Emergency departments (EDs) in the United States saw more visits for mental health conditions, suicide attempts, overdoses, and violence during the SARS-CoV-2 pandemic than they did in 2019, according to a study published in JAMA Psychiatry.

Previous studies point to increases in poor mental health, suicidal behavior, substance abuse, and violent behavior during the pandemic. A litany of factors, including social isolation, fear of contracting the virus, economic stress, and reduced access to mental health treatment, are to blame.

Researchers wanted to better understand the impact of COVID-19 on mental health and related outcomes and changes to ED visit rates.


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The cross-sectional study used data from the National Syndromic Surveillance Program of the Centers for Disease Control and Prevention (CDC), which captures about 70% of ED visits throughout the United States. The researchers examined national changes in ED visits for mental health conditions, suicide attempts, overdose, and violence from December 30, 2018 to October 10, 2020.

The analysis captured more than 187 million visits. A little over 6 million visits included at least 1 study outcome.

The number of total ED visits decreased starting March 16, 2020, when mitigation measures began, but rose beginning March 22. While drug overdoses decreased slightly from March 29 to April 11, 2020 compared with the same period in 2019, weekly overdose counts ranged from1% to 45% higher in 2020 compared with 2019.

The mean weekly ED visit rate for all outcomes was greater in weeks 12 to 41 of 2020 compared with the same period in 2019.

ED visit counts and rates for all outcomes began to decrease near the end of the study period, in parallel with total ED visits. This was when stay-at-home orders were lifted across most of the United States.

“This decrease could be indicative of a number of issues: the public resuming normal health-seeking behaviors, the lifting of stay-at-home orders and a perception of increased safety and reduced risk of COVID-19 spread, or the public’s adjustment to mitigation measures or ability to identify coping strategies,” the researchers said.

A limitation of the study is the fact that data are not nationally representative as results don’t take into account EDs that did not participate in the CDC program.

“Past research on public health crises suggests it is likely that COVID-19 and associated mitigation measures will have impacts that far outlast the short-term emergency period and that may intensify during periods of increased transmission,” the researchers said.

“This study’s findings underscore the need for continued mental health condition, suicide, overdose, and violence prevention messages, screening, and interventions at the individual, relationship, community, and societal levels, as well as longitudinal surveillance to track the long-term impacts of COVID-19.”

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. Published online February 3, 2021. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2020.4402