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. 2023 Jul 3;6(7):e2322720.
doi: 10.1001/jamanetworkopen.2023.22720.

Patterns of US Mental Health-Related Emergency Department Visits During the COVID-19 Pandemic

Sofia Villas-Boas  1 , Scott Kaplan  2 , Justin S White  3 , Renee Y Hsia  4
Affiliations

Patterns of US Mental Health-Related Emergency Department Visits During the COVID-19 Pandemic

Sofia Villas-Boas et al. JAMA Netw Open. .

Abstract

Importance: Numerous studies have shown that the prevalence of mental health (MH) conditions worsened during the COVID-19 pandemic. Further research is needed on this phenomenon over a longer time horizon that considers the increasing trend in MH conditions before the pandemic, after the pandemic onset, and after vaccine availability in 2021.

Objective: To track how patients sought help in emergency departments (EDs) for non-MH and MH conditions during the pandemic.

Design, setting, and participants: This cross-sectional study used administrative data on weekly ED visits and a subset of visits for MH from the National Syndromic Surveillance Program from January 1, 2019, to December 31, 2021. Data were reported from the 10 US Department of Health and Human Services (HHS) regions (Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle) for five 11-week periods. Data analysis was performed in April 2023.

Main outcomes and measures: Weekly trends in total ED visits, mean MH-related ED visits, and proportion of ED visits for MH conditions were investigated to determine changes in each measure after the pandemic onset. Prepandemic baseline levels were established from 2019 data, and time trends of these patterns were examined in the corresponding weeks of 2020 and 2021. A fixed-effects estimation approach with weekly ED region data by year was used.

Results: There were 1570 total observations in this study (52 weeks in 2019, 53 weeks in 2020, and 52 weeks in 2021). Statistically significant changes in non-MH and MH-related ED visits were observed across the 10 HHS regions. The mean total number of ED visits decreased by 45 117 (95% CI, -67 499 to -22 735) visits per region per week (39% decrease; P = .003) in the weeks after the pandemic onset compared with corresponding weeks in 2019. The mean number of ED visits for MH conditions (-1938 [95% CI, -2889 to -987]; P = .003) decreased significantly less (23% decrease) than the mean number of total visits after the onset of the pandemic, increasing the mean (SD) proportion of MH-related ED visits from 8% (1%) in 2019 to 9% (2%) in 2020. In 2021, the mean (SD) proportion decreased to 7% (2%), and the mean number of total ED visits rebounded more than that of mean MH-related ED visits.

Conclusions and relevance: In this study, MH-related ED visits demonstrated less elasticity than non-MH visits during the pandemic. These findings highlight the importance of addressing the provision of adequate MH services, both in acute and outpatient settings.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Hsia reported receiving grants from the National Institute on Aging, the National Institute on Minority Health and Health Disparities, and the National Heart, Lung, and Blood Institute outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Patterns of Emergency Department (ED) Visits and Mental Health (MH)–Related ED Visits Across 10 US Department of Health and Human Services Regions in 2019, 2020, and 2021
A, Total number of ED visits. B, Number of MH-related ED visits. C, Proportion of ED visits for MH conditions.
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Comment in

References

    1. Blanchflower DG, Bryson A. Covid and mental health in America. PLoS One. 2022;17(7):e0269855. doi:10.1371/journal.pone.0269855 - DOI - PMC - PubMed
    1. Holingue C, Kalb LG, Riehm KE, et al. . Mental distress in the United States at the beginning of the COVID-19 pandemic. Am J Public Health. 2020;110(11):1628-1634. doi:10.2105/AJPH.2020.305857 - DOI - PMC - PubMed
    1. Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686 - DOI - PMC - PubMed
    1. Darcy AM, Mariano T. Mental health in America: a growing crisis. Psychiatric Times. August 6, 2021. Accessed February 23, 2023. https://www.psychiatrictimes.com/view/mental-health-america-crisis
    1. Villas-Boas SB, White JS, Kaplan S, Hsia RY. Trends in depression risk before and during the COVID-19 pandemic. PLoS One. 2023;18(5):e0285282. doi:10.1371/journal.pone.0285282 - DOI - PMC - PubMed