International experiences of the active period of COVID-19 - Mental health care

The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in Italy

Objective

Comprehensive evidence on the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on the use of mental health services is scarce. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the access to mental health services in Italy and to assess the socioeconomic and citizenship inequalities for the same outcome.

Methods

A population-based longitudinal open cohort of residents aged ≥ 10 years was established in three large centers covering about 6 million beneficiaries (nearly 10% of the entire population) of the Italian National Health Service (NHS) from 01 January 2018 to 31 December 2021. The primary outcome of interest was the first access to one of the following mental health care services (FAMHS): outpatient facilities, hospital discharges, psychiatric drug prescriptions, emergency room admissions, residential and day care facilities, co-pay exemptions. To evaluate the effect of the COVID-19 pandemic on FAMHS, the temporal trend of FAMHS rates was investigated through an interrupted time series (ITS) analysis of their monthly rates. Crude incidence rates per 100,000 person days with 95%CI were calculated comparing the two time periods (pre- and post-COVID-19) by sex, age group, deprivation index (as a proxy of socioeconomic status), and citizenship. Finally, adjusted rates and rates ratios with 95%CI were estimated via ITS analysis using a step-change model.

Results

ITS analysis for the trend of FAMHS rates showed a significant drop at the outbreak of the pandemic in crude rates and after adjusting for age, sex, deprivation level, and citizenship (RR=0.83 p<0.001). After the outbreak of COVID-19, the trend increased, with rates returning to pre-pandemic levels. Adjusted incidence rate ratios (IRRs) showed a higher probability of having a FAMHS for females, Italians, and for residents in the most deprived areas. A gradient of higher rates with the increase in age was observed. Greater COVID-19 impact was found on the most deprived areas of residence, with a reduction in IRRs from pre- to post-COVID-19 significantly stronger.

Conclusions

The COVID-19 pandemic increased socioeconomic inequalities in mental health in Italy. Population-based cohorts are the most powerful instrument to monitor inequalities in access to mental health services and to provide timely information to drive policy.

Patterns of service provision in child and adolescent mental health care in Australia

Standard description of local care provision is essential for evidence-informed planning. This study aimed to map and compare the availability and diversity of current mental health service provision for children and adolescents in Australia. We used a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE) tool, to describe service availability in eight urban and two rural health districts in Australia. The pattern of care was compared with that available for other age groups in Australia. Outpatient care was found to be the most common type of service provision, comprising 212 (81.2%) of all services identified. Hospital care (acute and non-acute) was more available in urban than in rural areas (20 services [9.7%] vs 1 [1.8%]). The level of diversity in the types of care available for children and adolescents was lower than that for the general adult population, but slightly higher than that for older people in the same areas. Standardised comparison of the pattern of care across regions reduces ambiguity in service description and classification, enables gap analysis and can inform policy and planning.

Challenges and adaptations of mental health services during the COVID-19 Pandemic in Uganda

Introduction

Coronavirus disease (COVID-19) significantly impacted mental health and mental health services worldwide. We sought to explore the challenges faced by mental health services from the perspectives of service users, providers, and policymakers during the COVID-19 pandemic in Uganda and the strategies put in place to ensure the continuity of these services.

Methods

qualitative data were collected using semi-structured interviews with eight mental health service users, four mental health workers, four hospital administrators, four district mental health focal persons, and two policymakers. The data were analyzed using thematic analysis.

Results

the challenges reported by participants included human resource shortages, loss of space for service provision, low funding, drug shortages, changes in patient load, and lack of access to services due to restrictive measures. The adaptations included the use of innovative means like mobile phone technology, reorientation of health facility functioning to COVID-19 restrictions, using different methods to deliver medications, integration of mental health in general health services, and alternative financing for mental health services.

Conclusion

the COVID-19 pandemic posed significant challenges to mental health service provision. Nevertheless, the health system responded by implementing various measures to ensure continuity of care. Further research is needed to evaluate the effectiveness and scalability of these innovations in the long term.

Description of a telehealth mental health programme in the framework of the COVID-19 pandemic in Colombia

BACKGROUND

A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia].

OBJECTIVES

To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021.

METHODS

Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics.

RESULTS

In March 2020 and August 2021, 10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person.

CONCLUSIONS

The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.

Outcome analysis on individual health budgets in mental Health: finding from the Friuli Venezia Giulia Region, Italy

BACKGROUND

Individual Health Budget (IHB) is used for social and health integration and to facilitate processes of resource reorientation in healthcare. Despite its increased use in mental health settings, few studies investigated its effectiveness in severe mental disorders.

