Changes in trends of visits and service utilization by mental health patients in the community: a twelve-year study in Israel

Background: Mental health conditions, notably depression and anxiety, affect one in eight individuals globally, with 17.6% of Israelis reporting mood and anxiety disorders. Rising multimorbidity in primary care, with poorer health outcomes when combined with depression or anxiety, poses a challenge for primary care physicians (PCPs). This study aimed to track patient visits for depression and anxiety to PCPs over a period that included a national mental health reform, the COVID-19 pandemic, and the Iron Swords war, to characterize these patients and describe their health care service utilization. Methods: This observational study used data from Maccabi Healthcare Services, which serves over 2.7 million people in Israel. The study included patients aged eighteen and older who visited a PCP between 2013 and 2024. Patients were categorized into three groups for each year: depression/anxiety, severe mental illness (SMI), and a comparison group. ANOVA was used to compare mean PCP visit rates, and logistic regression to compare service utilization between the three groups. Results: Depression and anxiety patients were mainly female, older, of lower socioeconomic status, and had chronic illness. From 2013 to 2024, the number of patients increased, particularly during the COVID-19 pandemic and the Iron Swords war. Medical service utilization among these patients was more frequent than in the general population, averaging 14.2 primary care visits per year compared to 9.8, higher rates of emergency room and secondary care visits, hospitalizations, and polypharmacy. Conclusion: The study underscores the increasing impact of mental health conditions on primary care services in Israel between 2013–2014, along with the higher utilization rates of health services among anxiety and depression patients. The findings highlight the need for comprehensive care provided by primary care physicians (PCPs) who are proficient in both physical and mental health. Additionally, they stress the importance of enhancing access to community-based mental health interventions. Policy changes are recommended to improve the availability of mental health therapists and enhance PCP training programs to equip physicians better to treat patients with depression and anxiety.