Table 1.
Changes in MH-Related ED Visits for Adults Aged 18 to 64 Years in Selected Periods Before and During the COVID-19 Pandemic, US, February 10, 2019, to August 14, 2021a,b
| After Delta variant onset, index period: July 18-August 14, 2021 | After a COVID-19 case peak, index period: February 14, 2021-March 13, 2021 | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Index period compared with MH in the COVID-19 pandemic before the Delta variant period (April 18-May 15, 2021) | Index period compared with prepandemic MH (July 14, 2019-August 10, 2019) | Index period compared with MH during a COVID-19 case peak (December 27, 2020-January 23, 2021) | Index period compared with prepandemic MH (February 10, 2019-March 9, 2019) | |||||||||
| Disorder | Total ED visit counts for MH, No. | ED visits for MH per 100 000 ED visitsc | Change in ED counts for MH, %d | Visit ratio (95% CI)e | Change in ED counts for MH, %d | Visit ratio (95% CI)e | Total ED visit counts forMH, No. | ED visits for MH per 100 000 ED visitsc | Change in ED counts for MH, %d | Visit ratio (95% CI)e | Change in ED counts for MH, %d | Visit ratio (95% CI)e |
| All MH | 249 700 | 6725 | −3.3 | 0.86 (0.85–0.86) | −17.2 | 0.80 (0.79–0.80) | 256 628 | 8728 | 1.5 | 1.04 (1.03–1.04) | −5.4 | 1.11 (1.11–1.12) |
| Anxiety | 122 463 | 3298 | −3.4 | 0.86 (0.85–0.86) | −17.7 | 0.79 (0.78–0.80) | 125 900 | 4282 | 0.6 | 1.03 (1.02–1.03) | −4.2 | 1.13 (1.12–1.14) |
| Depressive | 72 674 | 1957 | −5.7 | 0.84 (0.83–0.84) | −30.7 | 0.67 (0.66–0.67) | 79 463 | 2703 | 1.2 | 1.03 (1.02–1.04) | −15.4 | 1.00 (0.99–1.01) |
| Bipolar | 29 460 | 793 | −6.2 | 0.83 (0.82–0.84) | −25.6 | 0.71 (0.70–0.73) | 32 010 | 1089 | 2.2 | 1.04 (1.03–1.06) | −8.7 | 1.08 (1.06–1.09) |
| Schizophrenia spectrum | 25 309 | 682 | −6.4 | 0.83 (0.82–0.84) | −15.6 | 0.81 (0.80–0.83) | 28 107 | 956 | 1.9 | 1.04 (1.02–1.06) | 5.2 | 1.24 (1.22–1.26) |
| Trauma- and stressor-related | 18 982 | 511 | −6.3 | 0.83 (0.81–0.85) | −24.7 | 0.72 (0.71–0.74) | 20 403 | 694 | 4.9 | 1.07 (1.05–1.09) | −3.9 | 1.13 (1.11–1.15) |
| Attention-deficit/hyperactivity | 6078 | 164 | −7.5 | 0.82 (0.79–0.85) | −30.5 | 0.67 (0.65–0.69) | 6337 | 216 | 3.4 | 1.06 (1.02–1.09) | −14.1 | 1.01 (0.98–1.05) |
| Disruptive behavioral and impulse | 2898 | 78 | −1.4 | 0.87 (0.83–0.92) | −14.2 | 0.82 (0.78–0.87) | 3131 | 106 | 2.1 | 1.04 (0.99–1.10) | 9.5 | 1.29 (1.23–1.36) |
| Obsessive-compulsive | 1276 | 34 | −5.8 | 0.83 (0.77–0.90) | −23.4 | 0.74 (0.68–0.79) | 1373 | 47 | 3.8 | 1.06 (0.98–1.14) | 9.8 | 1.29 (1.20–1.40) |
| Eating | 761 | 21 | −11.9 | 0.78 (0.71–0.86) | −12.1 | 0.84 (0.77–0.93) | 869 | 30 | 6.9 | 1.09 (0.99–1.20) | 11.1 | 1.31 (1.19–1.44) |
| Tic | 263 | 7 | −19.8 | 0.71 (0.60–0.84) | −6.4 | 0.90 (0.76–1.06) | 276 | 9 | 7.4 | 1.10 (0.93–1.30) | 11.3 | 1.31 (1.10–1.56) |
Abbreviations: ED, emergency department; MH, mental health.
The National Syndromic Surveillance Program collects free-text reason for visit (chief complaint), discharge diagnosis, and patient demographic details. Diagnosis information is collected using International Classification of Diseases, Ninth Revision, Clinical Modification codes; International Classification of Diseases, Tenth Revision, Clinical Modification codes; and Systematized Nomenclature of Medicine codes. ED visits associated with any MH-related visit and specific mental disorders were identified by querying ED visits data from the National Syndromic Surveillance Program using keyword syndromes developed by the US Centers for Disease Control and Prevention in partnership with state and local health departments (eTable 1 in the Supplement).
To reduce artifactual effects from changes in reporting patterns, analyses examining trends in MH-related ED visits overall were restricted to facilities with a coefficient of variation of 40 or less and mean weekly discharge diagnosis of 75% or more from January 2019 to August 2021.
Rate of ED visits for MH outcome equaled the number of ED visits for MH outcome in the period of interest divided by the number of total ED visits in the period of interest multiplied by 100 000.
Percentage change in visits was calculated as the difference in total visits between the index period and the comparison period divided by the total visits during the comparison period multiplied by 100.
Visit ratios equaled the proportion of ED visits for MH outcome during the index period divided by the proportion of ED visits for MH outcome during the comparison period.