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Americans’ mental health became collateral damage in the country’s fight against the COVID-19 virus—a more conspicuous physical enemy, perhaps, than anxiety or depression. At its peak over the last year and a half, more than 40% of adults reported anxiety or depression symptoms—four times the pre-pandemic rate.

But even in the decade before the emergence of the coronavirus, Americans were becoming more anxious and depressed. According to 2018 data collected by Blue Cross Blue Shield, major depression was the second most impactful health condition for commercially insured Americans, second only to high blood pressure. Between 2008 and 2018, anxiety became more prevalent across nearly all demographic subgroups, suggesting serious deficiencies in both cultural attitudes toward mental health, and access to the health care systems meant to protect an individual's overall wellbeing.

Social isolation, worry over economic stability and physical health, grief, fear, and uncertainty about the future are just some of the factors exacerbating depression and anxiety symptoms for many Americans. With the increasing prevalence of these behavioral health concerns across the population, the U.S. is also experiencing a shortage of mental health professionals to meet the rising demand.

According to a 2020 report by the Kaiser Family Foundation, more than 119 million Americans live in regions designated as mental health professional shortage areas, or HPSAs. Just over 25% of the need for mental health professionals is being met nationally.

Telehealth services are one emergent adaptation with staying power beyond the scope of the pandemic that can address this critical need at a more affordable cost. In a 2021 analysis, McKinsey found that telehealth utilization, across all medical services, increased 38 times from the pre-pandemic baseline. Of 23 medical specialities, psychiatry has the highest telehealth adoption rate with 50% of visits between April 2020 and February 2021 conducted virtually.

CirrusMD conducted a physician-led study to better understand how telemental health services can affect depression and anxiety outcomes. Study participants had access to behavioral health care via CirrusMD's telehealth platform beginning in June 2020 and were not required to self-diagnose as having behavioral health issues beforehand. The study was conducted over six months, with individual patients treated for an average of 8.1 weeks to analyze how telehealth could impact treatment for depression and anxiety. Patients' scores are captured through the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7).  Participants were limited to people seeking pharmacotherapy treatment. Diagnoses scores from the PHQ-9 and the GAD-7 are clinically recognized.

The PHQ9 assesses symptom severity based on total score where 5, 10, 15, and 20 are thresholds of mild, moderate, moderately severe, and severe depression, respectfully. The GAD7 assesses symptom severity based on total score of 5, 10, and 15, representing mild, moderate and severe symptoms, respectfully. Patient outcomes were determined to be clinically significant if the patient experienced a 5-point or greater reduction in either score.

Read on to learn more about the outcomes of CirrusMD’s telemental health treatment of anxiety and depression in participants with various forms of insurance coverage. Charts have been included at the end of the piece that capture the findings of the study.

- Reduction in PHQ-9 scores after six months: 10.5 (clinically significant)

--- Initial PHQ-9 score, average: 17.27 (moderately severe)

--- PHQ-9 score after treatment, average: 6.77 (mild)

- Reduction in GAD-7 scores after six months: 6.42 (clinically significant)

--- Initial GAD-7 score, average: 14.71 (severe)

--- GAD-7 score after treatment, average: 8.29 (mild)

Commercial insurance participants experienced a clinically significant reduction in both depression and anxiety scores and the greatest PHQ-9 score reduction of any insurance group. The average PHQ-9 score among commercially insured participants after six months of telehealth treatment is 6.77, indicating partial remission—or a final PHQ-9 score below 10—and improvement of symptom categorization from severe to mild. Roughly 10% of Americans have commercial insurance, also referred to as private, direct-purchase, and non-group insurance. Commercial plan holders typically either do not qualify for public programs like Medicaid, cannot receive insurance through their employer, or require insurance not offered through other available channels.

- Reduction in PHQ-9 scores after six months: 11.91 (clinically significant)

--- Initial PHQ-9 score, average: 17.72 (moderately severe)

--- PHQ-9 score after treatment, average: 5.81 (mild)

- Reduction in GAD-7 scores after six months: 4.83 (scores above 5 are considered clinically significant)

--- Initial GAD-7 score, average: 15.09 (severe)

--- GAD-7 score after treatment, average: 10.26 (moderate)

At 17.72, Medicaid users had the highest average initial PHQ-9 scores, expressing moderately severe to severe symptoms of depression. After telehealth treatment, and concurrent pharmacotherapy, participants saw a clinically significant decrease in PHQ-9 scores. Medicaid holders did not see meaningful results from telehealth treatment for anxiety, missing the 5-point reduction threshold to be considered clinically significant. Just under 20% of the population is covered by Medicaid, according to the U.S. Census Bureau. This public health insurance program provides affordable coverage and critical health care access to some of the most vulnerable populations, including those over age 65, low-income families, and people with disabilities.

