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Toxicology

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

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Psychiatry

Published Online: February 3, 2021

Original Investigation

Article Information and Disclosures

Author Affiliations

¹National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
²Commissioned Corps, US Public Health Service, Atlanta, Georgia
³Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
⁴Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
⁵National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
⁶Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
⁷National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia

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Key Points

Question Did US emergency department (ED) visits for mental health, suicide attempts, overdose, and violence outcomes change during the coronavirus disease 2019 (COVID-19) pandemic?

Findings This cross-sectional study of almost 190 million ED visits found that visit rates for mental health conditions, suicide attempts, all drug and opioid overdoses, intimate partner violence, and child abuse and neglect were higher in mid-March through October 2020, during the COVID-19 pandemic, compared with the same period in 2019.

Meaning These findings suggest that ED use and priorities for care seeking shifted during the COVID-19 pandemic, underscoring mental health, substance use, and violence risk screening and prevention needs during public health crises.

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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Article Information

Accepted for Publication: November 25, 2020.

Published Online: February 3, 2021. doi:10.1001/jamapsychiatry.2020.4402

Corresponding Author: Kristin M. Holland, PhD, MPH, Division of Overdose Prevention, National Center for Injury Prevention and Control, 4770 Buford Hwy, Atlanta, GA 30341 (imh1@cdc.gov).

Author Contributions: Dr Holland and Mr Idaikkadar had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Holland, Jones, Vivolo-Kantor, Zwald, Hoots, Swedo, Board, Law, Thomas, Peacock, Dowling.

Acquisition, analysis, or interpretation of data: Holland, Vivolo-Kantor, Idaikkadar, Hoots, Yard, D’Inverno, Swedo, Chen, Petrosky, Martinez, Stone, Law, Coletta, Adjemian, Thomas, Puddy, Dowling, Houry.

Drafting of the manuscript: Holland, Jones, Vivolo-Kantor, Swedo, Law, Houry.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Holland, Idaikkadar, Hoots, Law, Adjemian, Thomas.

Administrative, technical, or material support: Holland, Vivolo-Kantor, Yard, Swedo, Chen, Petrosky, Martinez, Stone, Coletta, Puddy, Peacock, Dowling.

Supervision: Holland, Jones, Hoots, Law, Puddy, Dowling, Houry.

Other—Development of measures: D’Inverno.

Conflict of Interest Disclosures: None reported.

Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Disease Registry.

Additional Contributions: We acknowledge state, local, and jurisdictional health departments participating in the Centers for Disease Control and Prevention’s National Syndromic Surveillance Program, as well as the facilities working closely with these health departments to build statewide syndromic surveillance systems.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.