(98) Predispositions of Living with Disability During COVID-19

Introduction:
Adults living with disability comprise over 25% of the U.S. adult population and suffer from an increased risk of developing associated conditions, frequently in the form of mental illness and substance use. Adults in this subgroup report depression and anxiety, decreased access to healthcare, and increased health-risk behaviors compared to the general population, making them a high-risk population for substance addiction, mental health deterioration, and overall susceptibility to infection during COVID-19. In order to better elucidate upon associations of comorbidities for disabled American adults, the COVID-19 Outbreak Public Evaluation (COPE) Initiative performed a self-reported cross-sectional survey study to screen for substance use, mental health, and healthcare access in this population since the COVID-19 pandemic began.

Methods:
In the period between February 16, 2021 to March 8, 2021, the 8,475 eligible adults sampled to match the 2019 US Census were invited to respond to an electronic survey to screen for disability, symptoms of anxiety and depression, suicidal ideation, pre-pandemic and past month substance use, and access to healthcare during the pandemic. Informed consent was provided electronically by respondents.

Results:
Out of 5119 respondents, or 62.1% of the adults surveyed, 32.2% reported living with at least one disability. Of these individuals, 38.8% reported new or increased substance use, 56.6% reported symptoms of depression/anxiety, and 30.6% reported severe suicidal ideation. Of the respondents who did not report a disability, 17.5% reported new or increased substance use, 28.7% reported symptoms of depression/anxiety, and 8.3% reported severe suicidal ideation. Further analysis of data revealed that adults with disabilities reported increased alcohol use compared to non-disabled respondents and nearly twice the past-month usage of substances like methamphetamines, non-opioid prescription drugs, and marijuana. Past month usage of substances like cocaine and illicit opioid use was found to have an even more significant difference, being nearly three times greater compared to adults who didn’t report a disability.

Discussion:
This study establishes new screening data from disabled and non-disabled US adults during the COVID-19 pandemic. It shows a clear disparity in nearly all categories of substance use and mental health outcomes, highlighting the vulnerability of this patient population amid the ongoing global pandemic. Increasing clinician access to prescription drug surveillance programs, patient counseling, and accessibility of substance use care and mental health resources for disabled Americans will serve crucial in mitigating this trend of negative public health outcomes.

References: 1) Cree, Robyn A., et al. “Frequent Mental Distress among Adults, by Disability Status, DISABILITY Type, and Selected Characteristics — United States, 2018.” MMWR. Morbidity and Mortality Weekly Report, vol. 69, no. 36, 2020, pp. 1238–1243., https://doi.org/10.15585/mmwr.mm6936a2.

2) Ornell F, Moura HF, Scherer JN, Pechansky F, Kessler FHP, von Diemen L. The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment. Psychiatry Res. 2020 Jul;289:113096. doi: 10.1016/j.psychres.2020.113096. Epub 2020 May 13. PMID: 32405115; PMCID: PMC7219362.

3) Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:882–887. DOI: https://dx.doi.org/10.15585/mmwr.mm6732a3external icon.

Diversity, Equity, and Inclusion: Americans with disability constitute nearly 25% of the adult population. During the ongoing global pandemic, this population has seen statistically significant rises in substance use of all domains and mental health deterioration compared to non-disabled population. While numerous factors account for this sharp increase, a greater emphasis is clearly needed in providing substance abuse treatment and mental health resources to this population. This study reveals data which is invaluable to clinicians to help mitigate the gap this pandemic has created.