Abstract
Background: A prolonged COVID-19 pandemic has the potential to trigger a global mental health crisis increasing demand for mental health emergency services. We undertook a rapid review of the impact of pandemics and epidemics on emergency department utilization for mental health (MH) and substance use (SU).Objective: To rapidly synthesize available data on emergency department utilization for psychiatric concerns during COVID-19.Methods: An information specialist searched Medline, Embase, Psycinfo, CINAHL, and Scopus on June 16, 2020 and updated the search on July 24, 2020. Our search identified 803 abstracts, 7 of which were included in the review. Six articles reported on the COVID-19 pandemic and one on the SARS epidemic.Results: All studies reported a decrease in overall and MH related ED utilization during the early pandemic/epidemic. Two studies found an increase in SU related visits during the same period. No data were available for mid and late stage pandemics and the definitions for MH and SU related visits were inconsistent across studies.Conclusions: Our results suggest that COVID-19 has resulted in an initial decrease in ED visits for MH and an increase in visits for SU. Given the relative paucity of data on the subject and inconsistent analytic methods used in existing studies, there is an urgent need for investigation of pandemic-related changes in ED case-mix to inform system-level change as the pandemic continues.
Highlights
The medical burden of the SARS CoV-2 virus (COVID-19) is well-documented, but the potential for a corresponding global mental health crisis is largely understudied (1)
Search terms were developed through discussion within the research team, including a librarian specializing in health sciences (L.D.), and were designed to capture the following concepts: (1) population – patients with Mental Health issues and/or substance use disorders; (2) exposure – pandemics (H1N1, COVID-19) and epidemics; (3) Setting – emergency department (ED) setting
6 studies were included in the final data extraction
Summary
The medical burden of the SARS CoV-2 virus (COVID-19) is well-documented, but the potential for a corresponding global mental health crisis is largely understudied (1). Pandemics and Emergency Department Utilization for Mental Health established links between unemployment and suicide attempts (2) They have underscored the relationship between loneliness and mental illness and hint that social isolation, a widespread public health policy to control COVID-19 infection risk, can destabilize existing MH or substance use (SU) disorders or cause new illness in those predisposed (4–6). Many patients with MH or SU disorders belong to underserved and vulnerable populations who typically have less access to the necessary technology and rely on the emergency department (ED) as a safety net Even for those without pre-existing SU disorder, an increase in SU during the pandemic may lead to ED visits for intoxication or overdose.
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