Program in Public Health, University of California, Irvine, Irvine, USA.
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA.
Community Ment Health J. 2023 May;59(4):622-630. doi: 10.1007/s10597-022-01043-4. Epub 2022 Dec 12.
Emergency department (ED) visits for psychiatric care in the US reportedly declined during the COVID-19 pandemic. This work, however, does not control for strong temporal patterning in visits before the pandemic and does not examine a potential "rebound" in demand for psychiatric care following the relaxation of initial societal restrictions. Here, we examine COVID-19-related perturbations in psychiatric care during and after the 1st stage of societal restrictions in the largest safety-net hospital in Los Angeles. We retrieved psychiatric ED visit data (98,888 total over 156 weeks, Jan 2018 to Dec 2020) from Los Angeles County + USC Medical Center. We applied interrupted time series methods to identify and control for autocorrelation in psychiatric ED visits before examining their relation with the 1st stage of societal restrictions (i.e., March 13 to May 8, 2020), as well as the subsequent "rebound" period of relaxed restrictions (i.e., after May 8, 2020). Psychiatric ED visits fell by 78.13 per week (i.e., 12%) during the 1st stage of societal restrictions (SD = 23.99, p < 0.01). Reductions in ED visits for alcohol use, substance use, and (to a lesser extent) anxiety disorders accounted for the overall decline. After the 1st stage of societal restrictions, however, we observe no "rebound" above expected values in psychiatric ED visits overall (coef = - 16.89, SD = 20.58, p = 0.41) or by diagnostic subtype. This pattern of results does not support speculation that, at the population level, foregoing ED care during initial societal restrictions subsequently induced a psychiatric "pandemic" of urgent visits.
据报道，美国因精神疾病前往急诊部（ED）就诊的人数在 COVID-19 大流行期间有所下降。然而，这项工作没有控制大流行前就诊的强烈时间模式，也没有检查在最初的社会限制放松后对精神保健需求的潜在“反弹”。在这里，我们研究了洛杉矶最大的社会救助医院在社会限制的第一阶段期间和之后与 COVID-19 相关的精神保健干扰。我们从洛杉矶县+南加州大学医疗中心检索了精神科 ED 就诊数据（156 周内共 98888 例，2018 年 1 月至 2020 年 12 月）。我们应用中断时间序列方法来识别和控制精神科 ED 就诊之前的自相关，然后检查它们与社会限制的第一阶段（即 2020 年 3 月 13 日至 5 月 8 日）以及随后限制放宽的“反弹”期（即 5 月 8 日之后）的关系。在社会限制的第一阶段，精神科 ED 就诊量每周减少 78.13 次（即 12%）（SD=23.99，p<0.01）。酒精使用、物质使用和（在较小程度上）焦虑障碍的 ED 就诊减少导致了总体下降。然而，在社会限制的第一阶段之后，我们没有观察到总体精神科 ED 就诊的“反弹”超过预期值（系数=-16.89，SD=20.58，p=0.41）或按诊断亚型划分。这种结果模式不支持这样的推测，即在人群层面上，最初的社会限制期间放弃 ED 护理随后会导致紧急就诊的精神“大流行”。
