Did patterns of US ED visits and mental health–related ED visits change during the COVID-19 pandemic?

By Dr. Sanchari Sinha Dutta, Ph.D.Jul 17 2023Reviewed by Benedette Cuffari, M.Sc.

A recent study published in JAMA Network Open reports that people without mental health conditions had higher numbers of emergency department visits than those with mental health conditions during the coronavirus disease 2019 (COVID-19) pandemic.

Study: Patterns of US Mental Health–Related Emergency Department Visits During the COVID-19 Pandemic. Image Credit: chrisdorney / Shutterstock.com

Background

The COVID-19 pandemic has caused unprecedented damage to the healthcare and economic sectors worldwide. In addition to the respiratory complications that can arise following infection with the causative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a considerable deterioration in mental and behavioral health conditions has been observed throughout the pandemic, primarily because of pandemic-related restrictions.

According to the World Health Organization (WHO), about 25% induction in the global prevalence of anxiety and depression has been observed during the first year of the COVID-19 pandemic. Likewise, the United States Centers for Disease Control and Prevention (CDC) reports that the proportion of adults with anxiety and depressive symptoms has increased from 36% in 2020 to 41% in 2021.

In the current study, scientists explore the patterns of emergency department visits for mental health and other non-mental health conditions in the United States during the first phase of the COVID-19 pandemic.    

Study design

The CDC National Syndromic Surveillance Program (NSSP) Mental Health Emergency Department visit dataset was used in this cross-sectional study to determine the patterns of emergency department visits for mental health-related and unrelated conditions before and during the COVID-19 pandemic.

The dataset included information about visits solely due to acute mental health crises, as well as visits where mental health conditions were present, along with other reasons. Data were reported from the ten U.S. Department of Health and Human Services (HHS) regions for five 11-week periods.   

Data were analyzed to determine the total number of emergency department visits, the average number of mental health-related emergency department visits, and the average proportion of emergency department visits for mental health conditions.

The 2019 data was regarded as pre-pandemic baseline data. Furthermore, data obtained for corresponding weeks in 2020 and 2021 was used to determine the pattern of changes in emergency department visits.   

Important observations

A total of 1,570 emergency department visits were reported every week across the 10 HHS regions between January 2019 and December 2021. The average number of weekly visits for each region was 126,117, whereas the average number of mental health-related weekly visits for each region was 9,374. The average proportion of visits for mental health conditions was 8%.

During the entire study period, a reduction in the average number of total visits and mental health-related visits was observed in 2020 as compared to that in the pre-pandemic year of 2019. The reduction in the average number of total visits was higher than the average number of mental health-related visits.

The average proportion of emergency department visits for mental health conditions increased from 8% in 2019 to 9% in 2020, followed by a reduction to 7% in 2021. This was primarily due to the average number of total emergency department visits returning to baseline levels to a greater extent than mental health-related visits.

Regarding the pattern of changes by week for each region, a 23% reduction in the average number of mental health-related visits was observed after the declaration of the pandemic in 2020 as compared to that in the same weeks in 2019.

Considering the average number of total visits, a 39% reduction was observed in weeks 12 through 23 of 2020 as compared to 2019. The average number of total visits eventually returned to 2019 levels during weeks 24 to 35 of 2021. However, mental health-related visits did not return to their pre-pandemic baseline levels.

Study significance

The study findings indicate that emergency department visits for non-mental health-related conditions have reduced to a greater extent than mental health-related visits in the first pandemic year as compared to that in the pre-pandemic year.

Although non-mental health-related visits returned to pre-pandemic levels in 2021, this type of reversal has not been observed for mental health-related visits.

Given these findings, scientists suggest that the availability and accessibility of mental health services should be increased in both acute and outpatient settings, especially during public health emergencies like the COVID-19 pandemic.