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Cited by 578COVID-19 and Mental HealthCOVID-19 and healthcare impactsSuicide and Self-Harm Studies

Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic

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Holland, Kristin M., Jones, Christopher, Vivolo-Kantor, Alana M., Idaikkadar, Nimi, Zwald, Marissa, Hoots, Brooke, Yard, Ellen, D’Inverno, Ashley +14 more·2021·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2020.4402PMC PMC7859873
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Abstract

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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  • Visits to an emergency department for mental health consults and suspected child abuse, a risk factor for potential suicide attempts, also increased in 2020 compared with 2019.

    “visits to an emergency department for mental health consults and suspected child abuse, risk factor for potential suicide attempts, also increased in 2020 compared with 2019 (10).”

    From Suspected Suicide Attempts by Self-Poisoning Among Persons Aged 10–19 Years During the COVID-19 Pandemic — United States, 2020–2022 (2023) · cites this paper as [10]

    The Results report higher ED visit rates for mental health conditions and suspected child abuse and neglect in weeks 12–41 of 2020 than in 2019. But suspected child abuse visit counts fell, and the paper measures mental health conditions rather than visits for mental health consults. It does not establish the claim’s risk-factor link to suicide attempts. (LLM, conf=0.88)

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  • The consistency of these findings with those in other published studies highlights the association of the COVID-19 pandemic with harmful effects on youth mental health.

    “However, the consistency of these findings with those in other published studies highlights the association of the COVID-19 pandemic with harmful effects on youth mental health”

    From Suspected Suicide Attempts by Self-Poisoning Among Persons Aged 10–19 Years During the COVID-19 Pandemic — United States, 2020–2022 (2023) · cites this paper as [10]

    The Results and Discussion (page unavailable) report higher rates of emergency-department visits for mental health conditions during the pandemic and describe a potential association. However, the Statistical Analysis says those visits were analyzed for patients older than 10, not youth separately; the Discussion also cautions that higher rates may reflect a decline in total ED visits rather than a worsening of mental health. (LLM, conf=0.85)

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  • Average emergency department visit rates for mental health concerns and suspected child abuse and neglect, risk factors for suicide attempts, also increased in 2020 compared with 2019.

    “average ED visit rates for mental health concerns and suspected child abuse and neglect, risk factors for suicide attempts, also increased in 2020 compared with 2019 (5)”

    From Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021 (2021) · cites this paper as [5]

    The Results (page not available) report significantly higher median ED visit rates for mental health conditions and suspected child abuse and neglect in weeks 12–41 of 2020 than in the same weeks of 2019. The paper does not establish in the retrieved passages that these two outcomes are risk factors for suicide attempts, and its comparison does not cover all of 2020. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The increases in emergency department visits for suspected suicide attempts observed earlier in the pandemic among all persons persisted among young persons as the pandemic progressed.

    “This report expands upon previous work highlighting increases in ED visits for suspected suicide attempts earlier in the pandemic among all persons (5) and suggests that these trends persisted among young persons as the pandemic progressed.”

    From Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021 (2021) · cites this paper as [5]

  • The review identified five common thematic recommendations for preventing suicidal deaths and attempts across included studies: systematic suicide screening, facilitating communication and access to interventions, mental health and psychological well-being interventions, economic mitigation measures, and regulation of media reporting.

    “Of them, we have identified common thematic recommendations for preventing suicidal deaths and suicidal attempts, and those were; 1) Develop a systematic suicide screening process and increase the suicide risk screening [23, 25, 28, 30, 37].”

    From Impact of the COVID-19 pandemic on suicidal attempts and death rates: a systematic review (2022) · cites this paper as [35]

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Authors
Holland, K. M., Jones, C., Vivolo-Kantor, A. M., Idaikkadar, N., Zwald, M., Hoots, B., Yard, E., D’Inverno, A., Swedo, E., Chen, M. S., Petrosky, E., Board, A., Martinez, P., Stone, D. M., Law, R., Coletta, M. A., Adjemian, J., Thomas, C., Puddy, R. W., Peacock, G., Dowling, N. F., & Houry, D.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Holland, Kristin M.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2021-04-01
Volume
78
Issue
4
Pages
372
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2020.4402
PMC
PMC7859873
OpenAlex
W3126297842
Cited by
578
References
31
Citations by year
2026: 29 · 2025: 32 · 2024: 88 · 2023: 129 · 2022: 166 · 2021: 133 · 2019: 1
FWCI
88.11
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Keywords
COVID-19 pandemic, emergency department visits, mental illness, suicide attempts, drug overdose, opioid overdose, intimate partner violence, child abuse, COVID-19 mitigation measures, sex differences, substance use, violence, access to mental health care, United States, 2020-2021 pandemic
MeSH terms
COVID-19, SARS-CoV-2, Adult, Mental Disorders, Emergency Service, Hospital, Female, Humans, Male, Mental Health, Patient Acceptance of Health Care, Suicide, Attempted, United States, Violence, Outcome Assessment, Health Care, Epidemiological Monitoring, Drug Overdose

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