# Impact of COVID-19 on emergency department visits for individuals with psychotic disorders in Newfoundland and Labrador, Canada: A longitudinal study

## TL;DR

This study found that emergency department visits increased for people with psychotic disorders during the early years of the COVID-19 pandemic in Newfoundland and Labrador, Canada.

## Contribution

The study provides a methodologically robust longitudinal analysis of ED utilization patterns for individuals with psychotic disorders before and during the pandemic.

## Key findings

- Mean monthly ED visits increased significantly during the first year of the pandemic compared to before.
- Female individuals and rural residents had higher ED visit rates than males and urban residents.

## Abstract

During the global COVID-19 pandemic, emergency departments (EDs) saw an overall decrease in utilization. However, some vulnerable groups, such as those living with psychotic disorders, must often rely on the services provided by EDs. The literature in this area lacks methodologically robust longitudinal studies which examine the ED utilization patterns of individuals with psychotic disorders both before and during the pandemic. This research was a longitudinal retrospective cohort study of individuals with a psychotic disorder in Newfoundland and Labrador before COVID-19 (2011–2019) and during the pandemic (2020–2022). Patients diagnosed with a psychotic disorder between April 1st, 2011, and March 31st, 2022, who were between 15–24 years old, and who visited an ED at least once, were included. Average monthly visits were used to measure ED visits to control for differences in each individual’s data. Independent variables in the analyses were: 1) age, 2) sex, 3) geographic region, 4) urban or rural residence, and 5) ED visit before or during COVID-19. Multiple linear regression with Generalized Estimating Equations (GEE) modelling was used to identify factors associated with mean monthly ED visits. Multivariate analysis showed the mean monthly ED visits increased significantly during the first year of COVID-19 than before the pandemic (Mean = 0.30 vs Mean = 0.21, p = 0.01). Female individuals and rural residents also had significantly higher mean monthly ED visits than male individuals (Female = 0.51 vs Male = 0.21, p < 0.01) and urban residents (rural = 0.38 vs urban = 0.21, p = 0.02). ED utilization by individuals with psychotic disorders increased during the first year of the COVID-19 pandemic, while ED use by most Canadians decreased. This study identified the demographics of Canadians who require extra support during a health crisis. There is always the possibility of another global pandemic, and the Canadian healthcare system must be equipped to provide adequate services to all Canadians, especially those who are most marginalized.