Mental health-related ED visits increase after COVID-19 surges, study finds

MARI DEVEREAUX / March 16, 2022

Hospitals are seeing more emergency department visits for mental health issues after COVID-19 surges, particularly among young adults and racial minority groups, a recent study found.

Compared with before and during peaks in COVID-19 cases, mental health-related ED visits following the pandemic's surges composed a larger proportion of all ED visits, according to a JAMA Psychiatry report released Wednesday.

Using National Syndromic Surveillance Program data, the study looked at a sample of U.S. adults between the ages of 18 and 64 with several million ED visits across 3,600 emergency facilities nationwide between Jan. 1, 2019 and Aug. 14, 2021 that were related to a set of 10 mental health disorders.

Across the overall population, there was relative stability in mental health-related emergency visits after a COVID-19 case peak versus during the peak, with only a 1.5% increase following a surge.

However, all racial groups had significant increases or decreases in rates of ED visits related to different disorders following a peak.

Across the overall population, there was relative stability
in mental health-related emergency visits after a COVID-19 case peak
versus during the peak, with only a 1.5% increase following a surge.

In the period after a COVID-19 case peak, Black people experienced a 14% increase in trauma- and stress-related disorder visits compared with during the surge itself. Similarly, Latino populations had a 24.3% increase in bipolar disorder visits and white people had a 11.5% increase in schizophrenia spectrum disorder visits after a surge, the study found.

Asian populations maintained stability in ED visits for several disorders following COVID-19 surges, but had a 26.6% increase in depressive disorder-related visits and a decrease of 31.6% in schizophrenia spectrum disorder visits.

For American Indian or Alaska Native people, anxiety and schizophrenia spectrum–related ED visits were stable after a COVID-19 case peak, but had increases in visits for depressive, bipolar and trauma and stress-related disorders of 9.9%, 40% and 42.4%, respectively.

These numbers are likely due to the stress and increased mental health issues that come from witnessing a public health crisis, the study stated. Existing socioeconomic conditions, high COVID-19 mortality rates and racially motivated violence have exacerbated the pandemic's effects on the mental health of marginalized communities.

To address health disparities, providers need to raise awareness of and increase access to meaningful and culturally competent mental healthcare services, such as telemedicine, primary care and other resources, said Caitlin Gillooly, senior associate director for policy at the American Hospital Association.

Social issues such as food insecurity, transportation and childcare also should be key focuses to improve the mental health of historically marginalized groups during the pandemic, she said.

Of the approximately 2.5 million ED visits included in the report's race and ethnicity analysis, around 1% were by American Indian or Alaska Native individuals and another 1% were by Asian populations. One-fifth of visits were by Black people, 16% were by Latino people and 0.2% were by Native Hawaiian or Other Pacific Islander groups. White people comprised 47% of the visits analyzed.

Young adults ages 18 to 24 experienced moderate-to-high increases in behavioral and impulse disorders, eating disorders and tic disorders, ranging from 11.8% to 25.8%, following a COVID-19 case peak.

For the most part, the number of mental health-related ED visits by all people between the pre-Delta and Delta periods in 2021 remained relatively stable, decreasing by an average of 1.4% to 7.5%. However, visits related to eating disorders and tic disorders dropped by 11.9% and 19.8%, respectively, during the Delta variant surge.

When comparing the Delta period with its corresponding pre-pandemic months in 2019, there was an average 17.2% decrease in all mental health-related ED visits, with visits for disorders decreasing between 6.4% and 30.7% per 100,000 visits.