The impact of the COVID-19 pandemic on mental health symptoms in new patients presenting to outpatient psychiatry

OBJECTIVE: To compare self-reported anxiety, depression, insomnia, functional impairment, and substance use among distinct cohorts of new adult psychiatric outpatients before and after the onset of the COVID-19 pandemic. METHODS: Outpatient intake visit data, collected pre-pandemic (May 1, 2019-February 28, 2020) and early in the pandemic (May 1, 2020-February 26, 2021), included the Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI), Work and Social Adjustment Scale (WSAS), and the World Health Organisation Alcohol, Smoking, and Substance Involvement Screening Test. Substance use treatment-seeking patients also completed the Brief Addiction Monitor. Analysis of variance models, adjusted for sex and race, examined between-cohort differences. RESULTS: Among 4,197 patients (pre-pandemic: 2,434; early pandemic: 1,763), anxiety and insomnia (GAD-7, ISI) symptoms were greater after pandemic onset. Depression (PHQ-9) and functioning (WSAS) were not different. Rates of cannabis, cocaine, and inhalant use were higher post-pandemic. Among substance use treatment seekers, drug and marijuana use was higher, with women reporting more binge drinking days. CONCLUSIONS: New psychiatric outpatients who presented after the pandemic reported greater anxiety and insomnia symptoms and different substance use patterns vs. a pre-pandemic cohort, underscoring the need for targeted interventions during public health crises.