way to reduce isolation and loneliness. We need more of that.

Question #3: What is the Mental Health Impact of COVID-19 on Working Age Adults?

Finally, the rest of the adult population is trying to adjust to mandated social distancing protocols, school closures, work-from-home policies, and in many cases loss of jobs and financial insecurity. The mental health impact of these changes can be profound and long-lasting. We have already seen an approximately 50% increase in engagement in our mental health programs. Patients are experiencing higher levels of anxiety and stress in the COVID-19 era compared to participants engaging in our program prior to the outbreak. A higher proportion have evidence of anxiety and stress and the average symptoms severity has also increased. 

All together, in some ways, our data revealed exactly what we expected, that many are suffering and feeling the acute mental health impact of this pandemic. On the other hand, there was also a silver lining, an unexpected decrease in loneliness in our older adults where we thought we would see a worsening. We remain vigilant of what a return to “normal” will bring and sadly expect a long tail of mental health issues to follow long after this pandemic has died down, We will need to ensure mental health resources are and remain available to help people address these mental health issues for months (years?) to come. We at AbleTo are comforted in the knowledge that while we are not physically on the front-line, in our own way, we are in fact front-line healthcare providers, making sure that individuals with mental health needs have access to high-quality, evidence-based, tele-behavioral health care.