- In this retrospective study, researchers reviewed electronic health records from two large academic medical centers and three affiliated community hospitals in the Boston area
- The study included all individuals seen during emergency department visits (60,428 patients) or outpatient visits (541,307 patients) for any reason between January 2 and March 25, 2020
- Inclusive of telemedicine, the researchers detected a marked reduction in notes documenting psychiatric symptoms, paralleling the emergence of COVID-19 in the Boston area
- Strategies are urgently needed to ensure that neglect of psychiatric illness is not another consequence of the pandemic
The COVID-19 pandemic has increased the burden of psychiatric symptoms for health care workers as well as the general public. Yet Victor M. Castro, MS, data scientist at Mass General Brigham, and Roy Perlis, MD, MSc, director of the Center for Quantitative Health in the Department of Psychiatry at Massachusetts General Hospital, documented a decrease in psychiatric evaluations, including telemedicine visits, during the time COVID-19 was emerging in the Boston area. The findings appear in a research letter in JAMA Network Open.
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The researchers reviewed electronic health records from two large academic medical centers and three affiliated community hospitals in the Boston area. They included all individuals seen in the emergency department or outpatient visits for any reason between January 2 and March 25, 2020.
Using a list of terms developed by the National Institute of Mental Health, the researchers electronically searched narrative clinical notes for documentation of depression, anxiety, suicide, psychosis and violence.
Emergency Department Visits
205,957 emergency department notes were analyzed, representing 60,428 patients. For depression, the average number of mentions were:
- January and February: 1,446 per week
- March 19 to March 25: 886 per week
This represented a 44% decrease. A similar pattern was observed for other psychiatric symptoms.
Most symptoms were not associated with SARS-CoV-2 testing. However, the odds of SARS-CoV-2 testing for an individual patient, adjusted for age, sex, race/ethnicity and hospital type, increased nearly 50% in visits when violence was referenced (aOR, 1.49; 95% CI, 1.25–1.76). This may reflect a shift in clinical presentations.
2,483,159 outpatient notes were analyzed, representing 541,307 patients. For depression, the average number of mentions were:
- January and February: 49,312 per week
- March 19 to March 25: 9,315 per week
This represented an 81% decrease and again, a similar pattern was observed for other psychiatric symptoms.
Notes that contained psychiatric terms were associated with a reduction in the likelihood of SARS-CoV-2 testing, with adjusted odds ratios of:
- 0.80 for anxiety
- 0.73 for suicide
- 0.64 for depression
- 0.63 for psychosis
- 0.40 for violence
The Bottom Line
It can be presumed that as rates of COVID-19 began spiking in Boston, outpatient visits were canceled, individuals became reluctant to come to the emergency department and clinicians seeking to reduce exposure conducted more focused interviews.
Unfortunately, psychiatric symptoms are likely to be increasing even while patients' willingness to seek care—and access to care—is decreasing. Especially considering the potential for longer-term sequelae, strategies such as telemedicine are urgently needed to ensure that neglect of psychiatric illness is not another consequence of the pandemic.
View the Department of Psychiatry's Guide to Mental Health Resources