Article Review: Smalley, C. M., et al. (2020). The impact of COVID-19 on suicidal ideation and alcohol presentations to emergency departments in a large healthcare system.

Sarah Watts, MS

WKPIC Doctoral Intern


Smalley et al. (2020) explored whether the rates of both suicidal ideation and binge drinking had increased during the “Stay at Home” orders with the COVID-19 pandemic. The authors conducted a retrospective study involving 20 emergency departments located in the midwestern United States. In a typical year, these emergency departments see over 750,000 annual visits for a variety of health-related concerns. Information was collected about the number of behavioral-health related visits between 03/24/2020 and 4/24/2020, during which a “Stay at Home” order was in place. Likewise, data pertaining to behavioral-health related visits to the same hospitals during the same time period in 2019 were also collected.


The results indicated a decrease of 44% of overall emergency department visits and a 28% decrease in behavioral-health related visits between 2019 and 2020. Approximately 7.9% of emergency department visits in 2020 were behavioral-health related, compared to 6.1% in 2019. Between 2019 and 2020, emergency department visits for suicidal ideation decreased by 60.6 % and there was a statically significant decrease in the percentage of suicidal ideation-related visits between 2019 and 2020. In addition, the results further indicated that the number of alcohol related visits increased from 28.2% to 33.5 % of the total behavioral health related emergency department visits (note: the statistical significance of this change was not reported).


This study provides information about the impact of a pandemic on mental health after the implementation of “Stay at Home” orders. There are many limitations to this study including the limited location of the study and the limited time frame after the implementation of the “Stay at Home” orders. Future studies may wish to explore whether the length of time after the implementation of the stay at home order has an impact on suicidal ideation related and alcohol related emergency department visits.



Smalley, C. M., Malone, D. A. J., Meldon, S. W., Borden, B. L., Simon, E. L., Muir, M. R., & Fertel, B. S. (2020). The impact of covid-19 on suicidal ideation and alcohol presentations to emergency departments in a large healthcare system. The American Journal of Emergency Medicine2020 Jun 01.

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