METHODS

383 IHB beneficiaries were recruited among Mental Health Departments users of the Italian region Friuli Venezia Giulia. Data involved sociodemographic and clinical variables, IHB type and scores of Health of the Nation Outcome Scale (HoNOS) at admission to IHB programme (T0), after 12 months (T1), and after 24 months (T2).

RESULTS

The length and the mean number of hospitalisations and healthcare interventions decreased at T1. A significant scores' reduction from T0 to T1 evaluation was found in HoNOS total score (T-test (P) < 0.05) and in most of its items. An improvement throughout the whole evaluation period (T0 vs. T2) was found in 36% of the IHB beneficiaries, while more than 60% of them remained in the same HoNOS severity category.

CONCLUSIONS

Our results support the use of IHB in patients with severe mental problems, since it may contribute to an improvement in social and clinical functioning, consequently lowering the burden on MHDs.

The impact of COVID-19 on mental health service utilisation in England

The COVID-19 pandemic has had a significant impact on population mental health and the need for mental health services in many countries, while also disrupting critical mental health services and capacity, as a response to the pandemic. Mental health providers were asked to reconfigure wards to accommodate patients with COVID-19, thereby reducing capacity to provide mental health services. This is likely to have widened the existing mismatch between demand and supply of mental health care in the English NHS. We quantify the impact of these rapid service reconfigurations on activity levels for mental health providers in England during the first thirteen months (March 2020-March 2021) of the COVID-19 pandemic. We use monthly mental health service utilisation data for a large subset of mental health providers in England from January 1, 2015 to March 31, 2021. We use multivariate regression to estimate the difference between observed and expected utilisation from the start of the pandemic in March 2020. Expected utilisation levels (i.e. the counterfactual) are estimated from trends in utilisation observed during the pre-pandemic period January 1, 2015 to February 31, 2020. We measure utilisation as the monthly number of inpatient admissions, discharges, net admissions (admissions less discharges), length of stay, bed days, number of occupied beds, patients with outpatient appointments, and total outpatient appointments. We also calculate the accumulated difference in utilisation from the start of the pandemic period. There was a sharp reduction in total inpatient admissions and net admissions at the beginning of the pandemic, followed by a return to pre-pandemic levels from September 2020. Shorter inpatient stays are observed over the whole period and bed days and occupied bed counts had not recovered to pre-pandemic levels by March 2021. There is also evidence of greater use of outpatient appointments, potentially as a substitute for inpatient care.

Involuntary psychiatric treatment during the COVID-19 pandemic. An international qualitative study

Background

During the COVID-19 pandemic, studies report that in the first few months of the lockdown there was a decrease in requests for mandatory psychiatric treatment, while, in contrast, following the second wave, the number of cases increased. This study investigates the use of compulsory psychiatric treatments internationally in the first and subsequent phases of the pandemic.

Methods

Sixteen key people were interviewed: eight mental health care professionals and eight scholars in Italy, Greece, China and Chile. Participants were asked to discuss their experience of the motivations, diagnoses and management of patients undergoing an involuntary psychiatric hospitalization.

Results

The analysis through Grounded Theory highlighted four themes: (a) the culture of psychiatric care services, (b) the effect of the pandemic on involuntary hospitalizations, (c) exceptional management of hospitalization, and (d) policies and suggestions for more inclusive mental health treatments.

Conclusion

During the first wave, respondents reported a decrease in the use of involuntary treatments, while a gradual increase was seen in the following months. Italy extended compulsory psychiatric treatment to a group of new users, including young people and adolescents with acute crises; in other contexts, the main users are chronic psychiatric patients.

[COVID-19 Pandemic-Related Effects on Psychiatric and Psychosocial Care in Urban and Rural Areas - Two Studies Implementing the Questionnaire PandA-Psy]

OBJECTIVE

To assess COVID-19 pandemic-related changes in psychiatric and psychosocial services and their impact on the care of people with severe mental illness in two contrasting regions.

METHODS

Development and use of an online questionnaire (PandA-Psy) in Leipzig (N=50) and Mecklenburg-Western Pomerania (N=126).

RESULTS

In community psychiatric care, mostly comparable changes caused by the COVID-19 pandemic were observed in the two selected regions. These mainly concern the decrease in face-to-face contacts and group services, the increase in digital and telephone services, as well as the increasing constraints of staff. Differences between the regions are discussed.

CONCLUSION

PandA-Psy was successfully used to map changes caused by the COVID-19 pandemic in psychiatric and psychosocial services in two areas. In addition to the predominantly negative consequences of the pandemic situation, we also found opportunities arising from the crisis.