- Reduction in PHQ-9 scores after six months: 8.32 (clinically significant)

--- Initial PHQ-9 score, average: 17.21 (moderately severe)

--- PHQ-9 score after treatment, average: 8.89 (mild)

- Reduction in GAD-7 scores after six months: 7.16 (clinically significant)

--- Initial GAD-7 score, average: 15.142 (severe)

--- GAD-7 score after treatment, average: 7.982 (mild)

Uninsured participants improved from exhibiting moderately severe-severe depression symptoms to mild symptoms over the course of the study. The group saw clinically significant reductions in both depression and anxiety scores. As of 2019, roughly 29 million people in the United States were uninsured, citing prohibitive costs and registration barriers. Due to a lack of affordable care options, uninsured individuals— many of the same demographic subgroups at risk of developing mental health disorders—will not seek out preventative or follow-up care. Telehealth companies have the potential to greatly improve access to critical mental health resources for those who need it most, like uninsured populations.

- Reduction in PHQ-9 scores after six months: 6.33 (clinically significant)

--- Initial PHQ-9 score, average: 14.85 (moderately severe)

--- PHQ-9 score after treatment, average: 8.52 (mild)

- Reduction in GAD-7 scores after six months: 7.18 (clinically significant)

--- Initial GAD-7 score, average: 14.99 (severe)

--- GAD-7 score after treatment, average: 7.81 (mild)

Employer-sponsored insurance participants saw clinically significant improvement of both anxiety and depression symptoms over the course of the study. According to the U.S. Census Bureau, roughly 55% of the population is covered by employer-sponsored insurance, or ESI. Limited by employers’ one-size-fits-all offerings, people with ESI may face greater difficulty finding adequate in-network care to treat behavioral disorders like anxiety or depression. Some even posit that ESI will lose its prevalence in the marketplace as more workers seek out insurance coverage prioritizing customization and flexibility.

Many of the findings around telehealth have significantly impacted those with anxiety and depression. While telehealth is a newer and less traditional form of medical care, it opens up the possibilities for greater accessibility. Between the COVID-19 pandemic, access to reliable transportation, and other accessibility barriers, telehealth can be a life-changing option for those suffering from anxiety and/or depression.

This story originally appeared on CirrusMD and was produced and distributed in partnership with Stacker Studio.    

Employees are working longer hours than they ever have, and the effects are starting to show.

Higher absentee levels, abandoned vacation time, and reduced productivity are all byproducts of an overtaxed workforce. Prioritizing mental health has taken on new relevance in today’s corporate world, though many wonder how to do this amid strict deadlines, unmanageable workloads, and overbooked personal lives.

Many companies have begun integrating policies to support a healthy work-life balance, indicating an acknowledgment that the most productive employees are often the most supported and least burnt out. These initiatives include robust wellness programs and educational offerings or expanded staffing to manage bandwidths.

But even if your employer hasn't rolled out programs like these, there are simple steps each of us can take to protect our emotional, psychological, and social well-being. Patient-driven telehealth company Ro compiled a list of 10 ways employees can prioritize their mental health while working, using information from health experts, human resource managers, and counselors.

These simple steps are designed to help prevent some of the major side effects of increased workloads and unending workdays, whether anxiety and stress or depression. Keep reading to learn more about setting clear boundaries and carving out time for yourself during every workday.

In a survey of 7,500 full-time employees, a full 44% reported feeling burned out sometimes while nearly a quarter reported feeling burned out always or often, according to a 2018 Gallup study. Limits and boundaries in the workplace are especially important for those who work from home, as the lines between work and home life often blur.

Setting boundaries can be as simple as making sure not to connect your phone to your work email or to avoid checking work emails between certain evening hours to shift focus to family or personal time. Realizing when and how to delegate responsibilities is also a necessity when boundary-setting.

