From mental illness flareups and overdose deaths, to intimate partner violence and child abuse, misery rose nationwide in 2020 along with COVID-19 risk.
“This cross-sectional study of almost 190 million emergency department visits found that visit rates for mental health conditions, suicide attempts, all drug and opioid overdoses, intimate partner violence, and child abuse and neglect were higher in mid-March through October 2020, during the COVID-19 pandemic, compared with the same period in 2019,” the researchers found.
“These findings suggest that emergency department use and priorities for care-seeking shifted during the COVID-19 pandemic, underscoring mental health, substance use, and violence-risk screening and prevention needs during public health crises.”
The study appears online in JAMA Psychiatry. The researchers work at the U.S. Centers for Disease Control and Prevention.
The cross-sectional study used data from the U.S. Centers for Disease Control and Prevention’s National Syndromic Surveillance Program to examine national changes in emergency department visits for (mental health, suicide, and overdose) deaths and violence from Dec. 30, 2018, to Oct. 10, 2020 (before and during the COVID-19 pandemic).
The National Syndromic Surveillance Program captures about 70 percent of U.S. emergency room visits from more than 3,500 emergency departments that cover 48 states and Washington, DC.
“These findings suggest that emergency department care-seeking shifts during a pandemic, underscoring the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises.”
People stuck inside with dangerous perpetrators
One of the reasons violence has spiked along with mental health problems is because COVID has forced perpetrators and victims to spend more time together.
“The shutdown of businesses, schools, and other public entities resulted in reduced or modified access to mental health treatment, addiction and recovery support services, and services designed to support families experiencing or at risk for violence victimization,” the researchers explained.
“To avoid risk of exposure to COVID-19, many people delayed or avoided seeking medical care, potentially increasing the risk of poor mental health, substance use, and violence outcomes.”
Past research of pandemics and national disasters has shown that events such as COVID-19 may result in mental health problems for some groups.
“One survey found that nearly one in seven U.S. adults reported psychological distress in April 2020, during the peak of stay-at-home orders, compared with one in 25 adults in April 2018,” the authors observed. “Furthermore, increased domestic violence and child abuse hotline call volume at the onset of the pandemic may indicate that violence increased while individuals likely spent more time with potential perpetrators.
“These findings suggest that increases in poor mental health, suicidal behavior, substance use, and violence outcomes have occurred during the COVID-19 pandemic; however, few studies have documented trends in these outcomes before and during the pandemic.”
Visits to ERs dip once COVID-19 mitigations begin
Visits to emergency departments decreased once COVID-19 mitigation measures went into place.
“At their lowest point, ED visits for (mental health, suicide, and interpersonal violence) decreased to a lesser extent (24.1 percent for mental health, 13.1 percent for suicide, and 33.7 percent for interpersonal violence) than overall ED visits (43.1 percent) during the early weeks of the COVID-19 pandemic,” the authors reported.
“All drug ODs had a slight decrease from March 29 to April 11 (range 3.4 percent to 4.3 percent) compared with the same weeks in 2019, but otherwise weekly counts of all drug and opioid ODs ranged from 1 percent to 45 percent higher in 2020 compared with the same week in 2019.”
The study marked the first to show COVID-19 outcomes related to suicide, mental health, and interpersonal violence.
“Fear and worry about the COVID-19 pandemic, combined with implementation of mitigation measures and resultant social isolation and economic distress, stand to markedly impact (mental health, suicide and overdoses) and violence,” the authors concluded. “Indeed, research has already documented self-reported psychological distress and loneliness among U.S. adults in the midst of COVID-19 stay-at-home orders.”
Problems severe enough to seek ER treatment
The findings suggest problems related to mental health, overdose and violence were severe enough for patients to violate the stay-at-home order and seek treatment.
“The findings suggest that visits for these outcomes were likely of sufficient severity that treatment at an ED was a necessary risk during the pandemic, despite stay-at-home orders advising people to avoid public spaces,” the authors reported.
Overdoses skyrocketed in 2020. “That all drug and opioid OD emergency department visits did not decrease in a similar manner to other emergency department visits is especially compelling, suggesting an increase in OD burden during the pandemic,” the authors concluded.
“Opioid ODs in particular exhibited the most consistent increases in counts, with only a limited decrease observed during the period in 2020 when overall emergency department visits were low, never decreasing below weekly counts observed in the first 41 weeks of 2019.
“This finding might reflect changes in the illicit drug supply during the pandemic and that persons using opioids used them alone or in higher-risk ways, increasing the likelihood of OD, or that they lacked access to naloxone or other risk-reduction services—all potential effects of COVID-19 mitigation measures.”
The authors call for strategies including “mass media campaigns that emphasize resilience, help-seeking, and available resources (e.g., the national Disaster Distress Helpline), strengthening economic supports to minimize financial stress, payment policies and regulatory changes to support expanded telehealth and addiction treatment services, and promoting social connectedness.
“These community-level prevention efforts may serve to blunt potential population-level associations of the pandemic with (mental health problems), substance use, and violence.”