Rates of Mental Health-Related ED Visits Higher During Pandemic

Emergency department (ED) visit rates for mental health conditions, suicide attempts, drug and opioid overdoses, intimate partner violence, and child abuse and neglect were higher during the first 6 months of the COVID-19 pandemic in the United States than they were during the same period the previous year, according to a study published online in JAMA Psychiatry.

“To our knowledge, this cross-sectional study is the first to provide hospital encounter data demonstrating a potential association between the pandemic and mental health conditions, suicide attempts, overdoses, and violence outcomes at the national level,” wrote researchers from the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

“Fear and worry about the COVID-19 pandemic, combined with implementation of mitigation measures and resultant social isolation and economic distress, stand to markedly impact mental health conditions, suicide attempts, drug overdoses, and violence.”

Researchers analyzed data from the CDC’s National Syndromic Surveillance Program, which captures nearly 70% of US emergency department visits—from more than 3500 emergency departments in 48 states and Washington, DC. The study included almost 190 million emergency department visits from December 30, 2018, to October 10, 2020.

Examining How the Pandemic Has Affected the Mental Health of Frontline Workers

Emergency department visit counts were consistently down at the start of the pandemic, when a national emergency and stay-at-home orders were declared, according to the study. Yet, when researchers looked at median weekly visit counts for the period between March 15, 2020, and October 10, 2020, compared with the same period a year before, they found significantly higher counts for emergency department visits for suicide attempts (4940 in 2019 vs 4656 in 2020), all overdoses (15,604 vs 13,371), and opioid overdoses (5502 vs 4168). Meanwhile, median weekly visit counts for intimate partner violence decreased by 42 visits during the 6-month period in 2020, while median visit counts for suspected child abuse and neglect were down by 154.

“Of importance, this study demonstrates that people still visited emergency departments for these outcomes and that, for the most part, visits for these outcomes decreased to a lesser extent than overall emergency department visits,” researchers wrote, “suggesting that mental health conditions, suicide attempts, overdoses, and violence remain a concern during the COVID-19 pandemic.”

Indeed, when researchers analyzed rates of emergency department visits associated with an outcome, all of the following were higher in 2020 compared with 2019: mental health conditions, suicide attempts, overdoses, intimate partner violence, and child abuse and neglect.

“These findings suggest that emergency department care seeking shifts during a pandemic, underscoring the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises,” researchers wrote.

—Jolynn Tumolo

Reference

Holland KM, Jones C, Vivolo-Kantor AM, et al. Trends in US emergency department visits for mental health, overdose, and violence outcomes before and during the COVID-19 pandemic. JAMA Psychiatry. 2021 February 3;[Epub ahead of print].