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Gartner SP, Olesen TB, Jensen H, Mortensen LM, Baandrup L. Recognition of schizophrenia and quality of treatment during the COVID-19 pandemic: A Danish nationwide study. Schizophr Res 2024; 274:98-104. [PMID: 39277925 DOI: 10.1016/j.schres.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/30/2024] [Accepted: 09/03/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND The COVID-19 pandemic may have exacerbated the state of ill-health among patients with schizophrenia. We examined the number of patients diagnosed with schizophrenia, the number of hospital admissions and outpatient contacts and the quality of treatment during the pandemic in comparison with the previous years. METHODS We identified patients ≥18 years old registered in the Danish Schizophrenia Registry from 2016 to 2022. Using a generalized linear model, we estimated prevalence ratios (PR) and 95 % confidence intervals (CI) for each variable of interest. RESULTS A minor reduction in the number of new cases, admissions and outpatient contacts was seen during the first lockdown; however, there was no overall change across the pandemic period compared with the pre-pandemic period. We found no change in the proportion of patients who were interviewed using a diagnostic tool (37.0 % during pandemic vs 37.9 % pre-pandemic; PR = 0.87; 95 % CI 0.68-1.12) or received family intervention (57.7 % vs 57.1 %; PR = 0.97; 95 % CI 0.81-1.15), and no decrease was observed in the proportion of patients assessed for social support. Furthermore, no change in the proportion of patients re-admitted within 30 days (35.9 % vs 35.0 %; PR = 0.96; 95 % CI 0.88-1.07) or screened for suicide risk in relation to discharge (55.2 % vs 56.8 %; PR = 0.96; 95 % CI 0.97-1.09) was observed. CONCLUSIONS Recognition and treatment of schizophrenia was minimally affected during the first lockdown, but across the pandemic period no overall change was observed. The quality of treatment of schizophrenia was unchanged.
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Affiliation(s)
- Simon Ploug Gartner
- Department Bispebjerg-Gentofte, Mental Health Center Copenhagen, Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Esther Ammundsens vej 36, 2400 Copenhagen, Denmark.
| | - Tina Bech Olesen
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Hedeager 3, 8200 Aarhus, Denmark
| | - Henry Jensen
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Hedeager 3, 8200 Aarhus, Denmark
| | - Lotte Maxild Mortensen
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Hedeager 3, 8200 Aarhus, Denmark
| | - Lone Baandrup
- Department Bispebjerg-Gentofte, Mental Health Center Copenhagen, Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Esther Ammundsens vej 36, 2400 Copenhagen, Denmark
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Gouse BM, Oblath R, Gibbs JS, Reagan EG, Brown HE. COVID-19 pandemic and emergency department visits for psychosis: Visit volume, restraint use, medication use, psychiatric hospitalization, and length of stay. Schizophr Res 2024; 267:301-307. [PMID: 38603838 DOI: 10.1016/j.schres.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/07/2023] [Accepted: 02/14/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Individuals with a schizophrenia spectrum disorder were at heightened risk for interruptions in psychiatric care during the coronavirus-19 (COVID 19) pandemic. There is limited work exploring the pandemic's impact on emergency department (ED) visit volume, use of restraint and parenteral medications, inpatient psychiatric (IP) hospitalization, and ED length of stay (LOS) among this population. METHODS We retrospectively examined 2134 ED visits with a billing code for psychosis between March 1, 2019-February 28, 2021. We used Poisson regression analysis to compare ED visit volume between the pandemic and pre-pandemic periods. Restraint use, parenteral antipsychotic or benzodiazepine use, IP hospitalization, and ED LOS were compared between the two periods using chi-square tests and independent samples t-tests. RESULTS Overall volume of psychosis-related ED visits during the pandemic did not differ significantly from the prior year. Rates of restraint use (16.2 % vs 11.6 %, p < .01), parenteral antipsychotic (22.6 % vs 14.9, p < .001), and parenteral benzodiazepine (22.3 % vs 16.3 %, p < .001) use were significantly higher during the pandemic. Fewer patients had an IP hospital disposition during the pandemic than the year prior (57.8 % vs. 61.9 %, p < .05). ED LOS was longer during the pandemic compared to pre-pandemic (28.37 h vs 20.26 h, p < .001). CONCLUSIONS Although the volume of psychosis-related ED visits remained constant, restraint and parenteral medication use rates were significantly higher during the pandemic. ED LOS increased but fewer ED visits resulted in IP hospitalization. These findings underscore the importance of planning for increased acuity of psychosis ED presentations during public health emergencies.
