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ObjectivePrevious literature finds an increase in depressive symptoms, substance use, and suicidal ideation following the COVID-19 pandemic in the US - suicides do not appear to increase. We examine whether 1) state lockdown policies in the US precede an increase in mental health symptoms; and 2) the extent to which using substances amplifies or attenuates the relation.MethodsWe specified, as our exposure variable, the timing of state-level lockdown orders. We used, as the outcome variable, the 4-item Patient Health Questionnaire (PHQ-4) that measures anxiety and depression symptoms. We utilized the Understanding America Study (UAS), a nationally representative sample of 7,597 adults across 50 states in the US, surveyed biweekly between March 10, 2020 and November 11, 2020. Linear fixed effect analyses controlled for time-invariant individual factors, as well as employment status, household income, and previous mental health diagnosis.ResultsRegression results indicate an increase in PHQ-4 scores of approximately 1.70 during lockdown, relative to no lockdown (p < 0.05). Relative to no lockdown, an increase in alcohol use corresponds with a 0.08 unit decrease in PHQ-4 scores during lockdown (p < 0.05).ConclusionState lockdown policies precede greater mental health symptoms. Increases in consuming alcohol attenuates the relation between state lockdown policies and mental health symptoms. Results may portend greater addiction following the pandemic warranting further investigation into utilization of substance use treatment.

BackgroundThe rise in opioid-related mortality and opioid-related emergency department (ED) visits has stimulated research on whether broader economic declines, such as the Great Recession, affect opioid-related morbidity. We examine in New York City whether one measure of morbidity-opioid-related ED visits-responded acutely to the large negative "shock" of the Great Recession.MethodsData comprise outpatient "treat and release" opioid-related ED visits in New York City for the 72 months spanning January 2006 to December 2011, taken from the Statewide Emergency Department Database (n = 150,246). We modeled the monthly incidence of opioid-related ED visits using Autoregressive, Integrated, Moving Average (ARIMA) time-series methods to control for patterning in ED visits before examining its potential association with the economic shock of the Great Recession.ResultsNew York City shows a mean of 1761 outpatient ED visits per month for opioid dependence and abuse. Unexpectedly large drops in employment coincide with fewer than expected opioid dependence and abuse ED visits in that same month. The result (coefficient = 0.046, 95% Confidence Interval [CI]: 0.002, 0.090) represents a 0.8% drop in overall incidence of opioid dependence and abuse ED visits during the Great Recession. We, however, observe no association between the Great Recession and ED visits for prescription opioid overdose or heroin overdose, or with inpatient ED visits for opioid dependence and abuse.ConclusionsFindings, if replicated, indicate distinct short-term reductions in opioid-related morbidity following the Great Recession. This result diverges from previous findings of increased opioid use following extended economic downturns.

Introduction: Toxicologic exposures (TE) are a major preventable public health issue, with most cases due to unintentional causes. Although these cases are well documented and reported via the National Poison Data System, there is little information regarding toxicologic exposure cases in the emergency department (ED). The aim of this study was to identify demographic groups at risk for potential poisoning.Methods: This was a cross-sectional study. We used data from the California State Emergency Department Database (SEDD) 2011 for statistical analysis. Results: The study included 10,124,598 ED visits in California in 2011. The prevalence of TE was 383.4 (379.6-387.3) per 100,000 visits. Toxicologic exposures were most common among patients aged

