加拿大安大略省 COVID-19 大流行后急性心理健康服务的使用情况：趋势分析。
Acute mental health service use following onset of the COVID-19 pandemic in Ontario, Canada: a trend analysis.
机构信息
Department of Paediatrics (Saunders, Toulany, Guttmann), University of Toronto, Toronto, Ont.; The Hospital for Sick Children (Toulany), Toronto, Ont.; Child Health Evaluative Sciences (Saunders, Toulany), SickKids Research Institute, Toronto, Ont.; ICES (Saunders, Deb, Strauss, Vigod, Guttmann, Chiu, Huang, Fung, Chen), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Vigod, Chiu, Kurdyak), University of Toronto, Toronto, Ont.; Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont.; Women's College Hospital and Women's College Research Institute (Vigod, Kurdyak), Toronto, Ont.; Department of Psychiatry (Vigod, Kurdyak), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.
出版信息
CMAJ Open. 2021 Nov 16;9(4):E988-E997. doi: 10.9778/cmajo.20210100. Print 2021 Oct-Dec.
BACKGROUND
The extent to which heightened distress during the COVID-19 pandemic translated to increases in severe mental health outcomes is unknown. We examined trends in psychiatric presentations to acute care settings in the first 12 months after onset of the pandemic.
METHODS
This was a trends analysis of administrative population data in Ontario, Canada. We examined rates of hospitalizations and emergency department visits for mental health diagnoses overall and stratified by sex, age and diagnostic grouping (e.g., mood disorders, anxiety disorders, psychotic disorders), as well as visits for intentional self-injury for people aged 10 to 105 years, from January 2019 to March 2021. We used Joinpoint regression to identify significant inflection points after the onset of the pandemic in March 2020.
RESULTS
Among the 12 968 100 people included in our analysis, rates of mental health-related hospitalizations and emergency department visits declined immediately after the onset of the pandemic (peak overall decline of 30% [hospitalizations] and 37% [emergency department visits] compared to April 2019) and returned to near prepandemic levels by March 2021. Compared to April 2019, visits for intentional self-injury declined by 33% and remained below prepandemic levels until March 2021. We observed the largest declines in service use among adolescents aged 14 to 17 years (55% decline in hospitalizations, 58% decline in emergency department visits) and 10 to 13 years (56% decline in self-injury), and for those with substance-related disorders (33% decline in emergency department visits) and anxiety disorders (61% decline in hospitalizations).
INTERPRETATION
Contrary to expectations, the abrupt decline in acute mental health service use immediately after the onset of the pandemic and the return to near prepandemic levels that we observed suggest that changes and stressors in the first 12 months of the pandemic did not translate to increased service use. Continued surveillance of acute mental health service use is warranted.
背景
在 COVID-19 大流行期间，痛苦加剧是否转化为严重精神健康问题尚不清楚。我们研究了大流行开始后 12 个月内急性护理环境中精神科就诊的趋势。
方法
这是对加拿大安大略省人口行政数据的趋势分析。我们检查了 2019 年 1 月至 2021 年 3 月期间，所有人群的住院和急诊就诊率，以及按性别、年龄和诊断分组（例如心境障碍、焦虑障碍、精神病性障碍）分层的住院和急诊就诊率，以及 10 至 105 岁人群因故意自伤的就诊率。我们使用 Joinpoint 回归分析确定大流行开始后 2020 年 3 月的显著拐点。
结果
在我们的分析中，纳入了 12968100 人，精神健康相关的住院和急诊就诊率在大流行开始后立即下降（与 2019 年 4 月相比，总体下降 30%[住院率]和 37%[急诊就诊率]），到 2021 年 3 月已接近大流行前水平。与 2019 年 4 月相比，因故意自伤的就诊率下降了 33%，并一直低于大流行前水平，直到 2021 年 3 月。我们观察到青少年（14 至 17 岁）和 10 至 13 岁（自伤就诊率分别下降 56%）、与物质相关障碍（急诊就诊率下降 33%）和焦虑障碍（住院率下降 61%）的服务使用率降幅最大。
解释
与预期相反，我们观察到大流行开始后急性精神卫生服务使用率的急剧下降，以及随后恢复到接近大流行前的水平，这表明在大流行的头 12 个月中发生的变化和压力源并未导致服务使用率增加。需要继续监测急性心理健康服务的使用情况。
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