Mental Health Emergency Department Visits Have Surged in the US Since the Onset of COVID-19

A cross-sectional study identified an increase in emergency department (ED) visits related with mental health (MH) since the beginning of the COVID-19 pandemic. These findings were published in JAMA Psychiatry.

Investigators with the United States Centers for Disease Control and Prevention (CDC) examined electronic medical records from EDs participating in the National Syndromic Surveillance Program (NSSP). The number of patients who visited an ED at >3600 centers for 10 MH disorders between January 2019 and August 2021 were evaluated for demographic features. ED visits (N=107,761,319) were stratified by periods of time corresponding with peaks of infection associated with the Delta variant and compared with the corresponding weeks during the prepandemic period.

The majority of the patient population were women (56%) aged 25 to 49 years (55%).

In general, there was a decline in ED visits in March 2020, increasing in July 2020, but not returning to prepandemic levels.

Between February 14, 2021, and March 13, 2021, after a peak in cases, the proportion of ED visits for MH conditions associated with tics increased by 11.3%, eating-related issues by 11.1%, obsessive-compulsive symptoms by 9.8%, disruptive behavioral impulse by 9.5%, and schizophrenia spectrum by 5.2%. The remaining conditions (anxiety, depression, bipolar, trauma- or stressor-related, and attention-deficit/hyperactivity) decreased in prevalence by 3.9%-15.4%.

During this time, the proportion of all MH visits tended to be increased compared with prepandemic, primarily among Asian (4.0%), Black (3.0%), and White (2.0%) populations. Stratified by condition, the largest increase was observed among American Indian or Alaska Native patients for trauma- or stressor-related disorders (42.4%) and the largest decreases were observed for Native Hawaiian or Pacific Islander for anxiety disorders (-38.5%) and Asian patients for schizophrenia spectrum disorders (-31.6%).

After the Delta variant onset (July 18-August 14, 2021), ED visits decreased for MH conditions overall (-17.2%) with the most modest decline observed for tics (-6.4%) and the most prevalent decline observed for depressive (-30.7%) and attention-deficit/hyperactivity (-30.5%) complaints.

During Delta, Native Hawaiian or Pacific Islander (-16.0%), American Indian or Alaska Native (-8.3%), and Hispanic (-0.5%) populations were associated with the greatest decline in ED visits for MH, while Asian (12.0%), White (1.7%), and Black (1.7%) populations sought emergency care more frequently for MH than before the pandemic.

This study was limited by the quality of the data from some NSSP participating centers and the fact that these findings may not be generalizable as the data were not nationally representative.

The study authors concluded, “This epidemiologic cross-sectional study described changes in MH-related ED visits into the Delta variant pandemic period and during and after peaks in US COVID-19 cases. The findings suggest that there were fluctuations in patterns of MH-related ED visits relative to COVID-19 case surges, which differed by race and ethnicity.”

Reference

Anderson KN, Radhakrishnan L, Lane RI, et al. Changes and inequities in adult mental health–related emergency department visits during the COVID-19 pandemic in the US. JAMA Psychiatry. 2022;e220164. doi:10.1001/jamapsychiatry.2022.0164