Psychiatric Emergencies in Los Angeles County During, and After, Initial COVID-19 Societal Restrictions: An Interrupted Time-Series Analysis

Abstract

Emergency department (ED) visits for psychiatric care in the US reportedly declined during the COVID-19 pandemic. This work, however, does not control for strong temporal patterning in visits before the pandemic and does not examine a potential “rebound” in demand for psychiatric care following the relaxation of initial societal restrictions. Here, we examine COVID-19-related perturbations in psychiatric care during and after the 1st stage of societal restrictions in the largest safety-net hospital in Los Angeles. We retrieved psychiatric ED visit data (98,888 total over 156 weeks, Jan 2018 to Dec 2020) from Los Angeles County + USC Medical Center. We applied interrupted time series methods to identify and control for autocorrelation in psychiatric ED visits before examining their relation with the 1st stage of societal restrictions (i.e., March 13 to May 8, 2020), as well as the subsequent “rebound” period of relaxed restrictions (i.e., after May 8, 2020). Psychiatric ED visits fell by 78.13 per week (i.e., 12%) during the 1st stage of societal restrictions (SD = 23.99, p < 0.01). Reductions in ED visits for alcohol use, substance use, and (to a lesser extent) anxiety disorders accounted for the overall decline. After the 1st stage of societal restrictions, however, we observe no “rebound” above expected values in psychiatric ED visits overall (coef = − 16.89, SD = 20.58, p = 0.41) or by diagnostic subtype. This pattern of results does not support speculation that, at the population level, foregoing ED care during initial societal restrictions subsequently induced a psychiatric “pandemic” of urgent visits.

ED Visits for Schizophrenia Spectrum Disorders During the COVID-19 Pandemic at 5 Campus Health Systems

“…Examination of the absolute change in ED visits for schizophrenia spectrum disorders (not controlling for ED visits for all other psychiatric conditions) cohere with our main inference in that we observed a mean (SE) increase of 69.5 (27.7) visits at exposure lag 3 (eTable 6 in Supplement 1) when the exposure was modeled as the initial phase of the pandemic, and at exposure lag 1 by 84.8 (37.1) visits, when the exposure was modeled as the extended phase of the COVID-19 pandemic (eTable 7 in Supplement 1). Finally, our examination of monthly ED visits for all other psychiatric conditions indicated a decrease in these visits in response to the exposure, in alignment with extant literature (eTables 8 and 9 in Supplement 1).…”

“…In the present study, we use monthly data from the University of California (UC) system, comprising 5 UC campuses (Los Angeles, Irvine, Davis, San Francisco, and San Diego, California), to examine changes in ED visits for schizophrenia following the start of COVID-19 pandemic . Contrary to other reports of decline in ED use for psychiatric emergencies, we hypothesize an increase in ED visits for schizophrenia spectrum disorders . We use time series analyses and examine whether any detected increase in ED visits for schizophrenia spectrum disorders is associated with the initial acute phase of the COVID-19 pandemic in California (ie, strict pandemic guidelines and stay-at-home orders in March, April, and May 2020) as well as a more extended formulation of the pandemic spanning March to December 2020.…”

“…Exploratory analyses included examination of northern (UC Davis and UC San Francisco) and southern (UC San Diego, UC Irvine, and UC Los Angeles) California campuses separately, to gauge consistency across broad geographic regions within California. Finally, we examined whether the temporal patterning of ED visits for all other psychiatric conditions vs our exposure aligned with expectations of rapid decline following onset of the COVID-19 pandemic from extant research . We specified 2-tailed tests using statistical significance level of P < .05.…”

Undiagnosed Cancer Cases in the US During the First 10 Months of the COVID-19 Pandemic

“…Yet while the world focused on the threat posed by a novel respiratory virus, the threat of cancer remained ever present, and any associated reduction in observed cancer incidence during this period is of particular concern. Unlike other population health outcomes studied, a decline in new cancer diagnoses in 2020 does not indicate that cancer occurrence in the US decreased, but rather that new cancers were undetected . The longer cancer exists undetected, the greater the risk of tumor progression and the lower the chances of survival and other positive outcomes for patients …”

“…Unlike other population health outcomes studied, a decline in new cancer diagnoses in 2020 does not indicate that cancer occurrence in the US decreased, but rather that new cancers were undetected. [1][2][3] The longer cancer exists undetected, the greater the risk of tumor progression and the lower the chances of survival and other positive outcomes for patients. 4 The negative association of the pandemic response with cancer diagnoses was widely anticipated.…”