在一个大型社区医疗保健系统中，在 COVID-19 大流行早期寻求心理健康保健的患者的诊断和人口统计学特征的变化。

Changes in Diagnostic and Demographic Characteristics of Patients Seeking Mental Health Care During the Early COVID-19 Pandemic in a Large, Community-Based Health Care System.

机构信息

The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California.

Division of Research, Kaiser Permanente Northern California, Oakland, California.

出版信息

J Clin Psychiatry. 2021 Mar 3;82(2):20m13685. doi: 10.4088/JCP.20m13685.

DOI:10.4088/JCP.20m13685

PMID:33979485

Abstract

OBJECTIVE

The early COVID-19 pandemic resulted in great psychosocial disruption and stress, raising speculation that psychiatric disorders may worsen. This study aimed to identify patients vulnerable to worsening mental health during the COVID-19 pandemic.

METHODS

This retrospective observational study used electronic health records from March 9 to May 31 in 2019 (n = 94,720) and 2020 (n = 94,589) in a large, community-based health care system. Percent change analysis compared variables standardized to the average patient population for the respective time periods.

RESULTS

Compared to 2019, psychiatric visits increased significantly (P < .0001) in 2020, with the majority being telephone/video-based (+264%). Psychiatric care volume increased overall (7%), with the greatest increases in addiction (+42%), behavioral health in primary care (+17%), and adult psychiatry (+5%) clinics. While patients seeking care with preexisting psychiatric diagnoses were mainly stable (−2%), new patients declined (−42%). Visits for substance use (+51%), adjustment (+15%), anxiety (+12%), bipolar (+9%), and psychotic (+6%) disorder diagnoses, and for patients aged 18–25 years (+4%) and 26–39 years (+4%), increased. Child/adolescent and older adult patient visits decreased (−22.7% and −5.5%, respectively), and fewer patients identifying as White (−3.8%) or male (−5.0) or with depression (−3%) or disorders of childhood (−2%) sought care.

CONCLUSIONS

The early COVID-19 pandemic was associated with dramatic changes in psychiatric care facilitated by a rapid telehealth care transition. Patient volume, demographic, and diagnostic changes may reflect comfort with telehealth or navigating the psychiatric care system. These data can inform health system resource management and guide future work examining how care delivery changes impact psychiatric care quality and access.

摘要

目的

新冠疫情早期造成了巨大的心理社会破坏和压力，人们猜测精神疾病可能会恶化。本研究旨在确定在新冠疫情期间心理健康恶化的高危患者。

方法

本回顾性观察性研究使用了 2019 年 3 月 9 日至 5 月 31 日（n=94720）和 2020 年同期（n=94589）大型社区医疗保健系统的电子健康记录。百分比变化分析比较了标准化为相应时间段内患者平均水平的变量。

结果

与 2019 年相比，2020 年精神科就诊显著增加（P<0.0001），其中大多数为电话/视频就诊（增加 264%）。总体上精神科就诊量增加（7%），其中成瘾科（增加 42%）、初级保健行为健康科（增加 17%）和成人精神病科（增加 5%）就诊量增幅最大。尽管有精神科既往诊断的患者主要保持稳定（减少 2%），但新患者减少（减少 42%）。因物质使用（增加 51%）、适应不良（增加 15%）、焦虑（增加 12%）、双相情感障碍（增加 9%）和精神病性（增加 6%）障碍就诊的患者以及 18-25 岁（增加 4%）和 26-39 岁（增加 4%）患者就诊增加。儿童/青少年和老年患者就诊减少（减少 22.7%和减少 5.5%），且寻求治疗的患者中白人（减少 3.8%）、男性（减少 5.0%）、抑郁症（减少 3.0%）或儿童期障碍（减少 2.0%）患者减少。