Rise in ED Visits for Suicide, Mental Health Concerns, Opioid Overdose During Pandemic

By Linda Carroll

February 05, 2021

(Reuters Health) - While U.S. emergency department visits dropped overall during the two weeks in March 2020 following declaration of a national emergency, certain issues involving mental health, violence and overdoses saw less of a decline and quickly picked up again, according to a new analysis.

After that brief dip in March, rates of ED visits for suicide attempts, opioid overdoses, mental health conditions, domestic violence and child abuse and neglect began rising, and remained significantly higher in 2020 than in 2019 - particularly for opioid overdoses - researchers from the Centers for Disease Control and Prevention (CDC) report in JAMA Psychiatry.

"Based on nearly 190 million emergency department (ED) visits from CDC's National Syndromic Surveillance Program (NSSP) database (or approximately 70% of all U.S. ED visits from more than 3,500 EDs in 48 states and Washington, DC), we found significantly higher ED visit rates for mental health conditions, suicide attempts, all drug and opioid overdoses, intimate partner violence, and child abuse and neglect during the COVID-19 pandemic, compared with the same period in 2019," said the study's lead author, Kristin Holland, a behavioral scientist at the CDC's Injury Center, in Atlanta, Georgia. "These findings underscore the critical need to implement clinical and community-based efforts to prevent these outcomes during the pandemic."

The data are especially striking when it comes to opioids, Holland said.

"Overdoses, particularly opioid overdoses, exhibited the most consistent increasing trends from 2019 to 2020, suggesting that, during the pandemic, people who used drugs may have done so alone or in high-risk ways that increased the potential for overdoses," she added.

Pandemic-related stresses may explain increases in the rates of other outcomes, Holland said.

"Like other disasters, the COVID-19 pandemic has left many people facing challenges that can be stressful, overwhelming, and cause strong emotions in adults and children," Holland said. "Public health actions, such as social distancing, are necessary to reduce the spread of COVID-19, but they can make people feel isolated and lonely and can increase stress and anxiety. Also, economic stress, including financial hardship and job loss from the pandemic, may worsen mental health and contribute to increases in suicide, substance use, and violence."

When the researchers compared weekly ED visit rates between 2019 and 2020, they found that visits for all six outcomes had decreased between March 8 and 28, 2020. But visits had already begun rising in the week of March 22-28, and remained elevated for the rest of 2020. Indeed, visits for opioid overdoses never declined below the mean count in 2019. And overall, the mean rate for opioid overdoses in weeks 12-41 of 2020 was 336.7 per 100,000 visits as compared to 220.4 per 100,000 in 2019.

For suicide attempts, mean weekly visit rates in weeks 12-41 of 2020 were also higher than in 2019 (314.2 vs 250.1), and the same was true for all drug overdoses (968.6 vs 711.1), intimate partner violence (28.4 vs 27.7) and for suspected child abuse and neglect (429.7 vs 292.7).

"There are prevention strategies for the outcomes we examined that have been shown to be effective," Holland said. "In emergency rooms, brief interventions such as counseling on safe storage of lethal means of suicide, ensuring naloxone provision, buprenorphine initiation, and screening for (intimate partner violence), and linking people to in-person or virtual behavioral health and social support services and medications for opioid use disorder can provide immediate assistance to those in crisis."

The new study is in line with what doctors have seen at Northwestern Memorial Hospital, in Chicago, since the start of COVID, said Dr. Yelena Semenova, an emergency department psychiatrist at the hospital.

"There was a dip in psychiatric patients and then the numbers came back," Dr. Semenova said. "I think COVID had an impact not just on emergency department visits and hospital capacity but also on mental health overall. There is a lot of stress associated with COVID. It is something no one had seen or experienced before. It's been very stressful for a lot of individuals. There's a lot more financial instability. People are worried about their own health and their loved ones' health."

The new study "identifies critical and alarming trends that now are the first published results from CDC officials," said Dr. Anita Gupta, an adjunct assistant professor in the department of anesthesiology and critical medicine at the Johns Hopkins School of Medicine, in Baltimore.

"Most concerning is the rise in opioid overdoses, which exhibited the most consistent increases in counts," Dr. Gupta said in an email. "This raises questions on whether or not these individuals had access to proper medical care and/or naloxone for reversal for prevention."

SOURCE: https://bit.ly/3trAoiv JAMA Psychiatry, online February 3, 2021.

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