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Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the
Kristin M Holland1, Christopher Jones1, Alana M Vivolo-Kantor1
1National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
The COVID-19 pandemic saw initial decreases in emergency department visits for mental health, overdose, and violence, but rates increased later. This highlights shifts in care-seeking behaviors during public health crises.
Area of Science:
- Public Health
- Epidemiology
- Emergency Medicine
Background:
- The COVID-19 pandemic and its associated mitigation measures have had profound social and economic impacts.
- These impacts may significantly affect mental health, suicidal behavior, substance use, and violence.
- Understanding these effects on emergency department (ED) utilization is crucial for public health response.
Purpose of the Study:
- To analyze changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdoses (ODs), and violence during the COVID-19 pandemic.
- To compare ED visit data before and during the pandemic to identify trends.
- To assess the impact of the pandemic on specific outcomes like opioid overdoses, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN).
Main Methods:
- A cross-sectional study utilizing data from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program (NSSP).
- The NSSP dataset covers approximately 70% of US ED visits across more than 3500 EDs in 48 states and Washington, DC.
- Analysis included weekly ED visit counts and rates for MHCs, SAs, all drug ODs, opioid ODs, IPV, and SCAN from December 30, 2018, to October 10, 2020, stratified by sex.
Main Results:
- Total ED visit volume decreased following the implementation of COVID-19 mitigation measures.
- Weekly ED visit counts for all studied outcomes initially decreased in late March 2020.
- However, ED visit rates for SAs, all ODs, and opioid ODs were significantly higher in mid-2020 compared to 2019, while IPV and SCAN visits were lower.
Conclusions:
- The COVID-19 pandemic has led to significant shifts in emergency department care-seeking behaviors.
- Findings underscore the need to integrate mental health, substance use, and violence screening and prevention into public health crisis response.
- Proactive integration of these services is essential for managing health outcomes during pandemics.
Importance:
The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence.
Objective:
To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), and violence outcomes during the COVID-19 pandemic.
Design, Setting, And Participants:
This cross-sectional study used data from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program to examine national changes in ED visits for MHCs, SAs, ODs, and violence from December 30, 2018, to October 10, 2020 (before and during the COVID-19 pandemic). The National Syndromic Surveillance Program captures approximately 70% of US ED visits from more than 3500 EDs that cover 48 states and Washington, DC.
Main Outcomes And Measures:
Outcome measures were MHCs, SAs, all drug ODs, opioid ODs, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN) ED visit counts and rates. Weekly ED visit counts and rates were computed overall and stratified by sex.
Results:
From December 30, 2018, to October 10, 2020, a total of 187 508 065 total ED visits (53.6% female and 46.1% male) were captured; 6 018 318 included at least 1 study outcome (visits not mutually exclusive). Total ED visit volume decreased after COVID-19 mitigation measures were implemented in the US beginning on March 16, 2020. Weekly ED visit counts for all 6 outcomes decreased between March 8 and 28, 2020 (March 8: MHCs = 42 903, SAs = 5212, all ODs = 14 543, opioid ODs = 4752, IPV = 444, and SCAN = 1090; March 28: MHCs = 17 574, SAs = 4241, all ODs = 12 399, opioid ODs = 4306, IPV = 347, and SCAN = 487). Conversely, ED visit rates increased beginning the week of March 22 to 28, 2020. When the median ED visit counts between March 15 and October 10, 2020, were compared with the same period in 2019, the 2020 counts were significantly higher for SAs (n = 4940 vs 4656, P = .02), all ODs (n = 15 604 vs 13 371, P < .001), and opioid ODs (n = 5502 vs 4168, P < .001); counts were significantly lower for IPV ED visits (n = 442 vs 484, P < .001) and SCAN ED visits (n = 884 vs 1038, P < .001). Median rates during the same period were significantly higher in 2020 compared with 2019 for all outcomes except IPV.
Conclusions And Relevance:
These findings suggest that ED care seeking shifts during a pandemic, underscoring the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises.
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