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Volume 23
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10.3390/ijerph23020177
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Emergency Department Utilization by Women of Reproductive Age for Mental Illness in St. Louis Before and During the COVID-19 Pandemic

by
Jen Jen Chang
1,
Christopher D. Hopwood
1,
Yuki Sugawara
1,
Abigail Andresen
2,
Thomas E. Burroughs
3,
Aya Bou Fakhreddine
1 and
Steven E. Rigdon
1,*
1
Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA
2
City of St. Louis Department of Public Health, St. Louis, MO 63134, USA
3
Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2026, 23(2), 177; https://doi.org/10.3390/ijerph23020177
Submission received: 18 November 2025 / Revised: 19 January 2026 / Accepted: 27 January 2026 / Published: 30 January 2026
Versions Notes

Abstract

Mental illness and related health inequities are disproportionately concentrated in economically disadvantaged urban neighborhoods. The COVID-19 pandemic has been associated with a rise in mental illness prevalence, with women generally at greater risk than men. Urban areas facing multiple structural and socioeconomic challenges may have limited capacity to meet the mental healthcare needs of residents, leading to increased reliance on emergency departments (EDs) for acute care. This ecological study uses data over four years (2018–2021) and examines spatial variations in ED utilization at the census tract level, focusing on geographic areas with women of reproductive age diagnosed with mental illness to compare patterns before and during the COVID-19 pandemic. Of the 22,565 ED visits in the four-year period, 12,832 occurred before COVID-19 and 9733 during COVID-19. Our findings highlight persistent structural disparities in mental healthcare access across census tracts characterized by high concentrations of vulnerable women of reproductive age. Understanding these spatial disparities allows for geographically targeted interventions and the prioritization of resources for neighborhoods identified as most underserved.
Keywords: mental illness; emergency department visit; CAR model; hierarchical Bayesian model; random walk; space–time interaction. mental illness; emergency department visit; CAR model; hierarchical Bayesian model; random walk; space–time interaction.

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MDPI and ACS Style

Chang, J.J.; Hopwood, C.D.; Sugawara, Y.; Andresen, A.; Burroughs, T.E.; Fakhreddine, A.B.; Rigdon, S.E. Emergency Department Utilization by Women of Reproductive Age for Mental Illness in St. Louis Before and During the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2026, 23, 177. https://doi.org/10.3390/ijerph23020177

AMA Style

Chang JJ, Hopwood CD, Sugawara Y, Andresen A, Burroughs TE, Fakhreddine AB, Rigdon SE. Emergency Department Utilization by Women of Reproductive Age for Mental Illness in St. Louis Before and During the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2026; 23(2):177. https://doi.org/10.3390/ijerph23020177

Chicago/Turabian Style

Chang, Jen Jen, Christopher D. Hopwood, Yuki Sugawara, Abigail Andresen, Thomas E. Burroughs, Aya Bou Fakhreddine, and Steven E. Rigdon. 2026. "Emergency Department Utilization by Women of Reproductive Age for Mental Illness in St. Louis Before and During the COVID-19 Pandemic" International Journal of Environmental Research and Public Health 23, no. 2: 177. https://doi.org/10.3390/ijerph23020177

APA Style

Chang, J. J., Hopwood, C. D., Sugawara, Y., Andresen, A., Burroughs, T. E., Fakhreddine, A. B., & Rigdon, S. E. (2026). Emergency Department Utilization by Women of Reproductive Age for Mental Illness in St. Louis Before and During the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 23(2), 177. https://doi.org/10.3390/ijerph23020177

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