Evaluating the association between COVID-19 and psychiatric presentations, suicidal ideation in an emergency department

McDowell, Michal J.; Fry, Carrie; Nisavic, Mladen; Grossman, Mila N.; Masaki, Charles; Sorg, Emily; Bird, Suzanne; Smith, Felicia A.; Beach, Scott R.

doi:10.1371/journal.pone.0253805

Cited by 17 publications

(21 citation statements)

References 33 publications

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“…There is increasing evidence suggesting that the response to the COVID-19 pandemic led to a disruption of health services. Several studies, mainly from Europe, North America and Asia, reported a substantial decrease in the rates of emergency department visits (Jeffery et al ., 2020 ; Wongtanasarasin et al ., 2021 ) and hospital admissions for acute medical conditions including cardiovascular diseases (Esenwa et al ., 2020 ; Pelletier et al ., 2021 ) and mental health problems (Boldrini et al ., 2021 ; Gómez-Ramiro et al ., 2021 ; McDowell et al ., 2021 ; Wyatt et al ., 2021 ) following the introduction of COVID-19 lockdowns. The effect of COVID-19 related lockdowns on outpatient care is less well researched.…”

Section: Introductionmentioning

confidence: 99%

The effect of the COVID-19 lockdown on mental health care use in South Africa: an interrupted time-series analysis

Wettstein

Tlali

Joska

et al. 2022

Epidemiol Psychiatr Sci

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Aims The coronavirus disease 2019 (COVID-19) pandemic and ensuing restrictions have negatively affected the mental health and well-being of the general population, and there is increasing evidence suggesting that lockdowns have led to a disruption of health services. In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic, entailing the suspension of all non-essential activities and a complete ban of tobacco and alcohol sales. We studied the effect of the lockdown on mental health care utilisation rates in private-sector care in South Africa. Methods We conducted an interrupted time-series analysis using insurance claims from 1 January 2017 to 1 June 2020 of beneficiaries 18 years or older from a large private sector medical insurance scheme. We calculated weekly outpatient consultation and hospital admission rates for organic mental disorders, substance use disorders, serious mental disorders, depression, anxiety, other mental disorders, any mental disorder and alcohol withdrawal syndrome. We calculated adjusted odds ratios (OR) for the effect of the lockdown on weekly outpatient consultation and hospital admission rates and the weekly change in rates during the lockdown until 1 June 2020. Results 710 367 persons were followed up for a median of 153 weeks. Hospital admission rates (OR 0.38; 95% confidence interval (CI) 0.33–0.44) and outpatient consultation rates (OR 0.74; 95% CI 0.63–0.87) for any mental disorder decreased substantially after the introduction of the lockdown and did not recover to pre-lockdown levels by 1 June 2020. Health care utilisation rates for alcohol withdrawal syndrome doubled after the introduction of the lockdown, but the statistical uncertainty around the estimates was large (OR 2.24; 95% CI 0.69–7.24). Conclusions Mental health care utilisation rates for inpatient and outpatient services decreased substantially after the introduction of the lockdown. Hospital admissions and outpatient consultations for alcohol withdrawal syndrome increased after the introduction of the lockdown, but statistical uncertainty precludes strong conclusions about a potential unintended effect of the alcohol sales ban. Governments should integrate strategies for ensuring access and continuity of essential mental health services during lockdowns in pandemic preparedness planning.

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Section: Introductionmentioning

confidence: 99%

The effect of the COVID-19 lockdown on mental health care use in South Africa: an interrupted time-series analysis

Wettstein

Tlali

Joska

et al. 2022

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

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“…Additionally, annual rates of psychiatric presentations to emergency departments were largely observed to fall during the COVID-19 pandemic compared with before in data from the USA [26] and Spain [27].Inmoretargetedexaminations, however, presentation rates of individuals with psychotic disorders specifically were elevated during lockdown periods across multiple countries relative to other groups [27,28,29 & ]. Given stretched resources during the COVID-19 pandemic, these suggest that individuals with psychotic disorders may not be getting the help they need.…”

Section: Impact On Acute and Emergency Servicesmentioning

confidence: 99%

Psychotic disorders amid the COVID-19 pandemic: a consideration of risks and impacts

