The CDC reports rates of anxiety, depression, and suicidal ideation seem to be rising during the pandemic.1 We wondered whether mental health visits were also on the rise. We studied whether outpatient visits for depression or anxiety and ED visits for suicidal ideation, suicide attempt, or self-harm were increasing.
Outpatient Visits
In the outpatient setting, there was a sharp decline in anxiety and depression visits at the onset of the pandemic, but visit volume returned to pre-pandemic levels by June and has now exceeded the forecasted level, as shown in Figure 1.
Prior to the pandemic, 79% of outpatient visits for depression or anxiety were in-person office visits, 18% ED visits, 3% telephone, and 0.1% telehealth. Telehealth visits for patients with anxiety or depression grew dramatically in response to the pandemic, as reported initially in August 2020.2
We then compared in-person office visit and telehealth visit volumes for depression or anxiety (Figure 2). In the weeks prior to the pandemic, we observed minimal telehealth activity. Telehealth visits skyrocketed in March and April and exceeded in-person visits for several weeks. When office visits began to increase in mid-April through July, telehealth visits plateaued at a level of approximately 20,000 per week. Telehealth visits have remained an important source of contact, comprising 28% of the total visit volume at the end of 2020.
Emergency department visits for suicide-related diagnoses rose steadily through 2018-2019, peaking at 2,665 visits per week in our sample in March 2020. At the outset of the pandemic, suicide-related ED visits dropped abruptly, in alignment with overall ED visits.3 Figure 3 shows ED visits related to suicide have returned to pre-pandemic levels but have not increased.
Emergency Department Visits
ED visits for patients with anxiety or depression showed a similar trend, with a steep initial drop during the pandemic and then return to nearly pre-pandemic levels. Compared to suicide-related ED visits, ED visits for depression or anxiety returned to pre-pandemic levels more quickly (Figure 4).
Summary
When we looked at telehealth visits for anxiety and depression back in June, we were unsure whether the volume would continue to rise, or if it would decrease as physician offices reopened. While office visits remain lower than pre-pandemic, total outpatient visits are up, mainly due to the increase in telehealth.
We did not see an increase in anxiety, depression, or suicide-related ED visits compared to pre-pandemic levels. We recognize that suicide-related ED visit volumes do not capture the overall rates of suicide attempts or deaths in the general population. Because our data include only deaths that occur in the hospital setting, further study is needed to assess the overall suicide rate in the population.
