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Disclosures: The authors report no relevant financial disclosures.
February 04, 2021
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COVID-19 pandemic has shifted ED use related to mental health, substance use, violence

Disclosures: The authors report no relevant financial disclosures.
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The COVID-19 pandemic appeared to shift ED use and priorities for care, particularly related to mental health, substance use and violence risk screening and prevention, according to study results published in JAMA Psychiatry.

Kristin M. Holland

“Previous studies during the pandemic have documented significantly increased levels of psychological stress and violence,” Kristin M. Holland, PhD, MPH, of CDC’s Division of Overdose Prevention at the National Center for Injury Prevention and Control, told Healio Psychiatry.However, few studies have documented trends in mental health, suicide attempts, overdoses and violence-related outcomes before and during the pandemic. To address this gap, we compared 2020 and 2019 ED visit data to understand the impact of the pandemic on six outcomes at the national level. We examined changes in ED visits for mental health conditions, suicide attempts, all drug overdoses, opioid overdoses, intimate partner violence, and suspected child abuse and neglect from the period before the pandemic (2019) to the period after the pandemic (beginning in mid-March 2020) using data from CDC’s National Syndromic Surveillance Program, which covers approximately 70% of U.S. emergency department facilities.”

Holland and colleagues captured 187,508,065 ED visits, of which 6,018,318 included at least one study outcome, between December 30, 2018, and October 10, 2020. Results showed a decrease in total ED visit volume after implementation of COVID-19 mitigation measure in the U.S. beginning on March 16, 2020.

Between March 8, 2020, and March 28, 2020, weekly ED visit counts decreased for all six outcomes; however, they increased beginning the week of March 22, 2020, to March 28, 2020. The researchers compared the median ED visit counts between March 15, 2020, and October 10, 2020, with the same period in 2019 and found that the 2020 counts were significantly higher for suicide attempts, all overdoses and opioid overdoses. They noted significantly lower counts for intimate partner violence ED visits and suspected child abuse and neglect ED visits. For all outcomes except intimate partner violence, median rates during the same period were significantly higher in 2020 vs. 2019.

“We know that the implementation of mitigation measures, such as avoiding crowds and staying 6 feet away from others, are necessary to reduce the spread of COVID-19, but we also know that these mitigation measures can contribute to fear and anxiety and may increase risk for the outcomes we examined,” Holland said. “Fortunately, we also know that death and disability related to mental health conditions, suicidal thoughts and behaviors, substance use, and violence are preventable. In ED settings, brief interventions, such as counseling on safe storage of lethal means of suicide, ensuring naloxone provision, buprenorphine initiation, and screening for intimate partner violence, and linking people to in-person or virtual behavioral health and social support services and medications for opioid use disorder can provide immediate assistance to those in crisis.”