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. 2023:45:e2023022.
doi: 10.4178/epih.e2023022. Epub 2023 Feb 14.

Changes in mental health service utilization before and during the COVID-19 pandemic: a nationwide database analysis in Korea

Affiliations

Changes in mental health service utilization before and during the COVID-19 pandemic: a nationwide database analysis in Korea

Kyoung Hoon Kim et al. Epidemiol Health. 2023.

Abstract

Objectives: The present study examined the impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health service utilization through a comparative analysis of nationwide data regarding inpatient care users, outpatient visits, emergency department (ED) visits, and admissions via the ED before and during the pandemic.

Methods: Data from approximately 350,000 Koreans diagnosed with mental illness were analyzed in terms of hospitalization, outpatient visits, and ED visits between January 2018 and June 2021. An interrupted time series analysis was conducted to determine the significance of changes in mental health service utilization indicators.

Results: The number of hospital admissions per patient decreased by 1.2% at the start of the pandemic and 0.7% afterward. The length of hospital stay increased by 1.8% at the outbreak of the pandemic, and then decreased by 20.2%. Although the number of outpatients increased, the number of outpatient visits per patient decreased; the number of outpatient visits for schizophrenia (3.4%) and bipolar disorder (3.5%) significantly decreased immediately post-outbreak. The number of ED visits per patient decreased both immediately post-outbreak and afterward, and ED visits for schizophrenia (19.2%), bipolar disorder (22.3%), and depression (17.4%) decreased significantly immediately post-outbreak. Admissions via the ED did not show a significant change immediately post-outbreak.

Conclusions: Mental health service utilization increased during the pandemic, but medical service use decreased overall, with a particularly significant decrease in ED utilization. As the pandemic worsened, the decline in outpatient visits became more pronounced among those with severe mental illness.

Keywords: COVID-19; Interrupted time series analysis; Mental health; Pandemics; Utilization.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors have no conflicts of interest to declare for this study.

Figures

Figure 1.
Figure 1.
Quarterly trends of mental health service use patterns according to the principal diagnosis. Each graph represents the trend of indicator: (A) number of admission per patient, (B) number of outpatient care per patient, (C) number of admission via emergency department (ED) per patient, (D) number of emergency care per patient, and (E) length of hospitalization per patient. Vertical lines shown in Q1 2020 represent when the coronavirus disease 2019 pandemic first started.
Figure 2.
Figure 2.
Changes in mental health service use after the coronavirus disease 2019 (COVID-19) outbreak according to the principal diagnosis, using interrupted time series analysis. Time represents the time since the start of the study period, "intervention" indicates whether the time is before (0) or after (1) the occurrence of COVID-19, and time after intervention represents the time elapsed after the occurrence of COVID-19, taking a value of 0 prior to COVID-19. ED, emergency department.
None

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