Effect of the COVID-19 Pandemic on ED Adult Psychiatric Visits

Objectives: Our goal was to determine whether the proportion of ED visits for specific psychiatric conditions, namely anxiety disorders, depression, self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders, changed after the arrival of COVID-19.Background: In March 2020, the COVID-19 pandemic reached the New York tri-state area, which, at the time, was one of the regions in the United States (US) that the virus most severely affected. ED visits dramatically declined, likely due to social isolation mandates and fear of exposure to the virus. Quarantining at home, fear of becoming sick, and job disruptions caused the level of stress in the population to increase. In a previous US study, the proportion of ED visits for some psychiatric conditions increased.Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Hospitals were teaching and non-teaching in rural, suburban and urban areas. Total annual ED volumes were 12,000 to 122,000. Population: Consecutive ED patients = 21 years old from March 1 to November 30 in 2019 and 2020. Data analysis: We tallied the number of patients in 2019 and 2020 with anxiety disorders, depression, self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders, identified using International Classification of Disease codes (version 10). We calculated the proportion of these visits to total ED visits in 2019 and 2020. We report the changes in these proportions from 2019 to 2020, along with 95% CIs.Results: Total ED visits decreased 27%, from 844,017 in 2019 to 618,195 in 2020. In 2019 and 2020 combined, the number of patients were: 13,151 with anxiety disorders, 6884 with depression, 8886 with suicidal ideation/self-harm, 3252 with bipolar disorder, and 7129 with psychotic disorders. The changes [with 95% CIs] in the proportion of visits from 2019 to 2020 were: anxiety disorders -1% [-4,+3%], depression -5% [-10,-1%], self-harm/suicidal thoughts +23% [+18,+29%], bipolar disorder +14% [+6, +22%], and psychotic disorders +23% [+18,+29%].Conclusion: The proportion of adult ED visits for self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders increased following the arrival of COVID-19, whereas the proportions for anxiety and depression changed minimally. These results are somewhat different from the findings in the previously reported study. Our study highlights the need for continued surveillance of the impact of COVID-19 on mental health