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Affiliation(s)
- Brittany M Gouse
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston 02118, USA; Wellness and Recovery After Psychosis Research Program, Boston Medical Center, Boston, MA 02118, USA.
| | - Rachel Oblath
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston 02118, USA
| | - Jada S Gibbs
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ellen G Reagan
- Wellness and Recovery After Psychosis Research Program, Boston Medical Center, Boston, MA 02118, USA
| | - Hannah E Brown
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston 02118, USA; Wellness and Recovery After Psychosis Research Program, Boston Medical Center, Boston, MA 02118, USA
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Milella MS, Petraccia L, Pirelli F, Foti G, Sapio M, Berardi R, Caprioli D, Pugliese F, Vivino G. Self-harm by single- and multi-agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022. Pharmacoepidemiol Drug Saf 2024; 33:e5767. [PMID: 38357800 DOI: 10.1002/pds.5767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Medication poisoning is the most common method of self-harm. Longitudinal studies incorporating pre- and post-COVID-19 pandemic data are required to describe the phenomenon and to evaluate the long-term impact on mental health. METHODS Calls to the Poison Control Center of Policlinico Umberto I Hospital - Sapienza University of Rome, Italy, were analyzed retrospectively for characteristics and clinical presentation of cases of interest from January 2018 to December 2022. RESULTS A total of 756 cases of self-harm by medication poisonings were recorded in the study period. A reduction in rate of cases in 2020 was followed by a return to pre-pandemic levels by 2021. When separately analyzing single- and multi-agent cases, occurrence of cases involving just one medication increased since early 2021, with a peak in 2022 (7.8% of total calls, 95% CI 6.2-9.5, from 4.9%, 95% CI 4.1-5.8 in 2018). This increase in the rate of cases, mostly of none or mild severity, was driven by youth aged 12-21, in which the relative proportion of single- versus multi-agent cases showed an increasing trend since 2020 (from 42.6% in 2018 to 78.6% in 2022). Acetaminophen was the medication most frequently involved and benzodiazepines the largest class. A psychiatric background was increasingly seen in 2022, especially in age group 12-21. CONCLUSION Single-agent medication self-harm may be an increasingly prevailing phenomenon. Young adolescents with a psychiatric background might be most vulnerable to this behavior in the COVID-19 pandemic aftermath. Healthcare professionals should expect favorable clinical outcome and improve both counseling and psychotherapy supervision in individuals at risk.
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Affiliation(s)
- Michele Stanislaw Milella
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Luisa Petraccia
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Francesca Pirelli
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Giuseppe Foti
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Maria Sapio
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Rosaria Berardi
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
| | - Daniele Caprioli
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
| | - Gabriella Vivino
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
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Valle A, Cavalli G, Miraglia L, Bracaglia EA, Fonagy P, Di Dio C, Marchetti A. The Risk-Taking and Self-Harm Inventory for Adolescents: Validation of the Italian Version (RTSHIA-I). Behav Sci (Basel) 2023; 13:bs13040321. [PMID: 37102835 PMCID: PMC10136143 DOI: 10.3390/bs13040321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023] Open
Abstract
The aim of the present paper is to establish the factorial validity and reliability of the Risk-Taking and Self-Harm Inventory for Adolescents (RTSHIA), proposed by Vrouva and colleagues in 2010, in an Italian sample. The RTSHIA measures both Risk-Taking and Self-Harm behavior in adolescents. We administered the scale to a total of 1292 Italian adolescents from 9th to 12th grade; to verify the validity of the scale, we also assessed emotion regulation and psychopathological traits. The exploratory factor analysis (EFA) (N = 638) and the confirmatory factor analysis (CFA) (N = 660) confirmed the original two-factor structure of the RTSHIA (Risk-Taking and Self-Harm). The only differences in the Italian version of the RTSHIA (RTSHIA-I) were that one item was moved from the original Risk-Taking factor to the Italian Self-Harm factor, and another item that was not included in the original RTSHIA is now part of the Risk-Taking factor in the Italian version. The reliability of the RTSHIA-I is also confirmed, and both factors correlate with emotion regulation and externalizing/internalizing traits. Our results suggest that the RTSHIA-I is a useful tool for assessing Risk-Taking and Self-Harm behaviors in Italian adolescents, and the correlational patterns indicate that these behaviors may be related to difficulties in mentalization skills.
