Did COVID-19 worsen the disparities among mental health patients at risk of exhibiting aggression in Ontario, Canada?
The COVID-19 pandemic has strained global health systems, exacerbating health disparities, especially among vulnerable groups. It has also worsened mental health, leading to increased rates of depression and anxiety. We study the impact of the COVID-19 pandemic on the prevalence of mental health episodes involving violence in Ontario, the largest province of Canada. We compare the dangerousness of mental health patients who needed hospitalization before and during/after the pandemic across different socio-demographic groups and geographic regions. This enables us to identify the vulnerable populations in this domain as well as the key factors associated with disparities among patients at risk of exhibiting aggression. We conducted a retrospective study from March 2017 to March 2023. The study involved 340,000+ observations from patients aged 15 and above admitted to mental health inpatient hospital wards in Ontario, Canada. We evaluated violent behavior using three mental health indicators, including the 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. We also examined associated disparities across several social determinants of health through a combination of absolute rate analysis, logistic regression, stratified autoregressive integrated moving average models, and Oaxaca-Blinder decomposition. Our findings indicated a pre-existing and noteworthy increase in violent behavior among patients with mental health conditions after the onset of the pandemic. Males, young and middle-aged adults, unmarried individuals, and low-income demographics suffered from the widening gap. The disparities were most evident in urban areas, and less educated groups showed higher levels of violent behavior. Policy announcements, such as school closures, had a substantial impact on mental health disparities, resulting in lasting effects on mental well-being. The COVID-19 pandemic has worsened mental health disparities related to violence, necessitating targeted interventions and policies to improve mental health outcomes and reduce violence-related health inequities.