Psychiatric hospitalization rates in Italy before and during COVID-19: did they change? An analysis of register data

Impact of the SARS-CoV-2 Pandemic on Hospitalizations in an Acute Psychiatric Ward

Background

The Sars-CoV-2 pandemic imposed unprecedented and drastic changes in health care organizations all over the world.

Purpose

To evaluate the impact of the pandemic on hospitalizations in an acute psychiatric ward.

Patients and Methods

We retrospectively identified and compared acute psychiatric hospitalizations in the Service for Psychiatric Diagnosis and Care (SPDC) of AUSL-Modena during the pre-pandemic (n = 1858) and pandemic period (n = 1095), from 01/01/2017 to 31/12/2022. Data were statistically analyzed using STATA12.

Results

We collected 1858 hospitalizations in the pre-pandemic and 1095 in the pandemic. During the pandemic, we observed a progressively sharp reduction in voluntary hospitalizations, whereas involuntary ones remained stable with an increase in 2022 (p < 0.001), longer hospital stays (12.32 mean days vs 10.03; p < 0.001), longer periods of involuntary hospitalizations (8.45 mean days vs 5.72; p < 0.001), more frequent aggressive behaviour (16.10% vs 9.12%; p < 0.001) and referral to psychiatric communities at discharge (11.04% vs 6.13%; p < 0.001); non-Italians (p = 0.001), people with disability pension (p < 0.001) and Support Administrator (p < 0.001) were more frequently hospitalized.

Conclusion

During the pandemic, voluntary psychiatric hospitalizations decreased, but not involuntary ones, and the most vulnerable people in serious clinical conditions were hospitalized.

Patterns and correlates of mental healthcare utilization during the COVID-19 pandemic among individuals with pre-existing mental disorder

How did mental healthcare utilization change during the COVID-19 pandemic period among individuals with pre-existing mental disorder? Understanding utilization patterns of these at-risk individuals and identifying those most likely to exhibit increased utilization could improve patient stratification and efficient delivery of mental health services. This study leveraged large-scale electronic health record (EHR) data to describe mental healthcare utilization patterns among individuals with pre-existing mental disorder before and during the COVID-19 pandemic and identify correlates of high mental healthcare utilization. Using EHR data from a large healthcare system in Massachusetts, we identified three "pre-existing mental disorder" groups (PMD) based on having a documented mental disorder diagnosis within the 6 months prior to the March 2020 lockdown, related to: (1) stress-related disorders (e.g., depression, anxiety) (N = 115,849), (2) serious mental illness (e.g., schizophrenia, bipolar disorders) (N = 11,530), or (3) compulsive behavior disorders (e.g., eating disorder, OCD) (N = 5,893). We also identified a "historical comparison" group (HC) for each PMD (N = 113,604, 11,758, and 5,387, respectively) from the previous year (2019). We assessed the monthly number of mental healthcare visits from March 13 to December 31 for PMDs in 2020 and HCs in 2019. Phenome-wide association analyses (PheWAS) were used to identify clinical correlates of high mental healthcare utilization. We found the overall number of mental healthcare visits per patient during the pandemic period in 2020 was 10-12% higher than in 2019. The majority of increased visits was driven by a subset of high mental healthcare utilizers (top decile). PheWAS results indicated that correlates of high utilization (prior mental disorders, chronic pain, insomnia, viral hepatitis C, etc.) were largely similar before and during the pandemic, though several conditions (e.g., back pain) were associated with high utilization only during the pandemic. Limitations included that we were not able to examine other risk factors previously shown to influence mental health during the pandemic (e.g., social support, discrimination) due to lack of social determinants of health information in EHR data. Mental healthcare utilization among patients with pre-existing mental disorder increased overall during the pandemic, likely due to expanded access to telemedicine. Given that clinical correlates of high mental healthcare utilization in a major hospital system were largely similar before and during the COVID-19 pandemic, resource stratification based on known risk factor profiles may aid hospitals in responding to heightened mental healthcare needs during a pandemic.

Adult psychiatric inpatient admissions and length of stay before and during the COVID-19 pandemic in a large urban hospital setting in Vancouver, British Columbia

Introduction

During the COVID-19 pandemic individuals with mental illnesses faced challenges accessing psychiatric care. Our study aimed to describe patient characteristics and compare admissions and length of stay (LOS) for psychiatric-related hospitalizations before and during the COVID-19 pandemic.

Methods

We conducted a retrospective analysis using health administrative data comparing individuals with an acute psychiatric admission between two time periods: 1st March 2019 to 31st December 2019 (pre-COVID) and 1st March 2020 to 31st December 2020 (during-COVID). Multivariable negative binomial regression was used to model the association between most responsible diagnosis type and the two-time periods to hospital LOS, reporting the Rate Ratio (RR) as the measure of effect.

