36 Comparison of Mental Health Visits at a Military Treatment Facility Emergency Department Pre- And Post-COVID-19 Pandemic

Abstract

There is a paucity of quantitative research regarding the effect of COVID-19 on emergency department (ED) visits in the United States, and specifically mental health-related ED visits. The small existing body of research describes an overall decline in ED visits worldwide; however, there are anecdotal reports that psychiatric complaints to the ED have increased during the pandemic. The primary objective of this study was to describe the volume of mental health ED visits at a single ED during the COVID-19 pandemic compared to previous years. This was a single-center, retrospective chart review of adult patients evaluated in the ED at an academic military medical facility from March-December of 2017-2020 for mental health. The electronic medical record was queried for 1,542 mental health ICD-10 diagnosis codes. Demographic data including age, sex, disposition, diagnosis, and beneficiary status were collected. Tests of association included Pearson Chi-square with Bonferroni correction for post-hoc tests and one-way ANOVA. There were a total of 1,486 mental health ED visits from March-December 2020, compared to an average of 1,668 visits from March-December 2017-2019. Statistically significant (p<0.05) differences, between 2020 and the prior three years combined, were identified in the categories of age, disposition, beneficiary status, and diagnosis. In 2020, there was a lower proportion of visits for patients aged ≥ 60 (1.2%) than in 2017-2019 (2.5%). Active duty patients comprised a lower proportion in 2020 (17.6%) versus 2017-2019 (23.0%). Proportionately fewer patients were admitted in 2020 (25.2%) versus 2017-2019 (29.2%). Adjustment disorders made up 19.0% of visits in 2020 versus 23.2% in 2017-2019 and suicidal ideation and intentional self-inflicted injury comprised 43.3% in 2020 compared with 40.4% in 2017-2019. There was a significant decline in ED visits for patients over the age of 60 and for active duty military patients. Overall, fewer patients were admitted compared to previous years. There was a significant increase in patients diagnosed with suicidal ideation and intentional self-inflicted injury in 2020 compared to previous years. The COVID-19 pandemic and associated quarantines have negatively affected mental health worldwide. Active duty military and elderly patients were uniquely impacted. Both groups have been subject to highly restrictive limitations during the pandemic. Alarmingly, this study shows increased rates of self-harm and suicidal ideation, yet a lower likelihood of these populations to present to the ED for mental health care. Further study is needed to determine why these effects were seen, and if there is a higher risk for suicide attempt or completion in these populations.