James Jose K, Jeffery Molly M, Campbell Ronna L, Wieland Mark L, Ryu Alexander J
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Division of Health Care Policy & Research, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2022 Oct;6(5):436-442. doi: 10.1016/j.mayocpiqo.2022.07.003. Epub 2022 Aug 8.
To describe changes in emergency department (ED) psychiatric visits during the pandemic in both rural and nonrural regions in the United States.
This cohort study was performed across 22 EDs in the Midwest and Southern United States from January 1, 2019 to April 22, 2021. Prevalence of psychiatric visits before and after the COVID-19 pandemic, defined as starting on March 1, 2020, were compared. Psychiatric and nonpsychiatric visits were defined on the basis of primary clinician-assigned diagnosis. The primary end point was average daily visits normalized to the average daily visit count before the pandemic, labeled as relative mean daily visits (RMDVs).
Psychiatric visits decreased by 9% [RMDVs, 0.91; 95% confidence interval (CI), 0.89-0.93] during the pandemic period, whereas nonpsychiatric visits decreased by 17% (RMDVs, 0.83; 95% CI, 0.81-0.84). Black patients were the only demographic group with a significant increase in psychiatric visits during the pandemic (RMDVs, 1.12; 95% CI, 1.04-1.19). Periods of outbreaks of psychiatric emergencies were identified in most demographic groups, including among male and pediatric patients. However, the outbreaks detected among Black patients sustained the longest at 6 months. Unlike older adults who experienced outbreaks in the spring and fall of 2020, outbreaks among pediatric patients were detected later in 2021.
In this multisite study, total ED visits declined during the pandemic; however, psychiatric visits declined less than nonpsychiatric visits. Black patients experienced a greater increase in psychiatric emergencies than other demographic groups. There is also a concern for increasing outbreaks of pediatric psychiatric visits as the pandemic progresses.
描述美国农村和非农村地区在疫情期间急诊科精神科就诊情况的变化。
这项队列研究于2019年1月1日至2021年4月22日在美国中西部和南部的22个急诊科开展。比较了2020年3月1日开始的新冠疫情前后精神科就诊的患病率。精神科和非精神科就诊是根据初级临床医生指定的诊断来定义的。主要终点是将每日就诊量标准化为疫情前的平均每日就诊量，标记为相对平均每日就诊量（RMDVs）。
在疫情期间，精神科就诊量下降了9%（RMDVs为0.91；95%置信区间[CI]为0.89 - 0.93），而非精神科就诊量下降了17%（RMDVs为0.83；95%CI为0.81 - 0.84）。黑人患者是疫情期间精神科就诊量显著增加的唯一人口群体（RMDVs为1.12；95%CI为1.04 - 1.19）。在大多数人口群体中都发现了精神科紧急情况的爆发期，包括男性和儿科患者。然而，在黑人患者中检测到的爆发期持续时间最长，为6个月。与2020年春季和秋季经历爆发的老年人不同，儿科患者的爆发期在2021年晚些时候被检测到。
在这项多地点研究中，疫情期间急诊科就诊总量下降；然而，精神科就诊量的下降幅度小于非精神科就诊量。黑人患者经历的精神科紧急情况增加幅度大于其他人口群体。随着疫情的发展，儿科精神科就诊的爆发情况也令人担忧。