The impact of COVID-19 on the mental health and substance use health (MHSUH) workforce in Canada: a mixed methods study

BACKGROUND

The increased need for mental health and substance use health (MHSUH) services during the COVID-19 pandemic underscores the need to better understand workforce capacity. This study aimed to examine the pandemic's impact on the capacity of MHSUH service providers and to understand reasons contributing to changes in availability or ability to provide services.

METHODS

We conducted a mixed method study including a pan-Canadian survey of 2177 providers of MHSUH services and semi-structured interviews with 13 key informants. Survey participants answered questions about how the pandemic had changed their capacity to provide services, reasons for changes in capacity, and how their practice had during the pandemic. Thematic analysis of key informant interviews was conducted to gain a deeper understanding of the impact of the pandemic on the MHSUH workforce.

RESULTS

Analyses of the survey data indicated that the pandemic has had diverse effects on the capacity of MHSUH workers to provide services: 43% indicated decreased, 24% indicated no change, and 33% indicated increased capacity. Logistic regression analyses showed that privately funded participants had 3.2 times greater odds of increased capacity (B = 1.17, p < 0.001), and participants receiving funding from a mix of public and private sources had 2.4 times greater odds of increased capacity (B = 0.88, p < 0.001) compared to publicly funded participants. Top reasons for decreases included lockdown measures and clients lacking access or comfort with virtual care. Top reasons for increases included using virtual care and more people having problems relevant to the participant's skills. Three themes were constructed from thematic analysis of key informant interviews: the differential impact of public health measures, long-term effects of pandemic work conditions, and critical gaps in MHSUH workforce data.

CONCLUSIONS

The COVID-19 pandemic has had a substantial impact on the capacity of the MHSUH workforce to provide services. Findings indicate the importance of increasing and harmonizing funding for MHSUH services across the public and private sectors, developing standardized datasets describing the MHSUH workforce, and prioritizing equity across the spectrum of MHSUH services.

Telemental health for clinical assessment and treatment

Telemental health-the use of videoconferencing or audio only (telephone) in mental health care-has accelerated tremendously since the start of the covid-19 pandemic. Meta-analyses have examined the reliability (ie, concordance) of assessment and the efficacy/effectiveness of telemental health compared with in-person care. Results indicate that telemental health assessment and clinical outcomes are similar compared with in-person care but there is much unexplained variability, as well as evidence that patient clinical and demographic characteristics can influence these findings. Further, gaps exist in the literature regarding specific patient populations (eg, psychotic disorders, children/adolescents), treatment modalities (eg, group therapy), audio only telemedicine, and hybrid care that mixes in-person with telemental health care. These gaps provide important directions for the next generation of telemental health research. Comprehensive clinical guidelines from mental health organizations are available to telemental health practitioners and focus on five content themes: legal and regulatory issues, clinical considerations, standard operating procedures and protocols, technical requirements, and considerations of specific populations and settings.

Patient and Clinician Experience of Using Telehealth During the Pandemic in a Public Mental Health Service in Australia

Background

During the coronavirus disease 2019 (Covid-19) pandemic, mental health services adopted telehealth to facilitate ongoing assessment and treatment of patients with severe mental illness. We aimed to assess the telehealth experience of mental health patients and clinicians during the COVID-19 pandemic to inform ongoing clinical telehealth service usage.

Methods

Two participant cohorts were recruited: Patients with severe mental illness at a community public mental health service; and clinicians working within this service. Participants from both cohorts were surveyed regarding their experience of using telehealth.

Results

The survey was completed by 44 patients and 51 clinicians. Most participants reported having access to appropriate telehealth technology. Among patients, 80% reported having participated in any telephone consultations, while 39% reported having taken part in video-telehealth consultations with their psychiatrist. Similarly, 77% of clinicians reported having used video telehealth. Patients reported feeling more confident with video telehealth if they were younger, lived with friends, family or partner, or had access to the internet or a smartphone. Patients reported that telehealth consultations were more convenient and may reduce nonattendance. They reported having good rapport when using video telehealth. The majority of clinicians reported feeling positively about assessing risk and delivering therapy using video telehealth but not with telephone consultations.

Conclusions

Our study suggests that video telehealth is a feasible way of delivering mental health care and appears to be acceptable to both patients and clinicians. However, clinicians raised concerns about their ability to assess risk and provide therapy using telephone consultations. Patients also reported that the convenience of telehealth may improve engagement.