Breaks are an important way to recharge during the workday, and no break is more important than the lunch hour (or half-hour). A Tork survey released in 2021 found that nearly 40% of workers take breaks occasionally, rarely, or never. There's a major gender divide, too: Women are twice as likely as men to not take breaks during the workday.

Many say they feel guilty stepping away, but the benefits of a lunch break are clear and include an increase in productivity, a boost to creativity, and a reduction in stress. Not taking lunch breaks can actually have a negative impact on employees and employers.

Not only does learning to say no help to set boundaries and limits, but it also helps to prioritize essential work tasks. Employees often overextend themselves at work by saying yes to everything, which can lead to burnout.

Those who have trouble saying no are more likely to suffer from burnout, stress, and depression, according to research from the University of California in San Francisco in 2013. With so much work and so little time, employees have to learn that saying no can not only be OK—it can be one of the most effective ways to prioritize mental health at work.

Some tips to saying no properly include being polite and brief, but firm; being honest; offering an alternative; and remembering that saying no does not make you a lazy or bad employee.

Many corporate workplaces have gyms or offer weekly workout classes like yoga. For those who work from home, there are apps featuring everything from tai chi to five-minute power workouts, and many offer free trials.

Sitting behind a desk is a sedentary activity, and lack of movement has all sorts of negative effects on not just physical health, but mental health as well. Being sedentary can increase the odds of depression and elevate anxiety levels. Doing a workout is not the only way to incorporate movement into your workday—taking a brief walk around the block works just as well.

Each year, North Americans work harder and longer. Nearly 800 million vacation days were left unused by American employees in 2018, up 9% from 2017, according to research from the U.S. Travel Association, Oxford Economics, and Ipsos.

The same research found that those who plan their vacations use more vacation time to travel and are happier in several areas, including their personal relationships and overall well-being. Either way, vacation time is an important way to recharge and find enjoyment outside of the workplace.

One study published in 2013 by the Journal of Environmental Psychology found a correlation between decorated workspaces and heightened productivity and energy.

Bringing a small lamp from home or a few favorite books to display and read on your lunch break offers a way to make office surroundings more comfortable. Inspiring quotes, color-coded accessories, family pictures, or a plant can all help to boost creativity and productivity while elevating your mood and making your workspace feel more like home.

While co-workers don’t have to be best friends, it is important to foster positive relationships at work. Those who engage in small talk perform better on cognitive tests and showed an increase in executive functioning, according to a study published in 2010 by researchers at the University of Michigan.

Whether making small talk when getting that morning cup of coffee or chatting up a colleague while waiting for the 4 p.m. conference call to begin, having a brief discussion can bolster mood and even serve as a small break from the monotony of the workday. Establishing workplace relationships can improve overall quality of life according to a study conducted by Globoforce and published in 2014. That study also found that having a work friend increased workers’ commitment to their employer.

There are several advantages to throwing on the radio or streaming a well-thought-out playlist at work. Listening to music helps with focus, absorption of information, reduces stress and anxiety, and boosts mood, all of which help to improve mental health. It also stimulates creativity and brings an increase in productivity, though not all music is good for all types of work.

Popular music may interfere with complicated tasks, while classical music can help with focus. One important rule to remember when it comes to listening to music is that not everyone has the same taste. Avoid upsetting co-workers by bringing in earbuds to listen at a respectful volume.

Whether it’s a professional development course offered online or through your workplace or a college course your company will reimburse, continuing education opportunities keep the mind sharp and help sustain interest at work by offering additional knowledge. This increase in knowledge often offers opportunities for advancement.

Approximately 50% of employers offer some type of undergraduate assistance, and 53% offer assistance for graduate degrees, according to a 2017 Employee Benefits Survey by the Society for Human Resource Management. Many companies have corporate accounts with online services like Coursera, which provides educational enrichment through online courses and certifications. To figure out what companies offer, employees should reach out to human resources.

Studies have shown that clutter can contribute to heightened anxiety and stress, decreased productivity, and feelings of losing control. A few minutes a day devoted to organization can work wonders in the workplace, and filing systems don’t have to be complex to be effective.

The effects of clutter on the body and mind are so significant that they can even cause people to overindulge in food and create other unhealthy habits. An Express Employment Professionals study found that disorganization causes significant loss of actual work time, with 57% of participants admitting to losing six work hours per week due to disorganization.

This story originally appeared on Ro and was produced and distributed in partnership with Stacker Studio.