Ambulance Services Attendance for Mental Health and OverdoseBefore and During COVID-19 in Canada and the United Kingdom:Interrupted Time Series Study

Background: The COVID-19 pandemic impacted mental health and health care systems worldwide.Objective: This study examined the COVID-19 pandemic's impact on ambulance attendances for mental health and overdose,comparing similar regions in the United Kingdom and Canada that implemented different public health measures. Methods: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in theUnited Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulanceattendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled thecount of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown wasinitiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. Results: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown(United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes wereobserved at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the studyregions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), therate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada:IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between studyregions. Conclusions: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differedbetween the UK and Canada study regions. These results may inform future pandemic planning and further research on the publichealth measures that may explain observed regional differences