Introduction: Our goal in this study was to identify stimulant abuser patients who are at specifically high risk of suicide attempt (SAT), in order to prioritize them in preventive and risk mitigation programs. Methods: We used the California State Emergency Department Database (SEDD) to obtain discharge information for 2011. The SEDD contains discharge information on all outpatient ED encounters, including uninsured patients and those covered by Medicare, Medicaid, and private insurance. We identified SAT and stimulant abuse by using the relevant International Classification of Diseases, Ninth Revision, codes. Results: The study included 10,124,598 outpatient ED visits. Stimulant abuse was observed in 0.97% of ED visits. Stimulant abuse was more common among young and middle-aged males and people with low median household income. Moreover, it was more common among Native American (1.8%) and Black (1.8%), followed by non-Hispanic White (1.1%) patients. The prevalence of SAT was 2.0% (n = 2000) for ED visits by patients with a history of stimulant abuse, and 0.3% (N = 28,606) for ED visits without a history of stimulant abuse (odds ratio 7.29, 95% confidence interval, 6.97-7.64). The SATs were directly associated with stimulant abuse, younger age (age groups >10), and non-Hispanic White and Native American race. Association of SAT with stimulant abuse was stronger in female patients. Conclusion: Stimulant abuse was the only modifiable risk factor for suicide attempt in our study. Reaching out to populations with higher prevalence of stimulant abuse (young and middle-aged individuals who are Native American or Black, with lower household income) to control the stimulant abuse problem, may reduce the risk of SAT. In this regard, people who are at higher risk of SAT due to non-modifiable risk factors (younger age, and Native American or White race) should be prioritized. Moreover, controlling stimulant abuse among women may be specifically effective in SAT prevention. [ABSTRACT FROM AUTHOR]

Background: The rise in opioid-related mortality and opioid-related emergency department (ED) visits has stimulated research on whether broader economic declines, such as the Great Recession, affect opioid-related morbidity. We examine in New York City whether one measure of morbidity-opioid-related ED visits-responded acutely to the large negative "shock" of the Great Recession.Methods: Data comprise outpatient "treat and release" opioid-related ED visits in New York City for the 72 months spanning January 2006 to December 2011, taken from the Statewide Emergency Department Database (n = 150,246). We modeled the monthly incidence of opioid-related ED visits using Autoregressive, Integrated, Moving Average (ARIMA) time-series methods to control for patterning in ED visits before examining its potential association with the economic shock of the Great Recession.Results: New York City shows a mean of 1761 outpatient ED visits per month for opioid dependence and abuse. Unexpectedly large drops in employment coincide with fewer than expected opioid dependence and abuse ED visits in that same month. The result (coefficient = 0.046, 95% Confidence Interval [CI]: 0.002, 0.090) represents a 0.8% drop in overall incidence of opioid dependence and abuse ED visits during the Great Recession. We, however, observe no association between the Great Recession and ED visits for prescription opioid overdose or heroin overdose, or with inpatient ED visits for opioid dependence and abuse.Conclusions: Findings, if replicated, indicate distinct short-term reductions in opioid-related morbidity following the Great Recession. This result diverges from previous findings of increased opioid use following extended economic downturns. [ABSTRACT FROM AUTHOR]

Background: Evidence from past pandemics suggests that fear, uncertainty, and loss of control during large-scale public health crises may lead to increased pandemic-related information seeking, particularly among persons predisposed to high anxiety. In such groups, a greater consumption of information pertaining to the COVID-19 pandemic may increase anxiety.Objective: In this study, we examine the association between online activity and Generalized Anxiety Disorder 7 (GAD-7) scores in the United States.Methods: We recruited participants for an online survey through advertisements on various platforms such as Google, Facebook, and Reddit. A total of 406 adult US participants with moderate to severe (≥10) GAD-7 scores met the inclusion criteria and completed the survey. Anxiety levels measured using the GAD-7 scale formed our primary outcome. Our key independent variables were average daily time spent online and average daily time spent online searching about COVID-19 within the past 14 days. We used as controls potential confounders of the relation between our key independent variables and GAD-7 scores, namely, sleep quality, the COVID-19 Fear Inventory scale, binge drinking, substance use, prescription drug abuse, and sociodemographic attributes.Results: Linear multivariate regression analyses showed that GAD-7 scores were higher among those who spent >4 hours online (per day) searching for information about COVID-19 (coefficient 1.29, P=.002), controlling for all other covariates. The total time spent online was not statistically associated with GAD-7 scores.Conclusions: Results from this study indicate that limiting pandemic-related online information seeking may aid anxiety management in our study population. [ABSTRACT FROM AUTHOR]