Did COVID-19 worsen the disparities among mental health patients at risk of exhibiting aggression in Ontario, Canada?

The COVID-19 pandemic exacerbated a pre-existing increase in violent behavior among patients with mental health conditions admitted to inpatient hospital wards in Ontario.

• Retrospective study spanning March 2017 to March 2023, covering both pre-pandemic and during/after pandemic periods.
• Study involved 340,000+ observations from patients aged 15 and above admitted to mental health inpatient hospital wards in Ontario, Canada.
• Three mental health indicators of violent behavior were evaluated: risk of harming others, hospital admissions due to threats or danger to others, and history of police intervention for violent behavior within the last 30 days.
• Methods included absolute rate analysis, logistic regression, stratified autoregressive integrated moving average (ARIMA) models, and Oaxaca-Blinder decomposition.

Males, young and middle-aged adults, unmarried individuals, and low-income demographics experienced a widening gap in mental health disparities related to violence after pandemic onset.

• These socio-demographic groups were identified as vulnerable populations in the domain of violence-related mental health outcomes.
• Disparities were assessed by comparing dangerousness of mental health patients who needed hospitalization before versus during/after the pandemic across different socio-demographic groups.
• The Oaxaca-Blinder decomposition was used to identify key factors associated with disparities among patients at risk of exhibiting aggression.

Mental health disparities related to violence were most evident in urban areas, and less educated groups showed higher levels of violent behavior.

• Geographic regions were included as a dimension of comparison alongside socio-demographic groups.
• Education level was identified as a social determinant of health associated with disparities in violent behavior.
• The study examined disparities across several social determinants of health.

Policy announcements such as school closures had a substantial impact on mental health disparities, resulting in lasting effects on mental well-being.

• Stratified autoregressive integrated moving average (ARIMA) models were used to assess temporal impacts of policy announcements.
• School closures were specifically identified as a policy event with measurable and lasting effects on mental health disparities.
• The study period covered pandemic-era policy interventions from March 2020 onward through March 2023.

Ontario, the largest province of Canada, served as the study setting, with mental health inpatient hospital ward admissions used as the unit of analysis.

• The study population included patients aged 15 and above.
• The dataset comprised 340,000+ observations over a six-year period (March 2017 to March 2023).
• The study design was retrospective, enabling comparison of pre-pandemic versus during/after pandemic periods.