Women’s Health
Emergency department utilization for mental and behavioral disorders among postpartum individuals in the context of the COVID-19 pandemic Sidra Goldman-Mellor* Sidra Goldman-Mellor Alison Gemmill Mark Olfson Jordan Jensen Shaina Sta. Cruz Claire Margerison
Pregnant and postpartum individuals faced unique challenges and uncertainties during the initial COVID-19 pandemic years, including concerns about the virus’ risk to their fetus or neonate, misinformation about impact of vaccination on maternal-fetal health, and burdensome childcare responsibilities. The distinctive nature of these stressors underscores the need to examine pandemic-era mental and behavioral health in this population. Using statewide linked hospital delivery and emergency department (ED) data from California, we compared incidence of postpartum ED visits for psychiatric disorder, alcohol use disorder, drug use disorder, and assault among exposure cohorts with a delivery in “pre-pandemic” (Jan. 2016-March 2019), “transitional” (April 2019-March 2020), or “peak pandemic” (April 2020-Sept. 2021) periods. Risk ratio models accounting for cohort differences in maternal age, race/ethnicity, and insurance found that 12-month postpartum incidence of ED utilization for psychiatric disorder, alcohol, and drugs did not vary by exposure cohort. However, 12-month postpartum incidence of ED utilization for assault was substantially reduced in the transitional (RRadj=0.91, 95% CI=0.86, 0.97) and peak-pandemic cohorts (RRadj=0.93, 95% CI=0.86, 0.99) compared to the pre-pandemic cohort. When analyses were restricted to a 3-month follow-up period, postpartum ED utilization for psychiatric disorder increased among transitional and peak-pandemic cohorts, but RRs for other outcomes were null. Next steps are to examine heterogeneity by race/ethnicity and insurance status. Results suggest that postpartum individuals sought ED care for psychiatric and substance use problems at consistent rates during the first two pandemic years, but decreased their ED utilization for assault. Additional research is needed to understand whether these patterns result from changes in the true incidence of, vs. treatment-seeking for, these outcomes.