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Physician Health Care Visits for Mental Health and Substance Use During the COVID-19 Pandemic in Ontario, Canada

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Has the incidence of physicians seeking outpatient care for mental health and substance use changed during the COVID-19 pandemic?

Findings  In a cohort study of 34 055 physicians, the rate of outpatient visits for mental health and substance use increased on average by 13% per physician during the first 12 months of the pandemic compared with the prior 12 months.

Meaning  These findings suggest that the COVID-19 pandemic is associated with greater mental health services use among physicians.


Importance  Physicians self-report high levels of symptoms of anxiety and depression, and surveys suggest these symptoms have been exacerbated by the COVID-19 pandemic. However, it is not known whether pandemic-related stressors have led to increases in health care visits related to mental health or substance use among physicians.

Objective  To evaluate the association between the COVID-19 pandemic and changes in outpatient health care visits by physicians related to mental health and substance use and explore differences across physician subgroups of interest.

Design, Setting, and Participants  A population-based cohort study was conducted using health administrative data collected from the universal health system (Ontario Health Insurance Plan) of Ontario, Canada, from March 1, 2017, to March 10, 2021. Participants included 34 055 physicians, residents, and fellows who registered with the College of Physicians and Surgeons of Ontario between 1990 and 2018 and were eligible for the Ontario Health Insurance Plan during the study period. Autoregressive integrated moving average models and generalized estimating equations were used in analyses.

Exposures  The period during the COVID-19 pandemic (March 11, 2020, to March 10, 2021) compared with the period before the pandemic.

Main Outcomes and Measures  The primary outcome was in-person, telemedicine, and virtual care outpatient visits to a psychiatrist or family medicine and general practice clinicians related to mental health and substance use.

Results  In the 34 055 practicing physicians (mean [SD] age, 41.7 [10.0] years, 17 918 [52.6%] male), the annual crude number of visits per 1000 physicians increased by 27%, from 816.8 before the COVID-19 pandemic to 1037.5 during the pandemic (adjusted incident rate ratio per physician, 1.13; 95% CI, 1.07-1.19). The absolute proportion of physicians with 1 or more mental health and substance use visits within a year increased from 12.3% before to 13.4% during the pandemic (adjusted odds ratio, 1.08; 95% CI, 1.03-1.14). The relative increase was significantly greater in physicians without a prior mental health and substance use history (adjusted incident rate ratio, 1.72; 95% CI, 1.60-1.85) than in physicians with a prior mental health and substance use history.

Conclusions and Relevance  In this study, the COVID-19 pandemic was associated with a substantial increase in mental health and substance use visits among physicians. Physician mental health may have worsened during the pandemic, highlighting a potential greater requirement for access to mental health services and system level change.

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Article Information

Accepted for Publication: November 4, 2021.

Published: January 21, 2022. doi:10.1001/jamanetworkopen.2021.43160

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Myran DT et al. JAMA Network Open.

Corresponding Author: Daniel T. Myran, MD, MPH, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Box 693, Ottawa, ON K2G 6E1, Canada (dmyran@ohri.ca).

Author Contributions: Dr Myran and Mr Pugliese had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Sood and Tanuseputro contributed equally as co-senior authors.

Concept and design: Myran, Cantor, Hensel, Taljaard, Sood, Tanuseputro.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Myran, Cantor, Rhodes, Hensel, Taljaard, Liu.

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

Statistical analysis: Myran, Cantor, Pugliese, Taljaard, Talarico, McArthur.

Obtained funding: Myran, Cantor, Rhodes, Hensel, Simon, McFadden, Gerin-Lajoie, Tanuseputro.

Administrative, technical, or material support: Myran, Cantor, Rhodes, Talarico, Jeyakumar.

Supervision: Myran, Talarico, Sood, Tanuseputro.

Conflict of Interest Disclosures: Drs Simon, McFadden, and Gerin-Lajoie are employees of the Canadian Medical Association. Dr Sood reported receiving speaker’s fees from AstraZeneca outside the submitted work. No other disclosures were reported.

Funding/Support: Dr Myran was supported as a Research Fellow Salary Award from the Canadian Institutes of Health Research and the University of Ottawa Department of Family Medicine. Dr Tanuseputro was supported by a PSI Graham Farquharson Knowledge Translation Fellowship. Dr Sood is supported by the Jindal Research Chair in the Prevention of Kidney Disease. Dr Garg was supported by the Dr Adam Linton Chair in Kidney Health Analytics and a Clinician Investigator Award from the Canadian Institutes of Health Research. This study was supported by the University of Ottawa site of ICES, which is funded by an annual grant from the Ontario Ministry of Health and Ministry of Long-Term Care. This study also received funding from Canadian Institutes for Health Research Operating Grant MS3-173107 and grant INN21-002from the Academic Medical Organization of Southwestern Ontario.

Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The opinions and conclusions expressed are the writers’ own and are not those of the Canadian Medical Association. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Additional Information: Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information.

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