Physicians report increase in mental health, substance use visits due to the pandemic

Physicians reported an increase in outpatient visits related to mental health and substance use during the first 12 months of the COVID-19 pandemic, according to a study published in JAMA Network Open.

“Physicians self-reported high levels of symptoms of anxiety and depression, and surveys suggest these symptoms have been exacerbated by the COVID-19 pandemic,” Daniel T. Myran, MD, MPH, a family physician and health services researcher within the clinical epidemiology program at the Ottawa Hospital Research Institute, and colleagues wrote.

The study was a population-based cohort of physicians, using data collected from the Ontario Health Insurance Plan from March 2017 to March 2021.

Of the 34,055 practicing physicians (mean age, 41.7 years; 52.6% men), mental health and substance use visits during the pandemic continued to follow seasonal patterns but globally increased with 39.8 (95% CI, 37.8-41.8) biweekly visits per 1,000 physicians compared with 30.8 (95% CI, 29.7-31.8) prepandemic.

Only 17.1% of the physicians had one or more mental health visits in the 2 years before the start of the pandemic, according to the study.

The crude annual number of visits per 1,000 physicians increased by 27% during the pandemic, with a significant increase in rate of visits per physician (aIRR = 1.13; 95% CI, 1.07-1.19.) Researchers observed increases across subgroups during the first year of the pandemic, with no significant differences between men (aIRR, 1.07; 95% CI, 0.97-1.18) and women (aIRR, 1.16; 95% CI, 1.09-1.25) (P = .10), older (aIRR, 1.10; 95% CI, 0.97-1.24) and younger physicians (aIRR, 1.14; 95% CI, 1.07-1.21) (P = .55), urban (aIRR, 1.13; 95% CI, 1.06-1.19) and rural physicians (aIRR, 1.30; 95% CI, 0.84-2.00) (P = .72) and for physicians who provided infrequent (aIRR, 1.23; 0.89-1.70), more frequent (aIRR, 1.05; 0.77-1.43) or no (aIRR, 1.13; 95% CI, 1.06-1.21) (P = .72) care for patients with COVID-19 in the ED or hospital.

“After adjusting for demographic and physician characteristics and a history of health care use related to mental health, visits increased on average by 13% per physician,” the authors wrote.

In a related editorial, Bernard P. Chang, MD, PhD, vice chair of research and associate professor in the department of emergency medicine at Columbia University Medical Center, suggested these findings are an important contribution of destigmatizing mental health challenges experienced by the health care workforce.

“This parallel fear of being labeled with a mental health disorder within the profession of medicine has existed long before the current pandemic,” Chang wrote. “Although the study’s use of population-level data limits our ability to examine granular associations between mental health stress and variables, such as individual COVID-19 volume/load exposure, the overall findings of increased mental health care use among the physician population is an important contribution, reiterating the looming mental health crises among health care workers in the wake of the pandemic.”

Reference:

• Chang BP, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2021.43167.