One-quarter of adults with symptoms of depression or anxiety reported needing mental health counseling but were unable to obtain it during the pandemic, according to a new study.

The findings come from a survey of nearly 70,000 adults in December 2020, HealthDay reports. Women were almost twice as likely as men to report having an unmet need for mental health counseling. Young adults were more likely than older adults to report not being able to access mental health counseling during the pandemic.

“Social isolation, COVID-related anxiety, disruptions in normal routines, job loss and food insecurity have led to a surge in mental illness during the pandemic,” lead author Jason Nagata of the University of California, San Francisco said in a news release. “Patients have experienced several [months-long] waitlists for counseling or therapy during the pandemic. Policymakers should include more funding for mental health services as part of pandemic relief legislation and extend the use of telehealth to address the widespread unmet mental health needs of Americans.”