Global impact of the COVID-19 pandemic on mental health services: A systematic review

The purpose of the review was to investigate the changes in mental health services during the COVID-19 pandemic. A systematic review of qualitative, quantitative and mixed-methods studies was conducted from February 2021 to March 2022 using four databases and five languages. 29 studies reporting on mental health services in 63 countries were included. Findings were organised according to nine major topics: (1) lack of preparedness vs. timely response and flexible solutions, (2) changes in access, referrals, and admission, (3) impacts on outpatient, community and psychosocial services, (4) inpatient: reorganisation of hospital psychiatric units/acute wards, (5) diagnostic and therapeutic adaptations, (6) effects on medication, (7) infection control measures, (8), changes in patients' demands, engagement, and mental health, and (9) impacts on staff and team. Many services were closed intermittently or considerably reduced while telepsychiatric services were extensively expanded. Face-to-face services decreased, as did the work with therapeutic groups. Many inpatient units restructured their services to accommodate COVID-19 patients. While the digitalisation of services allowed for better access to services for some, restrictive measures hindered access for most. Staff experienced changes such as heightened impacts on their own mental health, burdens on patients and the pausing of professional training. Clearly, diverse findings of studies relate to different (national) contexts, type of service offered, but also to the time of the investigation, as studies noted several distinct phases of change during the pandemic. This review suggests directions for policy and service development, such as fostering community services and providing support services for particularly vulnerable populations.

A Mental Health Management and Cognitive Behavior Analysis Model of College Students Using Multi-View Clustering Analysis Algorithm

In this new era that is full of social changes, ongoing economic transformation, an abundance of information resources, and a fast pace of life, the pressure that people feel to compete with one another is also increasing day by day. Because of the vast differences in people's states of consciousness and worldviews, interpersonal relationships have become increasingly difficult to navigate. Students in higher education institutions will eventually emerge as the dominant demographic in society. Their mental health has a significant bearing on all aspects of life, including learning and future growth. An objective condition that must be met in order to guarantee that the next generation of talent will have a high level of overall quality is the improvement of the mental health of college students (CSMH) in the new era. One component of public health is the emotional well-being of students in higher education. The state of the public's health is consistently ranked among the most urgent problems facing modern society. However, there is not much hope for the Chinese CSMH. In order to effectively manage their mental health, a variety of educational institutions, including colleges and universities, have proposed a large number of management strategies for CSMH. The vast majority of these strategies are not targeted, and they do not offer a variety of management strategies that are based on the many different psychological states. It is necessary to first be able to accurately predict the mental health status of each individual college student in order to achieve the goal of improving the mental health management of students attending colleges and universities. This study proposes using a multi-view K-means algorithm, abbreviated as MvK-means, to analyze the CSMH's data on mental health. This is possible because the data can be obtained from multiple perspectives. This paper presents a multi-view strategy as well as a weight strategy in light of the fact that each point of view contributes in its own unique way. Different weight values should be assigned to each view's data, which will ultimately result in an improved evaluation effect of the model. The findings of the experiments indicate that the model that was proposed has a beneficial impact on the analysis of the data pertaining to the mental health of college students.

Facing the Impact of the COVID-19 Pandemic: How Can We Allocate Outpatient Doctor Resources More Effectively?

The COVID-19 pandemic caused significant damage to global healthcare systems. Previous studies regarding COVID-19’s impact on outpatient numbers focused only on a specific department, lacking research data for multiple departments in general hospitals. We assessed differences in COVID-19’s impact on outpatient numbers for different departments to help hospital managers allocate outpatient doctor resources more effectively during the pandemic. We compared the outpatient numbers of 24 departments in a general hospital in Beijing in 2019 and 2020. We also examined an indicator not mentioned in previous studies, monthly departmental patient reservation rates. The results show that, compared with 2019, 2020 outpatient numbers decreased overall by 33.36%. Ten departments’ outpatient numbers decreased >33.36%; however, outpatient numbers increased in two departments. In 2020, the overall patient reservation rate in 24 departments was 82.22% of the 2019 reservation rate; the rates in 14 departments were <82.22%. Moreover, patient reservation rates varied across different months. Our research shows that COVID-19’s impact on different departments also varied. Additionally, our research suggests that well-known departments will be less affected by COVID-19, as will departments related to tumor treatment, where there may also be an increase in patient numbers. Patient reservation rates are an indicator worthy of attention. We suggest that hospital managers classify departments according to changes in outpatient numbers and patient reservation rates and adopt accurate, dynamic, and humanized management strategies to allocate outpatient doctor resources.