Tan

Neill²,

Rossell³

2022

Current Opinion in Psychiatry

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Purpose of reviewThe COVID-19 pandemic has had a severe and widespread global impact but particularly for those with psychosis. This review summarizes recent evidence on the relationship between the COVID-19 pandemic and psychotic disorders, highlighting the risks faced by these individuals including the negative impacts on treatment services, complications from contracting COVID-19, and the acceptability of digital interventions.Recent findingsMortality, morbidity, and infection outcomes are among the worst for individuals with psychotic disorders. Presentation rates for psychotic disorders are elevated at emergency departments compared with before the COVID-19 pandemic; demand for inpatient services has increased, and there have been complications in access because of pandemic restrictions. COVID-19 related stressors have led to the exacerbation and incidence of psychotic symptoms among individuals with and without preexisting psychotic diagnoses. Digital interventions may be an acceptable method for maintaining patient contact and treatment during extended isolation.SummaryMore data is needed on the longitudinal trajectory for psychotic symptoms post-COVID-19 infection and pandemic restrictions to better support individuals with psychotic disorders. Development of a long-term pandemic management plan is needed to monitor and support psychiatric health across the population.

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“…Recent studies have been conducted to evaluate the effects of SARS‐CoV‐2 on suicide. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 A recent meta‐analysis suggests that suicide ideation rates increased by nearly 11%, suicide attempts by 4.68%, and self‐harm by 9.63%. 26 The majority of published studies included samples of pediatric patients and we could not identify any study evaluating the effects of residing in a rural versus an urban geographic location on suicide attempts and suicide ideation.…”

Section: Introductionmentioning

confidence: 99%

Increased rates of suicide ideation and attempts in rural dwellers following the SARS‐CoV‐2 pandemic

Salt

Wiggins

Cerel

et al. 2022

The Journal of Rural Health

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Purpose Those factors identified to increase the risk of suicide in rural dwellers were exacerbated by the SARS‐CoV‐2 pandemic, specifically economic factors, substance use, access to health care, and access to lethal weapons. Because the effects of SARS‐CoV‐2 on suicide ideation and attempts in rural populations have not been fully characterized in published literature, this study compares: (1) the rates of suicide ideation and attempts between the 6 months affected by SARS‐CoV‐2 to same months of the preceding year (3/18/2020‐9/18/20; 3/18/2019‐9/18/19), (2) demographics (ie, age, sex, residence, race, and ethnicity), and (3) the locations in which the encounters were billed (inpatient, outpatient, and emergency department). Methods Deidentified claims data associated with patient encounters billed for Suicide Ideation and Suicide Attempt were grouped based on time period and analyzed using descriptive statistics, incidence rate ratio (IRR), 2‐sample t ‐test, chi‐square test of association, or Fisher's exact test. Findings Suicidal ideation encounters increased in the 6 months post‐SARS‐CoV‐2 when compared to the 6 months of the prior year ( IRR = 1.19; P < .001). Males ( IRR = 1.27, P < .001), those residing rural areas ( IRR = 1.22, P = .01), and Black, non‐Hispanic ( IRR = 1.24, P = .024) were found to have increased rates of suicide ideation post‐SARS‐Cov‐2. In adults, White, non‐Hispanics ( IRR = 1.16; P < .001) had increased rates of post‐SARS‐CoV‐2. In the pediatric subset, those who were aged 14‐17 ( IRR = 1.50; P < .001), resided in rural areas ( IRR = 1.61, P = .009), and idenitifed as Hispanic ( IRR = 1.89; P = .037) or Black, non‐Hispanic ( IRR = 1.61, P = .009) had increased rates post‐SARS‐CoV‐2. Conclusions Our study identified rural dwellers to be at increased risk for suicide ideation.

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Evaluating the association between COVID-19 and psychiatric presentations, suicidal ideation in an emergency department

Cited by 17 publications

References 33 publications

The effect of the COVID-19 lockdown on mental health care use in South Africa: an interrupted time-series analysis

The effect of the COVID-19 lockdown on mental health care use in South Africa: an interrupted time-series analysis

Psychotic disorders amid the COVID-19 pandemic: a consideration of risks and impacts

Increased rates of suicide ideation and attempts in rural dwellers following the SARS‐CoV‐2 pandemic

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