Impact of COVID-19 on psychiatric assessment in emergency and outpatient settings measured using electronic health records

Victor M. Castro; Roy H Perlis

We also examined the relationship between COVID-19 testing and presence or absence of psychiatric symptom documentation. In the outpatient setting, likelihood of such testing was significantly diminished when psychiatric symptoms were documented. This result may indicate a dichotomy between visits focused on suspected COVID-19, and psychiatric visits, with clinicians focusing treating such complaints as mutually exclusive. However, among emergency department notes, while symptoms were not associated with testing, reference to violence was associated with greater likelihood of testing. This latter finding may reflect a shift in psychopathology evaluation in the emergency department in the initial stages of the COVID-19 pandemic in the Boston area, although further investigation and longer follow-up will be required to understand this shift. Importantly, these results cannot establish causation, and do not imply that individuals with psychiatric symptoms are more or less likely to be tested as a result of their symptoms per se.