LeiP#netz 2.0: mapping COVID-19-related changes in mental health services in the German city of Leipzig

PURPOSE

The purpose of the study was to investigate the changes in psychosocial and psychiatric services in the German city of Leipzig during the COVID-19-pandemic.

METHODS

A participatory, mixed-methods study was used involving a quantitative online survey and qualitative semi-structured interviews with professionals. Quantitative findings were reported with descriptive statistics, and thematic analysis was conducted for qualitative data.

RESULTS

Fifty professionals from various mental health services participated in the survey and eleven professionals were interviewed. Quantitative findings showed that some services were closed intermittently and that there was a stiff increase in use of digital/telephonic service and a decrease in face-to-face services. Staff or funding did not change considerably during the pandemic. Psychosocial groups were suspended or reduced, while access to services became more difficult and professional training for staff was stopped. Thematic analysis of the interviews showed that professionals experienced different phases and levels of change during the pandemic, including changes on a structural level, on the users' level, and on the staff' level. Professionals particularly criticised the equivocality of COVID-19 regulations, a defective flow of information and lack of attention for mental healthcare in public policies. They also saw positive aspects, such as the capacity of users and the outpatient care system to adapt to the new situation.

CONCLUSION

This study suggests directions for policy and service development, such as communicating clearly in infection-control measures, fostering outpatient care and networks between services.

[Description of a telehealth mental health programme in the framework of the COVID-19 pandemic in Colombia]

Background: A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia].Objectives: To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021.Methods: Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics.Results: In March 2020 and August 2021, 10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person.Conclusions: The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.

Enhancing the capacity of the mental health and substance use health workforce to meet population needs: insights from a facilitated virtual policy dialogue

BACKGROUND

Timely knowledge mobilization has become increasingly critical during the COVID-19 pandemic and complicated by the need to establish or maintain lines of communication between researchers and decision-makers virtually. Our recent pan-Canadian research study on the mental health and substance use health (MHSUH) workforce during the pandemic identified key policy barriers impacting this essential workforce. To bridge the evidence-policy gap in addressing these barriers, we held a facilitated virtual policy dialogue. This paper discusses the insights generated at this virtual policy dialogue and highlights how this integrated knowledge mobilization strategy can help drive evidence-based policy in an increasingly digital world.

METHODS

We held a 3-hour virtual policy dialogue with 46 stakeholders and policy decision-makers as the final phase in our year-long mixed-methods research study. The event was part of our integrated knowledge mobilization strategy and was designed to generate stakeholder-driven policy implications and priority actions based on our research findings. The data collected from the virtual policy dialogue included transcripts from the small-group breakout rooms and main sessions, reflective field notes and the final report from the external facilitator. Coded data were thematically analysed to inform our understanding of the prioritization of the policy implications and action items.

RESULTS

Facilitated virtual policy dialogues generate rich qualitative insights that guide community-informed knowledge mobilization strategies and promote evidence-informed policy. Our policy dialogue identified actionable policy recommendations with equity as a cross-cutting theme. Adapting policy dialogues to virtual formats and including technology-assisted facilitation can offer advantages for equitable stakeholder participation, allow for deeper analysis and help build consensus regarding evidence-based policy priorities.

CONCLUSIONS

Our facilitated virtual policy dialogue was a key knowledge mobilization strategy for our research on the capacity of the Canadian MHSUH workforce to respond to the COVID-19 pandemic. Our policy dialogue allowed us to engage a diverse group of MHSUH workforce stakeholders in a meaningful action-oriented way, provided an avenue to get feedback on our research findings, and generated prioritized action items that incorporated the knowledge and experience of these MHSUH workforce stakeholders.

Fatores de risco e prevenção do suicídio na Atenção Primária à Saúde em tempos de pandemia por COVID-19

Introdução: O suicídio constitui-se em uma das principais causas de morte evitáveis. A pandemia da COVID-19 pode contribuir para reforçar os fatores de risco e a ideação suicida em razão da diminuição da capacidade de enfrentamento emocional ante a crise sanitária mundial. Ao mesmo tempo, os serviços de Atenção Primária à Saúde (APS) foram demandados a construir uma resposta rápida a questões relacionadas à saúde mental. Objetivo: Refletir sobre os fatores de risco e as possíveis intervenções para a prevenção do suicídio na atenção primária no contexto da pandemia da COVID-19. Métodos: Trata-se de uma revisão integrativa pautada na construção de uma análise crítica da literatura internacional sobre os fatores de risco e a prevenção do suicídio na APS durante a pandemia do novo coronavírus. Esta revisão foi construída por meio do levantamento de evidências na literatura internacional, feito pelo acesso às bases de dados científicas Web of Science, Science Direct e Scopus usando os descritores suicide AND prevention AND COVID-19 AND Primary Health Care. Foram incluídos artigos científicos disponibilizados entre dezembro de 2019 e setembro de 2020 e publicados em português, inglês e espanhol. Resultados: O corpus de análise foi composto de 15 artigos, com predominância da descrição de fatores de risco, da implementação e das adaptações de estratégias de intervenções específicas mediadas por recursos de tecnologia da informação e comunicação para oferecer cuidados de saúde mental. Conclusões: Os cuidados colaborativos pautados pelos atributos essenciais da APS destacaram-se como estratégias prioritárias para ofertar cuidados contínuos e longitudinais no contexto da pandemia.

