Beaudry Gabrielle, Drouin Olivier, Gravel Jocelyn, Smyrnova Anna, Bender Andreas, Orri Massimiliano, Geoffroy Marie-Claude, Chadi Nicholas
Department of Psychiatry, University of Oxford, Oxford, UK.
Sainte-Justine Hospital Research Center, Montréal, QC, Canada.
Ann Gen Psychiatry. 2022 Jun 13;21(1):17. doi: 10.1186/s12991-022-00398-y.
Reports on longitudinal trends in mental health-related (MHR) emergency department (ED) utilization spanning the pre- and post-pandemic periods are lacking, along with evidence comparing healthcare services utilization by sociodemographic subgroups. The aim of this study was to evaluate COVID-19-associated changes in MHR ED utilization among youth overall and by age, sex, and socio-economic status (SES).
This retrospective cross-sectional study analyzed MHR ED utilization before and during the COVID-19 pandemic at a large urban pediatric tertiary care hospital in Montréal, Canada. All ED visits for children (5-11 years) and adolescents (12-17 years) between April 1, 2016 and November 30, 2021 were included. The main outcome was the monthly count of MHR ED visits. Pre-pandemic and pandemic periods were compared using an interrupted time series design. The effect of seasonality (in months), age (in years), sex (male or female), and SES (low, average, high) were compared using a generalized additive model.
There were a total of 437,147 ED visits (204,215 unique patients) during the 5-year study period of which 9748 (5.8%) were MHR visits (7,686 unique patients). We observed an increase of 69% (95% CI, + 53% to + 85%; p = 0.001) in the mean monthly count of MHR ED visits during the pandemic period, which remained significant after adjusting for seasonality (44% increase, 95% CI, + 38% to + 51%; p = 0.001). The chance of presenting for a MHR ED visit increased non-linearly with age. There were increased odds of presenting for a MHR ED visit among girls between the pre-pandemic and pandemic periods (OR 1.42, 95% CI 1.29-1.56). No difference by SES group during and before the COVID-19 pandemic was found [OR 1.01, 95% CI 0.89-1.15 (low); OR 1.09, 95% CI 0.96-1.25 (high)].
Our study shows important increases in MHR ED utilization among youth, and especially among girls, during the first 20 months of the COVID-19 pandemic, highlighting the need for sustained, targeted and scalable mental health resources to support youth mental health during the current and future crises.
缺乏关于大流行前和大流行后心理健康相关（MHR）急诊科（ED）就诊纵向趋势的报告，也缺乏比较社会人口亚组医疗服务利用情况的证据。本研究的目的是评估COVID-19相关因素对青年总体以及按年龄、性别和社会经济地位（SES）划分的MHR急诊科就诊率的影响。
这项回顾性横断面研究分析了加拿大蒙特利尔一家大型城市儿科三级护理医院在COVID-19大流行之前和期间的MHR急诊科就诊情况。纳入了2016年4月1日至2021年11月30日期间所有儿童（5-11岁）和青少年（12-17岁）的急诊科就诊记录。主要结局是MHR急诊科就诊的月度计数。采用中断时间序列设计比较大流行前和大流行期间的情况。使用广义相加模型比较季节性（按月）、年龄（按年）、性别（男或女）和SES（低、中、高）的影响。
在5年的研究期间，共有437,147次急诊科就诊（204,215名不同患者），其中9748次（5.8%）是MHR就诊（7686名不同患者）。我们观察到在大流行期间，MHR急诊科就诊的平均月度计数增加了69%（95%CI，+53%至+85%；p=0.001），在调整季节性后仍具有统计学意义（增加44%，95%CI，+38%至+51%；p=0.001）。MHR急诊科就诊的可能性随年龄呈非线性增加。在大流行前和大流行期间，女孩进行MHR急诊科就诊的几率增加（OR 1.42，95%CI 1.29-1.56）。在COVID-19大流行期间和之前，SES组之间未发现差异[OR 1.01，95%CI 0.89-1.15（低）；OR 1.09，9%CI 0.96-1.25（高）]。
我们的研究表明，在COVID-19大流行的前20个月里，青年尤其是女孩的MHR急诊科就诊率显著增加，这凸显了在当前和未来危机期间需要持续、有针对性且可扩展的心理健康资源来支持青年心理健康。
