Impact of COVID-19 on psychiatric assessment in emergency and outpatient settings measured using electronic health records

Importance: As with other traumatic events, pandemics such as coronavirus-19 (COVID-19) may precipitate or exacerbate psychiatric symptoms such as anxiety and depression, while potentially interfering with health systems9 capacity to treat such symptoms. Objective: To quantify the impact of increasing COVID-19 infection on extent of psychiatric assessment across 5 Eastern Massachusetts hospitals. Design: In silico cohort using narrative clinical notes generated between 1/2/2020 and 3/25/2020 Setting: Emergency department and outpatient settings from 2 academic medical centers and 3 community hospitals Participants: All individuals age 13 and older presenting to emergency department or outpatient clinics Main Outcome or Measure: Documentation of psychiatric symptoms reflecting depression, anxiety, psychosis, or suicide, and documentation of violence, was drawn from previously-validated term lists. Results: A total of 2,483,159 outpatient and 205,957 emergency department visit notes were analyzed. Instances of notes referencing depression or anxiety decreased 75-81% in outpatient settings with onset of coronavirus in March 2019, and by 44-45% in emergency departments. In adjusted logistic regression, presence of individual psychiatric symptoms in outpatient notes was associated with significant decreases in likelihood of coronavirus testing (for depression, OR=0.636, 95% CI 0.606-0.667). Conversely, presence of violence in an emergency department note was associated with greater likelihood of testing (OR=1.487, 95% CI 1.249-1.761). Conclusions and Relevance: Documentation of psychiatric symptoms in both outpatient and emergency department settings diminished sharply in the context of increasing coronavirus infection in Massachusetts, suggesting that efforts to provide additional resources to manage psychiatric symptoms will be needed. Funding: none.