The Influence of Research Follow-Up during COVID-19 Pandemic on Mental Distress and Resilience: A Multicenter Cohort Study of Treatment-Resistant Depression

Background: During the COVID-19 outbreak, patients with mental disorders have faced more negative psychological consequences than the public. For people with treatment-resistant depression (TRD), it is unclear whether research engagement would protect them from the deterioration of their symptoms. The study aimed to examine if chronic depressive patients would have improved resilience and mental distress levels after follow-up interviews during an observation period under COVID-19. Methods: The study was nested within a three-year prospective cohort study. A two-group comparison design was conducted, i.e., the follow-up group with regular research interviews every three months after baseline assessment and the control group with one assessment-only interview. The two groups were compared with demographics, psychosocial, and suicide information. Results: Baseline assessments were not significantly different in sociodemographic variables, suicide risks, mental distress, and resilience between groups. Significant differences were detected in resilient coping and mental distress levels (p < 0.05). The follow-up group (n = 46) experienced a higher level of resilient coping (37% vs. 25%) and lower level of mental distress (47.8% vs. 64.7%) than the control group (n = 68). Conclusions: Findings highlight under universal government strategy against COVID-19, TRD patients receiving regular research follow-ups exhibited better resilience and less mental distress than those without regular support from healthcare providers.

The impact of COVID-19 stressors on psychological distress and suicidality in a nationwide community survey in Taiwan

COVID-19 stressors and psychological stress response are important correlates of suicide risks under the COVID-19 pandemic. This study aimed to investigate the prevalence of COVID-19 stress, its impact on mental health and associated risk factors among the general population during the outbreak of COVID-19 in July 2020 throughout Taiwan. A nationwide population-based survey was conducted using a computer-assisted telephone interview system with a stratified, proportional randomization method for the survey. The questionnaire comprised demographic variables, psychological distress assessed by the five-item Brief Symptom Rating Scale and independent psychosocial variables including COVID-19 stressors, loneliness, suicidality, and health-related self-efficacy. In total, 2094 respondents completed the survey (female 51%). The COVID-19 stress was experienced among 45.4% of the participants, with the most prevalent stressors related to daily life and job/financial concerns. Higher levels of suicidality, loneliness, and a lower level of self-efficacy had significantly higher odds of having COVID-19 stress. The structural equation model revealed that COVID-19 stress was moderately associated with psychological distress and mediated by other psychosocial risk factors. The findings call for more attention on strategies of stress management and mental health promotion for the public to prevent larger scales of psychological consequences in future waves of the COVID-19 pandemic.

Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review protocol

INTRODUCTION

There is a surplus of information and communication technology (ICT)-based interventions for suicide prevention. However, it is unclear which of these ICT-based interventions for suicide prevention have been implemented in clinical settings. Furthermore, evidence shows that implementation strategies have often been mismatched to existing barriers. In response, the authors recognise the critical need for prospectively assessing the barriers and facilitators and then strategically developing implementation strategies. This review is part of a multiphase project to develop and test tailored implementation strategies for mobile app-based suicide prevention in clinical settings. The overall objective of this scoping review is to identify and characterise ICT-based interventions for all levels of suicide prevention in clinical settings. Additionally, this review will identify and characterise the barriers and facilitators to implementing these ICT-based interventions as well as reported measures and outcomes. The findings will directly inform the subsequent phase to maximise implementation and inform future efforts for implementing other types of ICT-based interventions related to suicide prevention in clinical settings.

METHODS AND ANALYSIS

This review will adhere to the methods described by the Joanna Briggs Institute for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist. The following databases will be searched: Medline, PsycInfo, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science and Library, Information Science & Technology Abstracts (LISTA). Two reviewers will independently screen the articles and extract data using a standardised data collection tool. Then, authors will characterise extracted data using frameworks, typology and taxonomies to address the proposed review questions.

