Physician Health Care Visits for Mental Health and Substance Use During the COVID-19 Pandemic in Ontario, Canada

Abstract

Importance: Physicians self-report high levels of symptoms of anxiety and depression, and surveys suggest these symptoms have been exacerbated by the COVID-19 pandemic. However, it is not known whether pandemic-related stressors have led to increases in health care visits related to mental health or substance use among physicians.

Objective: To evaluate the association between the COVID-19 pandemic and changes in outpatient health care visits by physicians related to mental health and substance use and explore differences across physician subgroups of interest.

Design, setting, and participants: A population-based cohort study was conducted using health administrative data collected from the universal health system (Ontario Health Insurance Plan) of Ontario, Canada, from March 1, 2017, to March 10, 2021. Participants included 34 055 physicians, residents, and fellows who registered with the College of Physicians and Surgeons of Ontario between 1990 and 2018 and were eligible for the Ontario Health Insurance Plan during the study period. Autoregressive integrated moving average models and generalized estimating equations were used in analyses.

Exposures: The period during the COVID-19 pandemic (March 11, 2020, to March 10, 2021) compared with the period before the pandemic.

Main outcomes and measures: The primary outcome was in-person, telemedicine, and virtual care outpatient visits to a psychiatrist or family medicine and general practice clinicians related to mental health and substance use.

Results: In the 34 055 practicing physicians (mean [SD] age, 41.7 [10.0] years, 17 918 [52.6%] male), the annual crude number of visits per 1000 physicians increased by 27%, from 816.8 before the COVID-19 pandemic to 1037.5 during the pandemic (adjusted incident rate ratio per physician, 1.13; 95% CI, 1.07-1.19). The absolute proportion of physicians with 1 or more mental health and substance use visits within a year increased from 12.3% before to 13.4% during the pandemic (adjusted odds ratio, 1.08; 95% CI, 1.03-1.14). The relative increase was significantly greater in physicians without a prior mental health and substance use history (adjusted incident rate ratio, 1.72; 95% CI, 1.60-1.85) than in physicians with a prior mental health and substance use history.

Conclusions and relevance: In this study, the COVID-19 pandemic was associated with a substantial increase in mental health and substance use visits among physicians. Physician mental health may have worsened during the pandemic, highlighting a potential greater requirement for access to mental health services and system level change.

Figure 1.. Biweekly (14-day) Number of Outpatient Mental Health and Substance Use (MHSU) Visits by Physicians per 1000 Physicians Between March 1, 2017, and March 9, 2021

The vertical yellow column represents the declaration of the COVID-19 pandemic on March 11, 2020. The forecasted numbers and 95% CIs were generated from an autoregressive integrated moving average model, which was specified as (0,0,0) x (0,1,1)₂₆.

Figure 2.. Biweekly (14-day) Number of Outpatient Mental Health and Substance Use (MHSU) Visits by Physicians per 1000 Outpatient All-Cause Physician Visits Between March 1, 2017, and March 9, 2021

The vertical yellow column represents the declaration of the COVID-19 pandemic on March 11, 2020. The forecasted numbers and 95% CIs were generated from an autoregressive integrated moving average model, which was specified as (1,0,1) x (1,1,0)₂₆.