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.
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- 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.
Srdjan Randjelovic // Shutterstock
- 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.
Emma Rubin // Stacker
This story originally appeared on CirrusMD and was produced and distributed in partnership with Stacker Studio.
Treadmills have always been one of the most popular pieces of at-home workout equipment, but when gyms shut down in 2020, demand for a home treadmill went through the roof. As such, most home fitness brands have responded by developing better, more advanced models than their predecessors. Many of the best home treadmill options now have smart features, like full integration with streaming services, preset workouts and access to live workout programs with live incline and decline. Other manufacturers skipped the bells and whistles, and they focused on the running deck — developing advanced cushioning for improved shock absorption and biomechanically correct belts that help simulate the feel of outdoor running.
Because every treadmill user has different needs and goals, we’ve included a variety of both categories on this list. We considered factors like design, incline (and decline), speed, price and size while making sure that no matter which home treadmill running machine you choose, you’ll still get a good machine that you’ll be happy with. That’s right, even the cheap treadmill on this list is a quality treadmill.
If you’re looking to get a great cardio workout at home, consider one of CNET’s three favorite treadmills for 2021.
Best treadmill overall
Bowflex Treadmill 22
The Treadmill 22 is the latest and most advanced model from Bowflex, and it’s designed to please (mostly) everyone. Built like an absolute tank, this treadmill has a 4-horsepower motor, a 22-inch-wide by 60-inch-long running path and Comfort Tech deck cushioning that helps absorb shock even at higher running-deck speeds. It has the largest incline range on this list, going from minus 5% decline up to a 20% incline to simulate running up and down hills, and supports the highest weight (400 pounds).
It also has an adjustable 22-inch touchscreen that allows you to follow along with trainer-led workouts (via the JRNY, which requires a subscription) or lets you stream your favorite shows from a handful of popular streaming services. But before ordering this treadmill, make sure you have the space. At 85 inches long, 39.6 inches wide and 70 inches tall, it’s fairly large, but it does have a SoftDrop folding system that reduces its total footprint by more than 40%.
Best smart treadmill
The NordicTrack Commercial 2950 is equipped with a 4.25 continuous horsepower commercial motor. (NordicTrack/CNET/TNS)
NordicTrack Commercial 2950
The NordicTrack Commercial 2950 got a redesign for 2021, and the attention to customer feedback shows. This version is equipped with a 4.25-continuous-
horsepower commercial motor and a 22-inch deck that sits on top of 2.5-inch precision nonflex rollers for frictionless movement, even at higher workout speeds. The RunnersFlex cushioning in the deck allows you to choose between a real road-feel or engaging dampers that soften impact on your joints and reduce the risk of injury.
Like the Bowflex, this treadmill has an ultra-large 22-inch touchscreen, but one thing that gives the NordicTrack an edge over the others is the live control offered through its iFit subscription. During live workouts, the treadmill will automatically adjust from a minus 3% decline to a 15% incline to simulate whatever you’re following along with on the screen. The iFit membership is a (worthwhile) additional monthly cost, but if you purchase this machine directly from the site, you’ll get a free monthly membership.
At a retail price of $2,800, the NordicTrack treadmill is one of the most expensive options on this list, so you’ll have to figure out what’s important to you — a more intense manual workout or interaction with trainers and extra smart features.
Best budget-friendly smart treadmill
ProForm Pro2000 has a 10-inch smart touchscreen embedded right into the console so you can follow along with trainers as you run while simultaneously tracking your calories, speed and heart rate.(Best Buy/CNET/TNS)
Another option from ICON Health & Fitness — the parent company of NordicTrack — this treadmill is a more budget-friendly option that still gives you access to iFit integration, if that’s what you’re looking for. The ProForm Pro has a 10-inch smart touchscreen embedded right into the console so you can follow along with trainers as you run while simultaneously tracking your calories, speed and heart rate.
At minus 3% decline to 12% incline, it has a narrower incline range than the NordicTrack and a slightly less powerful 3.25-continuous-horsepower motor, but it’s more than sufficient for most runners (or walkers). The 20-inch tread belt is equipped with ReBound Pro Cushioning, ProForm’s patented shock-absorbing system that reduces impact and puts less stress on your feet, ankles, hips and knees.