ETHICS AND DISSEMINATION

Ethics approval is not required for this scoping review. Authors will share the results in a peer-reviewed, open access publication and conference presentations. Furthermore, the findings will be shared with relevant health organisations through lay language summaries and informal presentations.

Developing a Brief Tele-Psychotherapy Model for COVID-19 Patients and Their Family Members

Objective: The COVID-19 pandemic is negatively impacting the mental health of COVID-19 patients and family members. Given the restrictions limiting in person contact to reduce the spread of the virus, a digital approach is needed to tackle the psychological aftermath of the pandemic. We present the development of a brief remote psychotherapy program for COVID-19 patients and/or their relatives. Methods: We first reviewed the literature on psychotherapeutic interventions for COVID-19 related symptoms. Based on this evidence, we leveraged ongoing clinical experiences with COVID-19 survivors and family members to design an intervention model that could be disseminated and integrated into the workflow of the mental health system. Results: This 8-session model -inspired by constructivist and hermeneutic-phenomenological therapies- serves COVID-19 patients during hospitalization, remission and recovery. This model can also be delivered to people dealing with the COVID-19 hospitalization/discharge of a family member, or the loss of a family member due to COVID-19. Conclusion: We described a remote psychotherapeutic approach to tackle the COVID-19 pandemic psychological aftermath. To date, the approach seems feasible and highly customizable to patients' needs. Studies are underway to test its preliminary efficacy. Once proven efficacious, this treatment model could provide a blueprint for future tele-psychology wide-scale interventions.

Position Statement for Mental Health Care in Long-Term Care During COVID-19

COVID-19 has disproportionately impacted older adults in long-term care (LTC) facilities in Canada. There are opportunities to learn from this crisis and to improve systems of care in order to ensure that older adults in LTC enjoy their right to the highest attainable standard of health. Measures are needed to ensure the mental health of older adults in LTC during COVID-19. The Canadian Academy of Geriatric Psychiatry (CAGP) and Canadian Coalition for Seniors' Mental Health (CCSMH) have developed the following position statements to address the mental health needs of older adults in LTC facilities, their family members, and LTC staff. We outlined eight key considerations related to mental health care in LTC during COVID-19 to optimize the mental health of this vulnerable population during the pandemic.

Management and Plan of Undergraduates' Mental Health Based on Keyword Extraction

Mental health issues are alarmingly on the rise among undergraduates, which have gradually become the focus of social attention. With the emergence of some abnormal events such as more and more undergraduates' suspension, and even suicide due to mental health issues, the social attention to undergraduates' mental health has reached a climax. According to the questionnaire of undergraduates' mental health issues, this paper uses keyword extraction to analyze the management and plan of undergraduates' mental health. Based on the classical TextRank algorithm, this paper proposes an improved TextRank algorithm based on upper approximation rough data-deduction. The experimental results show that the accurate rate, recall rate, and F1 of proposed algorithm have been significantly improved, and the experimental results also demonstrate that the proposed algorithm has good performance in running time and physical memory occupation.

Public Policy Responses to Address the Mental Health Consequences of the COVID-19 Pandemic: Evidence From Chile

Objectives: This paper reviews the mental health policies that have been implemented in Chile in response to the COVID-19 pandemic and the international context of countries' responses. Even before the start of the pandemic, there were significant barriers to access mental health services in Chile, coupled with a scenario of nationwide social unrest and protests that questioned the legitimacy of public institutions; now the rapidly worsening outbreaks of COVID-19 are exacerbating the pre-existing mental health crisis. Methods: We conducted a bibliometric and content analysis of the Chilean mental health public policies implemented during the COVID-19 pandemic and then compared these policies with international experiences and emerging scientific evidence on the mental health impact of pandemics. Results: Our analysis of the policies identifies five crucial points of action developed in Chile: (i) an established framework to address mental health in emergency and disaster situations; (ii) a timely COVID-19 Mental Health Action Plan; (iii) inclusion of mental health in the public health agenda; (iv) development of a presidential strategy during the pandemic for comprehensive mental health and well-being; and (v) emerging research assessing the mental health implications of COVID-19. Conclusions: In Chile, the public policy responses to address the mental health consequences of the COVID-19 pandemic has been characterized by the coordinated implementation of mental health plans, ranging from a health sectoral initiative to inter-agency and intersectoral efforts. However, it is imperative that increased funding is allocated to mental health, and efforts should be made to promote the participation of people with lived experiences and communities in the design and implementation of the proposed actions. This aspect could be of key importance to social peace and community recovery after the pandemic.

