Mental health, overdose, and violence outcomes and the COVID-19 pandemic

1. From March to October 2020, emergency departments in the United States have experienced a higher rate of visits from mental health related concerns, overdoses, and domestic abuse/violence, compared to the same months in 2019.

2. In the same period, emergency departments have experienced a higher absolute number of visits from mental health concerns and overdoses, but a lower absolute number from domestic abuse/violence.

Evidence Rating Level: 2 (Good)

The COVID-19 pandemic has led to the necessitation of stay-at-home orders and other physical distancing measures. This has been shown to lead to worsening mental health, with 1 in 7 American adults reporting psychological distress in April 2020, compared to 1 in 25 in April 2018. Furthermore, hotlines for domestic violence and child abuse spiked at the pandemic’s onset, which may have been a result of greater time spent with perpetrators of abuse. This cross-sectional study compared the number of mental health, substance use, and domestic violence related emergency department (ED) visits, before and during COVID-19 in the United States. The following factors from ED visits were analyzed: Mental health conditions (MHC), suicide attempts (SA), drug overdose (OD), intimate partner violence (IPV), and suspected child abuse neglect (SCAN). ED visits from December 2018 to October 2020 were analyzed, which amounted to 187,508,065 ED visits from 3500 facilities across the country. The results showed that ED visits across these outcomes decreased from March 8 compared to March 28, 2020 (March 16 was when COVID-19 measures were implemented). However, when comparing the median ED visits from March to October 2020, to the same period in 2019, significant differences were found. The 2020 visit counts were higher for SAs (4940 vs 4656, p = 0.02), all ODs (15,605 vs 13,371, p < 0.001), and opioid ODs specifically (5502 vs 4168, p < 0.001). Contrastingly, ED visit counts were lower for IPV (442 vs 484, p < 0.001) and SCAN (884 vs 1038, p < 0.001). However, although median counts were lower for some outcomes, median rates of ED visits for all of the outcomes were higher in the 2020 period than in the 2019 period: MHCs (2539.9 vs 2150.5, p < .001), SAs (310.8 vs 248.0, p < .001), all drug ODs (940.2 vs 711.1, p < .001), opioid ODs specifically (330.2 vs 222.3, p < .001), and SCAN (439.3 vs 286.3, p < .001). Overall, this study demonstrating that emergency departments during the COVID-19 pandemic have experienced a shift towards mental health, substance use, and domestic violence related visits, further highlighting the importance of robust screening and prevention strategies for these outcomes.

Click to read the study in JAMA Psychiatry

Image: PD

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