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Factors Associated with Leaving Ambulatory Psychiatric Treatment in a Large, Academic Health System During the COVID-19 Pandemic

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Abstract

Detailed evaluation of changes in patient retention in psychiatric care as a result of the onset of the COVID-19 pandemic have not been studied. Here, we present a retrospective analysis of aggregate data from a large academic health system (n = 16,701 patients) to examine if there were differences in patients leaving psychiatric care from the pre-COVID-19 period to the first 12 months of the COVID-19 pandemic. Demographic, clinical, and behavioral factors were studied using logistic regressions to determine significant associations in leaving psychiatric care during COVID-19 and in the 12 months immediately prior to the pandemic. Factors identified with a higher odds of leaving psychiatric care during COVID-19 that were not associated with leaving care prior to COVID-19 included demographic (male sex, uninsured (self-pay) status), behavioral (inactive patient health portal), and diagnostic (anxiety and trauma stressor disorders, pervasive and specific developmental disorders, and disorders of childhood) factors. These results highlight that the reasons patients left care during the period immediately after the COVID-19 pandemic may have been multifactorial in nature, although certain patterns seem to have appeared. Further study is needed to elucidate why these specific factors may have driven patients to leave psychiatric treatment during the COVID-19 pandemic.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and privacy but are available from the corresponding author upon reasonable request. Data re located in a controlled access data storage at the University of North Carolina-Chapel Hill.

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Acknowledgements

The authors would like to acknowledge Kai Xia for assistance with statistical interpretation.

Funding

The authors report no funding supported this research.

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Authors and Affiliations

  1. Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA

    Nathaniel A. Sowa & Xiaoming Zeng

Authors
  1. Nathaniel A. Sowa
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Contributions

Conceptualization (Nathaniel A. Sowa); Project administration (Nathaniel A. Sowa); Data Curation (Xiaoming Zeng); Formal Analysis (Xiaoming Zeng); Methodology (National A. Sowa, Xiaoming Zeng); Writing – original draft preparation (Nathaniel A. Sowa, Xiaoming Zeng); Writing – reviewing and editing (Nathaniel A. Sowa, Xiaoming Zeng); Resources (Xiaoming Zeng); Visualization (Nathaniel A. Sowa, Xiaoming Zeng).

Corresponding author

Correspondence to Nathaniel A. Sowa.

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Ethics Approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional review board (IRB) of the University of North Carolina-Chapel Hill and with the 1964 Helsinki Declaration.

Compliance with Ethical Standards

The authors have nothing to disclose related to this work. The University of North Carolina Institutional Review Board reviewed this study and determined it exempt from further review.

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The authors declare that they have no conflicts of interest.

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Sowa, N.A., Zeng, X. Factors Associated with Leaving Ambulatory Psychiatric Treatment in a Large, Academic Health System During the COVID-19 Pandemic. Psychiatr Q (2025). https://doi.org/10.1007/s11126-025-10129-7

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