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Affiliation(s)
- Annalisa Valle
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
| | - Giulia Cavalli
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
| | - Laura Miraglia
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
| | - Edoardo Alfredo Bracaglia
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College, UCL, London WC1E 6BT, UK
| | - Cinzia Di Dio
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
| | - Antonella Marchetti
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
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Beghi M, Alamia A, Alippi M, Colombo RA, Fraticelli C. Psychiatric ward admissions during the COVID-19 pandemic in Canton of Ticino (Swiss Confederation) and the province of Como (Italy): a comparison between two different systems of care and outbreak response strategies. EMERGENCY CARE JOURNAL 2023. [DOI: 10.4081/ecj.2023.11000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
The aim of the study was to estimate the effect of the COVID- 19 pandemic and response policies on the psychiatric ward admissions in the hospitals referring to the ASST Lariana (province of Como, Italy) and the Hospital of Mendrisio (Canton of Ticino, Switzerland), two similar territories that belong to countries that dealt differently with the pandemic. We compared the two territories for type of admission (voluntary vs. compulsory), the Stringency Index (SI) and the country’s number of admission in Intensive Care Units (ICU). We found a significant reduction in the psychiatric ward admission in the lockdown period in both territories, even in periods with milder lockdown measures. The admission rate’s reduction in the ASST Lariana was significantly associated with the ICU admissions (p<0.001). In the Hospital of Mendrisio, admissions included a weekly seasonality, were significantly correlated with SI (p=0.001) and period (pre-pandemic and pandemic; p<0.001) and we observed also a significant reduction of compulsory admission that is influenced both by the stringency index (p<0.001) and period (p<0.001). The differences between the two territories seem influenced by the different mental health systems.
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Pazzagli L, Reutfors J, Lucian E, Zerial G, Perulli A, Castelpietra G. Increased antidepressant use during the COVID-19 pandemic: Findings from the Friuli Venezia Giulia region, Italy, 2015-2020. Psychiatry Res 2022; 315:114704. [PMID: 35830755 PMCID: PMC9245333 DOI: 10.1016/j.psychres.2022.114704] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few studies investigated the impact of the pandemic on antidepressant (AD) use. METHODS The Social and Health Information System of Friuli Venezia Giulia region, Italy, provided data on AD use. Sex, age, AD class and month used the amount of AD prescriptions, measured by defined daily doses (DDD) per 1000 inhabitants per day, to compare AD use in 2020 with the period 2015-2019. A linear trend model predicted AD use for 2020, based on years 2015-2019. RESULTS AD use was on average 20% higher in each month of 2020 when compared with the same month for the period 2015-2019, with an increase of more than 30% in the first four and in the last two months of 2020. The observed AD use in 2020 was higher than predicted, particularly in men, and in the 30-59 years age group. LIMITATIONS Descriptive study of AD use without analysis of data at the individual level. No information on psychiatric diagnoses of AD users. CONCLUSION AD use was higher in the first year of the COVID-19 pandemic. Further research is warranted to understand if this may be related to a rise in mental disorders in the general population during the COVID-19 pandemic.
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Affiliation(s)
- Laura Pazzagli
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ejlli Lucian
- Central Health Directorate, Friuli Venezia Giulia region, Riva Nazario Sauro 8, Trieste 34100, Italy
| | - Giovanna Zerial
- Central Health Directorate, Friuli Venezia Giulia region, Riva Nazario Sauro 8, Trieste 34100, Italy
| | - Alfredo Perulli
- Central Health Directorate, Friuli Venezia Giulia region, Riva Nazario Sauro 8, Trieste 34100, Italy
| | - Giulio Castelpietra
- Central Health Directorate, Friuli Venezia Giulia region, Riva Nazario Sauro 8, Trieste 34100, Italy.
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Jollant F, Roussot A, Corruble E, Chauvet-Gelinier JC, Falissard B, Mikaeloff Y, Quantin C. Prolonged impact of the COVID-19 pandemic on self-harm hospitalizations in France: A nationwide retrospective observational study. Eur Psychiatry 2022; 65:e35. [PMID: 35694827 PMCID: PMC9251820 DOI: 10.1192/j.eurpsy.2022.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The first wave of the COVID-19 pandemic in France was associated with a reduced number of hospitalizations for self-harm, with the exception of older people. The on-going pandemic may have both sustained and delayed effects. Methods Data were extracted from the French national hospital database (PMSI), a nationwide exhaustive database. The number of self-harm hospitalizations (ICD-10 codes X60–84) between September 1, 2020 and August 31, 2021 (N = 85,679) was compared to 2019 (N = 88,782) using Poisson regression models. Results There was a decrease in the total number of self-harm hospitalizations during the studied period versus 2019 (−3.5%; Relative Risk [RR] [95% Confidence Intervals] = 0.97 [0.96–0.97]; p < 0.0001). However, sex and age effects were identified. While adults aged 30–59-years-old showed a decrease (monthly decreases: −12.6 to −15.0%), we found an increase in adolescent girls (+27.7%, RR = 1.28 [1.25–1.31]; p < 0.0001), notably since January 2021. Moreover, the numbers were similar to 2019 in adolescent boys, in youths aged 20–29 years, and in people aged 70 and more. Hospitalizations in intensive care units decreased (−6.7%, RR = 0.93 [0.91–0.96]; p < 0.0001) and deaths at hospital following self-harm remained stable (+0.6%, Hazard Ratio = 0.99 [0.91–1.08], p = 0.79). Conclusions During this second stage, the number of self-harm hospitalizations remained at a lower level than in the prepandemic period. However, significant variations over time, age, and sex were observed. Young people (notably adolescent girls) appear to have particularly suffered from the persistence of the pandemic, while older people did not show any decrease since the beginning. Vigilance and continuing prevention are warranted.
