Mental Health Conditions– and Substance Use—Associated Emergency Department Visits during the COVID-19 Pandemic in Nevada, USA

Abstract

Background—Mental health conditions and substance use are linked. During the COVID-19 pandemic, mental health conditions and substance use increased, while emergency department (ED) visits decreased in the U.S. There is limited information regarding how the pandemic has affected ED visits for patients with mental health conditions and substance use. Objectives—This study examined the changes in ED visits associated with more common and serious mental health conditions (suicidal ideation, suicide attempts, and schizophrenia) and more commonly used substances (opioids, cannabis, alcohol, and cigarettes) in Nevada during the COVID-19 pandemic in 2020 and 2021 compared with the pre-pandemic period. Methods—The Nevada State ED database from 2018 to 2021 was used (n = 4,185,416 ED visits). The 10th Revision of the International Classification of Diseases identified suicidal ideation, suicide attempts, schizophrenia, and the use of opioids, cannabis, alcohol, and cigarette smoking. Seven multivariable logistic regression models were developed for each of the conditions after adjusting for age, gender, race/ethnicity, and payer source. The reference year was set as 2018. Results—During both of the pandemic years (2020 and 2021), particularly in 2020, the odds of ED visits associated with suicidal ideation, suicide attempts, schizophrenia, cigarette smoking, and alcohol use were all significantly higher than those in 2018. Conclusions—Our findings indicate the impact of the pandemic on mental health- and substance use-associated ED visits and provide empirical evidence for policymakers to direct and develop decisive public health initiatives aimed at addressing mental health and substance use-associated health service utilization, especially during the early stages of large-scale public health emergencies, such as the COVID-19 pandemic.

Changes in characteristics of inpatient respiratory conditions from 2019 to 2021 (before and during the COVID-19 pandemic)

“…Age, gender, race/ethnicity, and payer source had previously been linked to these dependent variables (23) and were thus included as independent variables in the regression model. In order to control for time and detect a potential trend, year was included in all regression analyses, as used by other prior studies (6).…”

“…Multiple visits from the same patient would be considered distinct hospitalizations because the data had been deidentified. To account for variations within hospitals due to the clustering effect, we utilized the generalized linear model for multivariable analysis and treated hospitals as random effects while estimating the fixed effect of the independent variables of individual hospital discharges (6). The binomial family with the link function of logit was used for mortality analysis.…”

“…As the virus spread, hospitals quickly became overwhelmed, especially with patients requiring respiratory assistance and acute care (1)(2)(3). The pandemic has also highlighted existing healthcare disparities, with marginalized communities disproportionately affected by COVID-19 and faced barriers to accessing healthcare resources (4)(5)(6). The spectrum of respiratory conditions in the hospital setting has been previously compared before and during the pandemic (7).…”

“…For example, COVID-19-related death disparity was highest among Hispanics in California (19), while it was highest among African Americans in New York (20), implying that social determinants of health can be different even in the same country, and local public health prevention strategies might be needed for equitable resource allocation. Evidence also indicates that the distinction between the early effects of the pandemic and its late effects can also be important from a policy standpoint, and it should be taken into account in investigations focusing on the COVID-19 pandemic (6,17). It has been previously shown that emergency department visits for patients with mental illnesses increased throughout the COVID-19 pandemic in Nevada; however, this increase was significantly greater in the early pandemic in 2020 than in the late pandemic in 2021, implying the necessity of more resource allocations for mental health early in a pandemic (6).…”

“…Evidence also indicates that the distinction between the early effects of the pandemic and its late effects can also be important from a policy standpoint, and it should be taken into account in investigations focusing on the COVID-19 pandemic (6,17). It has been previously shown that emergency department visits for patients with mental illnesses increased throughout the COVID-19 pandemic in Nevada; however, this increase was significantly greater in the early pandemic in 2020 than in the late pandemic in 2021, implying the necessity of more resource allocations for mental health early in a pandemic (6). Data from the CDC also indicate that during 2020-2021, age-adjusted mortality decreased for African American (−6.1%), Asian (−1.9%), and Hispanic people (−1.2%) but increased for non-Hispanic Native Hawaiian or other Pacific Islander (68.3%), multiracial (57.1%), White (35.1%), and non-Hispanic American Indian or Alaska Native populations (3.8%) (21), providing robust evidence that the early impacts of the COVID-19 pandemic on the healthcare system could be different from its late impact.…”