Acute Mental Health Service Utilization in the Military Health System: A Comparative Analysis of Pre-Pandemic and...

The coronavirus disease 2019 (COVID-19) pandemic led to well-documented surges in psychological distress. Although trends in emergency department (ED) utilization for mental health (MH) needs were studied in the civilian sector during the pandemic's early stages, research on later stages and within the Military Health System (MHS) is limited. This study aimed to examine trends in MH-related ED visits and subsequent inpatient admissions among TRICARE beneficiaries throughout the pandemic.

This retrospective cross-sectional study analyzed administrative healthcare data from the Military Health System Data Repository (MDR) for TRICARE beneficiaries aged 3 and older. Associations between demographic characteristics of MH-related ED visits and subsequent inpatient admissions were compared across 3 periods: pre-pandemic (January 1, 2019-March 10, 2020), acute pandemic (March 11, 2020-July 31, 2021), and post-acute pandemic (August 1, 2021-December 31, 2022). Multivariable logistic regression analyses and generalized estimating equations (GEEs) were used to calculate odds for MH-related ED visits, subsequent inpatient admissions, and associated diagnosis categories, adjusting for sex, age, race, and sponsor's military rank. This study was declared exempt by the Institutional Review Board of the Uniformed Services University of the Health Sciences.

The study included 153,346 MH-related ED encounters for 124,053 unique patients. Compared to the pre-pandemic period, the odds of an ED visit being MH-related were higher in the acute period (OR: 1.18, 95% CI: 1.05-1.28) but lower in the post-acute period (OR: 0.87, 95% CI: 0.85-0.94). The odds of a subsequent inpatient admission following an MH-related ED visit were significantly higher during both the acute (OR: 1.46, 95% CI: 1.41-1.52) and post-acute periods (OR: 1.37, 95% CI: 1.33-1.41) compared to the pre-pandemic period. Significant changes in the odds of some MH-related diagnosis categories (relative to absence of specified MH-related diagnosis categories) associated with the MH-related ED visit and inpatient admissions were found in the acute and post-acute comparisons to the pre-pandemic period.

The MHS experienced a significant increase in the acuity of MH-related ED presentations, evidenced by higher odds of inpatient admissions throughout the pandemic. However, the overall odds of ED visits for MH concerns decreased in the later pandemic stage, potentially reflecting changes in care pathways. These findings highlight the sustained impact of the pandemic on acute MH needs within the military community and underscore the importance of continued monitoring and resource allocation to support beneficiary well-being and military readiness.