The impact of the COVID-19 pandemic on mental health care utilization among people living with HIV: A real-world data study
Authors: Pasha Atana , Qiao Shan , Zhang Jiajia , Cai Ruilie , He Buwei , Yang Xueying , Liang Chen , Weissman Sharon , Li Xiaoming 
Published: September 2024

Objective

The COVID-19 pandemic has profoundly impacted mental health worldwide, particularly among vulnerable populations such as people living with HIV (PLWH). However, large-scale, real-world data on mental health care utilization and associated factors among PLWH remain limited. This study leveraged electronic health records (EHR) and Basics survey data from the All of Us program to explore mental health care utilization and associated factors among PLWH during the COVID-19 pandemic.

Methods

Using a retrospective cohort design, we identified and included 4,575 PLWH through computational phenotyping based on relevant Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) concept sets from the All of Us program between March 2018 and March 2022. Mental health care utilization was measured using the yearly count of mental health care visits over this period. The pattern of mental health care utilization was compared between pre-pandemic (2018-2020) and during the pandemic (2020-2022). Incidence rate ratios (IRR) from the Poisson generalized linear mixed models (GLMM) were used to examine associations between mental health care utilization, history of COVID-19 infection, demographic factors, pre-existing chronic conditions (e.g., hypertension, diabetes), and socioeconomic status.

Results

Among 4,575 PLWH, the annual number of mental health care visits decreased significantly during the pandemic period (March 2020 – March 2022) compared to the pre-pandemic period (March 2018 – February 2020) (IRR = 0.89, p < 0.001). The Poisson regression analysis found that a history of COVID-19 infection was associated with a higher number of mental health care visits (IRR = 1.35, p < 0.001). Middle-aged groups with participants aged 30-39 (IRR= 2.35, p = 0.002), 40-49 (IRR= 3.49, p < 0.001), and 50-64 (IRR= 2.07, p = 0.004) had significantly higher visit numbers compared to the youngest group (18-29 years). Black or African American participants were less likely to have visits compared to White participants (IRR = 0.71, p = 0.002). Medicaid health insurance was associated with an increase (IRR = 1.29, p = 0.007), while employer- or union-sponsored insurance was associated with a decrease in mental health care utilization (IRR = 0.54, p < 0.001, p < 0.001). Pre-existing comorbidities greatly increased the number of mental health care visits (one comorbidity: IRR = 5.49, two or more: IRR = 10.4, p < 0.001).

Conclusion

Our study reveals a significant decrease in mental health care utilization and the diverse experiences of mental healthcare among PLWH during the COVID-19 pandemic. These findings underscore the importance of addressing disparities in mental health care access, particularly during public health emergencies, and suggest the need for tailored interventions to meet the mental health care needs of PLWH.

Key Points

Question

How did the COVID-19 pandemic affect mental health care utilization among people living with HIV (PLWH)? What are the factors associated with mental care health utilization among PLWH across both the pre-pandemic and pandemic periods?

Findings

Real-world data from a nationwide cohort of 4,575 PLWH identified from the All of Us program in the United States between March 2018 and March 2022 were used to investigate the effect of COVID-19 pandemic on mental health care utilization (i.e., the yearly count of mental healthcare visits). There was a considerable decrease in mental health care utilization during the pandemic (2020-2022) compared to the pre-pandemic period (2018-2020). Factors associated with higher mental health care utilization during the pandemic were the experience of COVID-19 infection, being middle-aged, Medicaid health coverage, and having comorbidities. Black African American participants, those with employer- or union health insurance, and high annual income (>$35,000), had lower mental health care utilization.

Meaning

Our study highlights the diverse and unequal experiences of PLWH during the pandemic, with variations in mental health care utilization over time and across different disadvantaged subgroups. These findings underscore the need for timely and targeted mental health care services and delivery in future public health crises.