Associations between Anxiety and Depression Symptoms and Medical Care Avoidance during COVID-19
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J Gen Intern Med DOI: 10.1007/s11606-020-06156-8 © Society of General Internal Medicine 2020
INTRODUCTION
Since the outbreak of the novel coronavirus disease 2019 (COVID-19) pandemic, emergency health care utilization has acutely declined by 23% for heart attacks, 20% for strokes, and 10% for hyperglycemic crises.1 Ambulatory visits have also declined by nearly 60%.2 The lack of health care utilization is concerning as it may result in significant medical complications resulting from untreated medical problems.1 Little is known about what is driving these declines in health care utilization. A study from Italy suggested that fear of COVID-19 infection may be one such factor.3 Recent research has documented pervasive anxiety and depression during the COVID-19 pandemic.4, 5 We conducted this study to estimate the association between mental health symptoms and medical care avoidance among US adults.
METHODS
We analyzed data from June 11–June 16, 2020, of the weekly, cross-sectional Household Pulse Survey (HPS; n = 73,472) which is conducted by the US Census Bureau in collaboration with five other federal agencies to produce data on the social and economic impacts of COVID-19 among adults in the USA. The HPS questionnaire was reviewed by independent experts at the Center for Behavioral Science Methods, as well as the Demographic Directorate and subject matter representatives from the five partner federal agencies. To gather the sample, HPS used the Census Bureau’s Master Address File as the primary sampling frame to collect responses from a large sample that is sufficient for the anticipated low responses rates. The Census Bureau used the online platform Qualtrics as the primary data collection method. See the Census Bureau website (https://www.census.gov/ Prior Presentations The results from this study have not been presented previously. Received July 20, 2020 Accepted August 14, 2020
householdpulsedata) for more information and access to publicly available data. We fitted modified multivariable Poisson regression models to estimate the associations between four mental health symptoms (nervous, anxious, or on edge; not being able to stop or control worrying; little interest or pleasure in doing things; feeling down, depressed, or hopeless) in the past 7 days and medical care avoidance (delayed medical care; needed non-coronavirus medical care but did not get it) due to the coronavirus pandemic in the past 4 weeks. The use of robust estimates of variance permits straightforward interpretation of the exponentiated regression coefficients as risk ratios. We adjusted for potential confounding by age, sex, race/ethnicity, income, education, employment loss, and marital status. Nonresponse sample weighing was applied. Analyses were conducted using Stata 15.1.
RESULTS
Demographic and descriptive results are displayed in Table 1. Individuals who experience all four symptoms of anxiety and depression had higher adjusted relative risk ratios of delayed medical care and not receiving needed non-coronavirus medical care, a
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