Physician Mental Health Care Visits Ticked Up Significantly During First Year of Pandemic

Family physicians and psychiatrists were the specialties with the greatest number of visits, according to study authors.

Rates of outpatient visits for mental health and substance use among physicians increased 27% during the first year of the COVID-19 pandemic, according to new research published online in JAMA Network Open.

The study, conducted among practicing physicians in Ontario, Canada, found notably that the relative increase in visits was significantly greater among physicians without prior histories of mental health or substance use problems.

“Surveys of physicians during the COVID-19 pandemic have found increased reports of depression, anxiety and burnout. However, because these surveys generally only capture a single point in time and many had a very low response rate, it was unclear how reflective they were of physician mental health overall,” said lead author Daniel Myran, MD, MPH, a family physician, public health and preventive medicine specialist, and postdoctoral fellow at the University of Ottawa Department of Family Medicine and The Ottawa Hospital in a press release. “To help understand how COVID-19 has been impacting physician mental health we looked at changes over time in health care visits by physicians.”

Using health data from the universal Ontario Health Insurance Plan for the period from March 1, 2017 to March 10, 2021, Myran et al compared the rate of all virtual and in-person outpatient visits to a primary care physician or a psychiatrist coded for mental health or substance for the 12 months following and preceding the start of the pandemic (March 11, 2020) among 34 055 physicians, residents and fellows in Ontario, Canada. Mean age of the cohort was 41.7 years and half (52.6%) were men.

The authors report that the proportion of physicans making first-time mental health/substance abuse visits during the pandemic grew by 40.6%, compared with a 19.3% increase among those who had made such visits before the start of the pandemic. Overall, the annual number of visits increased 27%, from 816.8 to 1,037.6 per 1000 physicians.

The findings suggest, according to the researchers, that the increases in visits result from both an increase in the number of doctors accessing mental health services and in the number of those with multiple mental health visits.

“Together, these findings suggest that generally, physicians have displayed resiliency during the pandemic, but a small group may have developed very high new mental health care needs…which are possibly related to pandemic-specific stressors.”

Among practicing specialists, surgeons and anesthesiologists were the least likely to seek mental health/substance abuse help, with 460.6 and 740.3 visits per 1000 physicians, respectively. On the other hand, visits among anesthesiologists grew by 74% after the start of the pandemic, the largest among any of the specialties in the study. Specialties with the greatest number of visits were psychiatrists (4,252 per 1000) and family physicians (890.3 per 1000).

The authors note that while earlier studies have shown prolonged contact with COVID-infected patients to be a risk factor for negative psychological outcomes, their results found little difference between those who did or did not provide acute care for these patients. They speculate this may be because physicians providing acute care for COVID-19 patients had lower rates of mental health/substance abuse visits before the pandemic.

This result may, in turn, suggest that this group of doctors has greater resilience to mental health conditions, be more reluctant to seek mental health care, or a combination of the two that continued during the pandemic. Another possibility is that their increased workloads during the pandemic may not have allowed them time to seek mental health care.

The authors say that their findings of increases in mental health/substance abuse visits, when combined with surveys of doctors showing high levels of self-reported anxiety, depression and stress, may indicate worsening mental health among doctors generally.

Reference: Myran DT, Cantor N, Rhodes E, et al. Physician health care visits for mental health and substance abuse during the COVID-19 pandemic in Ontario, Canada. JAMA Netw Open. 2022;5:e2143160.