Mental health-related ED visits, suicide attempts in SG soar during COVID-19 pandemic

High-acuity mental health-related emergency department (ED) attendances increased relative to other reasons during the COVID-19 pandemic, reports a Singapore study. The incidence of suicide attempts also rose with the progress of the pandemic.

“As one of the first points of contact for mental health presentations, emergency physicians must be aware of the ways that COVID-19 has impacted the population’s mental health,” the researchers said.

A total of 1,421 patients were identified for the study, of whom 27 were excluded due to non-mental health-related diagnosis, and 1,394 were left for analysis. [Singapore Med J 2025;66:p645-650]

Mental health-related ED visits rose from 589 in 2019 to 805 in 2020, representing a 36.7-percent increase. As the COVID-19 situation progressed, the total number of mental health-related ED attendances also increased, according to the researchers.

Likewise, the number of suicide attempts significantly increased during the pandemic. In 2019, suicide attempts accounted for 30.7 percent of mental health-related presentations, and this proportion rose to 35.3 percent in the following year.

“At the onset of the COVID-19 pandemic, a study conducted at the same ED found that the total number of ED attendances for any reason decreased, likely due to the fear of exposure to COVID-19 among the public,” the researchers said. [Ann Acad Med Singap 2021;50:184-187]

“However, data in this study show that the number of mental health-related ED attendances in the same hospital increased,” they added.

Because of this, mental health-related ED visits constituted a greater percentage of ED attendances during the pandemic compared to the prepandemic period. The results also suggested the negative impact of the pandemic and social restrictions on the mental health of Singapore residents.

Circuit breaker

The first confirmed case of COVID-19 in Singapore was recorded on 23 January 2020, but the number of mental health presentations only showed an increase in May 2020, following the introduction of the circuit breaker on 7 April 2020.

Such trend hints at the greater negative impact of movement restrictions—which caused disruption to work, school, and recreation—on the mental health of the people than fear of contracting COVID-19, according to the researchers.

“This was further supported by the data that showed that the number of mental health presentations started to decrease with the relaxation of movement restrictions as evidenced by a sharp decline in attendances between phases 1 and 2,” they said.

“The effect of COVID-19 on the mental health of healthcare workers in Singapore should be studied in the future,” the researchers added.

This retrospective, descriptive study involved patients who presented to the ED between 1 January 2019 and 31 December 2020. Those diagnosed with mental health-related systematized nomenclature of medicine who visited the ED during this period were identified and placed into mental health diagnosis categories for analysis.

Finally, the researchers compared patients who presented to the ED before the pandemic (2019) and during the pandemic (2020).