Decreasing Psychiatric Emergency Visits, but Stable Addiction Emergency Visits, During COVID-19—A Time Series Analysis 10 Months Into the Pandemic

Abstract

Background: The COVID-19 pandemic has been suspected to increase mental health problems, but also to possibly lead to a decreased treatment seeking, for example due to fear of attending hospital. Early findings demonstrate decreased treatment seeking for mental health, which may differ across diagnostic groups. This study aimed to examine treatment uptake at a general psychiatry emergency unit and at an addiction psychiatry emergency unit in Malmö, Sweden, separately. In addition, the study aimed to investigate treatment uptake for different diagnostic groups—during and prior to the COVID-19 pandemic.Methods: Monthly data for number of unique patients and number of contacts were extracted for the three-year period of January 2018 through December 2020. Data from each facility were analyzed separately for women, men and patients with psychotic, affective, anxiety and substance use-related disorders. Interrupted time series were used to demonstrate possible effects of COVID-19.Results: COVID-19 was associated with a marked decrease in treatment contacts, both for women and men, in the general psychiatry emergency unit—driven by a significant decrease in anxiety-related disorders (p < 0.001) and affective disorders (p < 0.01)—but not in psychotic or substance use disorders (SUDs). Also, in the addiction psychiatry emergency unit, no significant impact of COVID-19 was seen.Conclusions: COVID-19 may decrease treatment uptake for acute affective and anxiety-related disorders. Given the hypothesized increase in the population regarding these conditions, societal efforts are needed to facilitate adequate treatment for these patients during the COVID-19 pandemic. Society should also remain vigilant with respect to SUDs during the pandemic.

Changes in Psychiatric Inpatient Service Utilization During the First and Second Waves of the COVID-19 Pandemic

“…The largest absolute reduction among the different psychiatric diagnoses was seen among patients with substance abuse disorders and those with neurotic, stress-related, and somatoform disorders. A recent study at another large Swedish hospital reported similar results in patients with unipolar and anxiety-related disorders but, contrary to our results, the number of contacts related to substance use disorders remained unaltered ( 15 ). The mean weekly PEVs for patients with no diagnosis were numerically small during all time periods.…”

“…The unaltered number of PEVs among patients with schizophrenia and other related psychotic disorders stands in contrast to a report by the National Board of Health and Welfare in Sweden where other Swedish regions showed an increased rate of visits among patients with this psychiatric diagnosis ( 12 ). On the other hand, there are studies that show similar results to ours with either no significant reduction in this patient group ( 15 , 24 ) or a smaller absolute reduction compared to other diagnoses ( 11 ). The largest absolute reduction among the different psychiatric diagnoses was seen among patients with substance abuse disorders and those with neurotic, stress-related, and somatoform disorders.…”

“…Acute psychiatric services have been affected during the first wave of the pandemic with a reported 13–56% decrease across countries in adult psychiatric emergency room visits (PEVs) ( 8 – 15 ). A similar decrease in psychiatric admission rates to inpatient services has been reported between 10 and 41% ( 13 , 16 , 17 ).…”

Impact of the COVID-19 Pandemic on the General Mental Health in Sweden: No Observed Changes in the Dispensed Amount of Common Psychotropic Medications in the Region of Scania

“…Overall treatment-seeking within the mental health care system was unaffected and constant in numbers over the last years, while the number of new psychiatric patients decreased after the COVID-19 outbreak. In line with these findings, another study observed decreased contact to the health care system regarding acute cases of depression and anxiety (19).…”

“…On the other hand, a negatively affected public mental health state and impaired possibilities to seek help could potentially compensate each other in the recorded dispensed amounts of psychotropic medication and hence become undetectable by this study design. As mentioned in the introduction, several studies in Sweden suggest a deterioration in mental health and a compromised access to mental health care (16)(17)(18)(19). Especially new and acute patients seem to be affected, perhaps struggling the most with searching help while avoiding physical contact during the pandemic.…”