Division of Epidemiology, College of Public Health, The Ohio State University, Columbus.
Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus.
JAMA Netw Open. 2023 Dec 1;6(12):e2349305. doi: 10.1001/jamanetworkopen.2023.49305.
Although substantial research has reported grave population-level psychiatric sequelae of the COVID-19 pandemic, evidence pertaining to temporal changes in schizophrenia spectrum disorders in the US following the pandemic remains limited.
To examine the monthly patterns of emergency department (ED) visits for schizophrenia spectrum disorders after the onset of the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study used time-series analyses to examine whether monthly counts of ED visits for schizophrenia spectrum disorders across 5 University of California (UC) campus health systems increased beyond expected levels during the COVID-19 pandemic. Data included ED visits reported by the 5 UC campuses from 2016 to 2021. Participants included persons who accessed UC Health System EDs had a diagnosis of a psychiatric condition. Data analysis was performed from March to June 2023.
The exposures were binary indicators of initial (March to May 2020) and extended (March to December 2020) phases of the COVID-19 pandemic.
The primary outcome was monthly counts of ED visits for schizophrenia spectrum disorders. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes, categorized within Clinical Classification Software groups, were used to identify ED visits for schizophrenia spectrum disorders and all other psychiatric ED visits, from the University of California Health Data Warehouse database, from January 2016 to December 2021. Time-series analyses controlled for autocorrelation, seasonality, and concurrent trends in ED visits for all other psychiatric conditions.
The study data comprised a total of 377 872 psychiatric ED visits, with 37 815 visits for schizophrenia spectrum disorders. The prepandemic monthly mean (SD) number of ED visits for schizophrenia spectrum disorders was 519.9 (38.1), which increased to 558.4 (47.6) following the onset of the COVID-19 pandemic. Results from time series analyses, controlling for monthly counts of ED visits for all other psychiatric conditions, indicated 70.5 additional ED visits (95% CI, 11.7-129.3 additional visits; P = .02) for schizophrenia spectrum disorders at 1 month and 74.9 additional visits (95% CI, 24.0-126.0 visits; P = .005) at 3 months following the initial phase of the COVID-19 pandemic in California.
This study found a 15% increase in ED visits for schizophrenia spectrum disorders within 3 months after the initial phase of the pandemic in California across 5 UC campus health systems, underscoring the importance of social policies related to future emergency preparedness and the need to strengthen mental health care systems.
尽管大量研究报告了 COVID-19 大流行对人群层面精神健康的严重影响，但在美国大流行后精神分裂症谱系障碍的时间变化方面，仍缺乏相关证据。
研究 COVID-19 大流行后，美国精神分裂症谱系障碍在急诊科（ED）的就诊模式是否存在月度变化。
设计、地点和参与者：本观察性队列研究使用时间序列分析，研究了在 COVID-19 大流行期间，加州大学（UC）5 个校区健康系统中精神分裂症谱系障碍的 ED 就诊月度计数是否超过预期水平。数据包括 2016 年至 2021 年期间，UC 校园报告的 ED 就诊数据。参与者包括在 UC 健康系统 ED 就诊的，有精神疾病诊断的人。数据分析于 2023 年 3 月至 6 月进行。
暴露因素是 COVID-19 大流行初始（2020 年 3 月至 5 月）和扩展（2020 年 3 月至 12 月）阶段的二进制指标。
主要结果是 ED 就诊的月度计数，用于精神分裂症谱系障碍。从加州大学健康数据仓库数据库中，使用国际疾病分类第十版和相关健康问题诊断代码，以及临床分类软件组进行分类，识别 ED 就诊的精神分裂症谱系障碍和所有其他精神科 ED 就诊。时间序列分析控制了 ED 就诊的自相关、季节性和所有其他精神科疾病的同期趋势。
研究数据共包含 377872 例精神科 ED 就诊，其中 37815 例为精神分裂症谱系障碍。在大流行前，每月平均（SD）精神分裂症谱系障碍 ED 就诊次数为 519.9（38.1），在 COVID-19 大流行开始后增加到 558.4（47.6）。时间序列分析的结果表明，在 COVID-19 大流行的初始阶段后 1 个月，精神分裂症谱系障碍的 ED 就诊增加了 70.5 次（95%CI，11.7-129.3 次就诊；P =.02），在 3 个月时增加了 74.9 次（95%CI，24.0-126.0 次就诊；P =.005）。
本研究发现，在加州的 5 个 UC 校区健康系统中，精神分裂症谱系障碍的 ED 就诊在 COVID-19 大流行的初始阶段后 3 个月内增加了 15%，这突显了与未来应急准备相关的社会政策的重要性，以及加强精神卫生保健系统的必要性。
