International comparison of hospitalizations and emergency department visits related to mental health conditions across high-income countries before and during the COVID-19 pandemic.

IF 3.1 2区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Nicholas Bowden, Aaron Hedquist, Dannie Dai, Olukorede Abiona, Enrique Bernal-Delgado, Carl Rudolf Blankart, Julie Cartailler, Francisco Estupiñán-Romero, Philip Haywood, Zeynep Or, Irene Papanicolas, Mai Stafford, Steven Wyatt, Reijo Sund, Jean Pierre Uwitonze, Walter P Wodchis, Robin Gauld, Hien Vu, Tania Sawaya, Jose F Figueroa
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引用次数: 0

Abstract

Objective: To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high-income countries before and during the COVID-19 pandemic.

Data sources and study setting: Administrative patient-level data between 2017 and 2020 of eight high-income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US).

Study design: Multi-country retrospective observational study using a federated data approach that evaluated age-sex standardized rates of hospitalizations and ED visits for mental health conditions.

Principal findings: There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre-COVID-19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID-19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France.

Conclusion: The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID-19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID-19 preparedness, and community-based care may contribute to these variations.

What is known on this topic: Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high-income countries, with substantial differences in access to effective care. The COVID-19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries.

What this study adds: This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high-income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross-country differences in acute care management of mental health conditions coinciding with the onset of the COVID-19 pandemic.

高收入国家在 COVID-19 大流行之前和期间与精神健康状况有关的住院和急诊就诊情况的国际比较。
目的:探讨高收入国家在 COVID-19 大流行之前和期间因精神健康状况(包括住院和急诊就诊)而使用急诊服务的比率差异:探讨在COVID-19大流行之前和期间,高收入国家因精神健康状况(包括住院和急诊室就诊)而使用急诊服务的比率差异:八个高收入国家在 2017 年至 2020 年间的患者层面行政数据:研究设计:研究设计:多国回顾性观察研究,采用联合数据方法,评估因精神疾病住院和急诊室就诊的年龄-性别标准化比率:主要发现:各国的急性精神疾病就诊率差异很大。在同时拥有住院和急诊就诊数据的四个国家子集中,美国的 COVID-19 前综合年平均急诊就诊率最高,为 1613 次/100,000 人(95% CI:1428, 1797)。芬兰的发病率最低,为 776 例(686 例,866 例)。如果仅考察住院率,法国的住院率最高,为 988 次/100,000 人(95% CI:858, 1118),而西班牙的住院率最低,为 87 次/100,000 人(95% CI:76, 99)。在精神疾病的急诊率方面,美国最高,为 958/100,000(95% CI 861-1055),法国最低,为 241/100,000(95% CI 216-265)。与 COVID-19 大流行同时出现的显著变化包括:美国的医疗机构从急诊室转为住院部,而加拿大和法国的急诊使用率总体下降:本研究强调了了解和解决不同医疗系统中精神疾病急症护理利用率差异(包括 COVID-19 的不同影响)的重要性。还需要进一步研究,以阐明劳动力能力、就医障碍、经济激励、COVID-19 准备情况和社区护理等因素在多大程度上可能导致这些差异:全球约有十亿人患有精神疾病,这对个人和社会都造成了重大影响。高收入国家的心理健康诊断率各不相同,在获得有效护理方面也存在巨大差异。COVID-19 大流行加剧了全球的心理健康挑战,对各国的影响也各不相同:本研究对八个高收入国家的精神疾病住院率和急诊就诊率进行了全面的国际比较。研究发现,在 COVID-19 大流行爆发的同时,各国在精神疾病的急诊管理方面也存在着时间差异和国家差异。
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来源期刊
Health Services Research
Health Services Research 医学-卫生保健
CiteScore
4.80
自引率
5.90%
发文量
193
审稿时长
4-8 weeks
期刊介绍: Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
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