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Affiliation(s)
- F Jollant
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany.,CHU Nîmes, Nîmes, France.,Université Paris Cité, Paris, France & GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,McGill Group for suicide studies, McGill University, Montréal, Canada.,Moods Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France
| | - A Roussot
- Biostatistics and Bioinformatics (DIM), University Hospital, BP 77908, 21079 Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - E Corruble
- Moods Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France.,Psychiatry department, Bicêtre Hospital, GHU Paris-Saclay; APHP, Université Paris-Saclay, France
| | - J C Chauvet-Gelinier
- Service de Psychiatrie et d'Addictologie, Centre Hospitalier Universitaire, Dijon, France.,Laboratoire de Psychopathologie et Psychologie Médicale, EA 4452, IFR Santé STIC 100, Université de Bourgogne-Franche-Comté, Dijon, France
| | - B Falissard
- Université Paris-Saclay, UVSQ, Inserm, Developmental psychiatry, CESP, Villejuif, France
| | - Y Mikaeloff
- Pediatrics department, GHU Paris-Saclay; Université Paris-Saclay, UVSQ, Inserm, Developmental psychiatry, CESP, Villejuif, France
| | - C Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, BP 77908, 21079 Dijon, France; Bourgogne Franche-Comté University, Dijon, France.,Inserm, CIC 1432, Dijon, France; Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/clinical trials unit, Dijon, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France
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Menculini G, Pomili G, Brufani F, Minuti A, Mancini N, D'Angelo M, Biscontini S, Mancini E, Savini A, Orsolini L, Volpe U, Tortorella A, Steardo L. COVID-19 and Youth Psychopathological Distress in Umbria, Central Italy: A 2-Year Observational Study in a Real-World Setting. Front Psychiatry 2022; 13:869326. [PMID: 35664479 PMCID: PMC9160367 DOI: 10.3389/fpsyt.2022.869326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Adolescents and young adults represent a vulnerable population in the context of the Coronavirus disease 2019 (COVID-19) pandemic. The present retrospective study aims to investigate the pandemic's psychological impact on adolescents and young adults by analyzing data from an outpatient mental health service dedicated to youths in Umbria, central Italy. MATERIALS AND METHODS The clinical charts of subjects aged 14-24 who first accessed the service in the timeframe between March 1st, 2019, and February 28th, 2021, were reviewed. Subjects were divided into two subgroups according to the period of time when they accessed the service (pre-COVID-19 vs. during- COVID-19 outbreak). Bivariate analyses were performed using the Chi-square test and the Welch's t-test. A secondary analysis was performed considering only subjects suffering from psychiatric disorders. Furthermore, data concerning individuals who were already followed by the service before the pandemic were analyzed by the McNemar's test and the t-paired test to assess changes in treatment features. RESULTS The number of new accesses during the pandemic period remained stable. After the emergency onset, youths accessing the service showed a higher prevalence of anxiety disorders (p = 0.022). During the COVID-19 period, services were more frequently delivered by using a digital mental health approach (p = 0.001). Psychopharmacological treatment was more frequently prescribed among subjects that were referred to the service after the pandemic onset (p = 0.033). As for substance use, a highly significant reduction in opioid use was observed (p = 0.003). Family therapy was delivered less frequently in the during-COVID-19 subgroup, especially in the subpopulation of subjects suffering from psychiatric disorders (p = 0.013). When considering subjects referred to the service in the pre-COVID-19 period, the number of interventions provided to this population increased after the pandemic outbreak (p = 0.038). CONCLUSION In the context of the COVID-19-related public health crisis, youths represent an at-risk population for which pathways to care should be reinforced, and targeted interventions, including psychosocial treatments, should be implemented.
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Affiliation(s)
- Giulia Menculini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giorgio Pomili
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Francesca Brufani
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Agnese Minuti
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Niccolò Mancini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Martina D'Angelo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Sonia Biscontini
- Mental Heath Department, Azienda Unità Sanitaria Locale (AUSL) Umbria 2, Terni, Italy
| | | | - Andrea Savini
- Comunità "La Tenda" Cooperativa Sociale, Foligno, Italy
| | - Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Alfonso Tortorella
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Steardo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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