Available online 22 July 2023, 100607

Many communities were identified in clusters both before and during the pandemic

More communities were identified in clusters during the pandemic than before

Mental health burdens remain high in many communities, both rural and urban

Rapidly emerging research on the mental health consequences of the COVID-19 pandemic shows increasing patterns of psychological distress, including anxiety and depression, and self-harming behaviors, particularly during the early months of the pandemic. Yet, few studies have investigated the spatial and temporal changes in depressive disorders and suicidal behavior during the pandemic. The objective of this retrospective analysis was to evaluate geographic patterns of emergency department admissions for depression and suicidal behavior in North Carolina before (March 2017-February 2020) and during the COVID-19 pandemic (March 2020 - December 2021). Univariate cluster detection examined each outcome separately and multivariate cluster detection was used to examine the co-occurrence of depression and suicide-related outcomes in SatScan; the Rand index evaluated cluster overlap. Cluster analyses were adjusted for age, race, and sex. Findings suggest that the mental health burden of depression and suicide-related outcomes remained high in many communities throughout the pandemic. Rural communities exhibited a larger increase in the co-occurrence of depression and suicide-related ED visits during the pandemic period. Results showed the exacerbation of depression and suicide-related outcomes in vulnerable communities and emphasize the need for targeted and sustained mental health interventions throughout the many phases of the COVID-19 pandemic.

Mental health

Cluster Analysis

COVID-19

SaTScan

Depression

Self-Injury

Self-Harm

The authors do not have permission to share data.

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