Nonattendance at Scheduled Appointments in Outpatient Clinics Due to COVID-19 and Related Factors in Taiwan: A Health Belief Model Approach

During the COVID-19 pandemic, the number of hospital visits and attendance at scheduled appointments have dropped significantly. We used the health belief model (in three dimensions) to examine the determinants of non-attendance of scheduled appointments in outpatient clinics due to the COVID-19 pandemic. Participants in Taiwan (n = 1954) completed an online survey from 10 April 10 to 23 April 2020, which assessed how people perceived and responded to the outbreak of a fast-spreading infectious disease. We performed both univariate and multivariate logistic regression to examine the roles of cognitive, affective, and behavioral health belief constructs in nonattendance at scheduled appointments. The results indicated that individuals who perceived high confidence in coping with COVID-19 were less likely to miss or cancel their doctor's appointments, whereas individuals who reported high anxiety and practiced more preventive health behaviors, including avoiding crowded places, washing hands more often, and wearing a mask more often, were more likely to miss or cancel their appointments due to the COVID-19 pandemic. Non-heterosexual participants had a lower rate of nonattendance at scheduled appointments compared with heterosexual ones. The study results increase our understanding of the patients' cognitive health beliefs, psychological distress, and health behaviors when assessing adherence to medical appointments during a pandemic.

Patterns of Psychological Responses among the Public during the Early Phase of COVID-19: A Cross-Regional Analysis

This study aimed to compare the mediation of psychological flexibility, prosociality and coping in the impacts of illness perceptions toward COVID-19 on mental health among seven regions. Convenience sampled online survey was conducted between April and June 2020 from 9130 citizens in 21 countries. Illness perceptions toward COVID-19, psychological flexibility, prosociality, coping and mental health, socio-demographics, lockdown-related variables and COVID-19 status were assessed. Results showed that psychological flexibility was the only significant mediator in the relationship between illness perceptions toward COVID-19 and mental health across all regions (all ps = 0.001-0.021). Seeking social support was the significant mediator across subgroups (all ps range = <0.001-0.005) except from the Hong Kong sample (p = 0.06) and the North and South American sample (p = 0.53). No mediation was found for problem-solving (except from the Northern European sample, p = 0.009). Prosociality was the significant mediator in the Hong Kong sample (p = 0.016) and the Eastern European sample (p = 0.008). These findings indicate that fostering psychological flexibility may help to mitigate the adverse mental impacts of COVID-19 across regions. Roles of seeking social support, problem-solving and prosociality vary across regions.

The impact of Covid-19 pandemic on community-oriented mental health services: The experience of Friuli Venezia Giulia region, Italy

OBJECTIVES

to assess the changes in prevalence, incidence and hospitalisation rates during the first four months of 2020, compared to the same period of 2019, in Friuli Venezia Giulia Mental Health Departments (MHDs); to analyse the features of MHDs patients tested for Sars-Cov-2, and to monitor whether MHDs applied and adhered to regional recommendations.

METHODS

Observational study using MHDs' administrative data and individual data on suspected and positive cases of Sars-Cov-2. Adherence to recommentations was assessed using 21 indicators. Changes in rates were calculated by Poisson regression analysis, while the Fisher exact test was used for assessing differences between suspected and positive cases.

RESULTS

The decrease in voluntary admission rates on 100,000 inhabitants in hospital services was significantly larger from January to April 2020, compared to the same period of 2019 (P<0.001), while no other data showed a significant decrease. Among the 82 cases tested for Sars-Cov-2, five were positive, and they significantly differ from suspected cases only in that they were at home or in supported housing facilities prior to the test. The MHDs mostly complied with the indicators in the month after the publication of recommendations.

CONCLUSIONS

Outpatient services continued to work normally during the emergency, while hospital services decreased their activities. A low number of positive cases was found among MHDs' users, which might be linked to a rapid reconversion of services, with an extensive use of home visits and telepsychiatry. These preliminary data should be interpreted with caution, due to the small size and the limited period of observation.

Indians vs.COVID-19: The scenario of mental health

The fight with COVID-19 pandemic seems nowhere near the end and is extremely daunting. An upsurge in cases of mental illness in India post the pandemic is a clear indicator of its scary impact. The situation of lockdown is causing the feeling of distress, agitation and helplessness among the people. Healthcare workers, poverty-stricken people, elderly, kids and persons with some pre-existing medical condition are more vulnerable to anxiety currently. Practicing a healthy lifestyle; yoga, meditation, avoiding reading too much about the pandemic and being with family are the ways to assuage stress.