Results

The cohort comprised 939 individuals who were predominately male (60.3%) with a severe mental illness (schizophrenia or mood-affective disorder) (72.7%) and a median age of 38 (IQR: 28.0, 52.0) years. In the multivariable analysis, anxiety disorders (RR: 0.63, CI: 0.4, 0.99) and personality disorders (RR: 0.52, CI: 0.32, 0.85) were significantly associated with a shorter LOS when compared to individuals without those disorders. Additionally, when compared to hospital admissions for non-substance related disorders the LOS for patients with substance-related disorders were significantly shorter during the COVID period (RR: 0.45, CI: 0.30, 0.67) and pre-COVID period (RR: 0.31, CI: 0.21, 0.46).

Conclusions

We observed a significant difference in the type and length of admissions for various psychiatric disorders during the COVID-19 period. These findings can support systems of care in adapting to utilization changes during pandemics or other global health events.

Adolescent Mental Health: A Focus on Psychiatric Counseling from the Emergency Room of an Italian University Hospital in the Five Years from 2019 to 2023

Recent studies have revealed increasingly worse and more complex mental health conditions in young people, which is reflected in a growing trend in emergency room (ER) visits for acute psychopathological symptoms (APSs). This phenomenon has become exacerbated in recent decades, with a peak in the post-pandemic period. To better characterize the phenomenon, we investigated the change in the rate and type of ER counseling requests provided at the Child Neuropsychiatry Unit of the University Hospital of Bari, Italy over the period between 2019 and 2023 for subjects younger than 18 years old. For this purpose, we retrospectively analyzed a total number of 1073 urgent consultation reports retrieved through the reporting computerized operating system of our hospital. The distribution of the counseling requests provided for APSs and, among these, the distribution of the numbers of APSs and of the male: female ratio were significantly different over the years, with an increasing linear trend identified for APSs (p = 3.095 × 10-7), the average number of APSs (p = 3.598 × 10-7), and female gender prevalence (p = 0.03908), as well as for the patients with a history of psychotropic drug assumption (p = 0.0006319). A significant change in the number of urgent counseling requests received for eating disorders (p = 0.0007408), depression (p = 7.92 × 10-8), somatization (p = 4.03 × 10-6), self-harm (SA) (p = 1.358 × 10-6), and non-suicidal self-injury (NSSI) (p = 8.965 × 10-6) was found, with a significant increasing trend for anxiety (p = 0.0444), depression (p = 8.06 × 10-6), somatization (p = 0.004616), SA (p = 3.998 × 10-8), and NSSI (p = 5.074 × 10-7). The findings of our study support the hypothesis of an alarming progressive worsening of the mental health of children and adolescents, with an overlapping effect of the pandemic exacerbating the process.

A mixed method study on the impact of COVID-19 on mental healthcare in Ghana: rethinking mental health service delivery

BACKGROUND

Since its emergence, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused severe health, social and economic challenges. Mental healthcare has been significantly affected globally, and even worse in developing countries. An emerging economy like Ghana in West Africa was not spared its disruptive effects. This study aimed to elucidate the impact of the coronavirus disease 2019, the COVID-19 pandemic (caused by SARS-CoV-2), on Ghana's mental healthcare system.

METHODS

This is a mixed-method study using an emergent sequential exploratory design. A total of 15 front-line healthcare professionals were recruited from the three psychiatric hospitals, including the mental health department of a new teaching hospital in Ghana. Purposive sampling techniques and a semi-structured interview approach were used for recruitment and data collection. Quantitative data from hospital registries were collected and analysed to triangulate qualitative findings.

RESULTS

Fifteen mental health workers were enrolled in the study. The mean age of participants was (34.47 ± 4.07) years, average work experience of (6.23 ± 3.64) years and the majority as males (60%). This study found an average decline of 23% in hospital attendance and a 35% decline in admissions in all four facilities compared to the previous year, 2019. The lived experiences shared by mental healthcare providers were grouped under 3 main themes: Adjustments to workplace regulations, accessibility to mental healthcare, and psychological wellbeing of mental healthcare workers. The fear of contracting SARS-CoV-2 among healthcare workers, medication shortages, and logistical challenges were also reported to affect Mental Health services during the pandemic.

CONCLUSION

This study highlights the challenges in mental healthcare during the COVID-19 pandemic in Ghana. The experiences encountered present an opportunity to gain insights into future pandemic preparedness and establish a framework for optimal mental healthcare delivery in Ghana.

The impact of COVID-19 pandemic and lockdown on emergency psychiatry department admissions

This study aimed to explore the impact of the coronavirus disease 2019 pandemic and lockdown period measures on patients' visits to the psychiatric emergency department (PED) of a University Hospital in İstanbul. We compared the number and characteristics of patients during the initial lockdown with visits in the pre- and post-lockdown months. We also investigated the number of monthly PED visits and hospitalizations between March 11, 2020 and 2021 and compared it to the same period in 2019 and between March 2021 and 2022. PED visits in the initial lockdown period in our university increased by 109% compared to the prelockdown months in the previous year. Anxiety and depressive disorders were responsible for most of this increase. The decline in PED visits was 3.1% and 42% during the first and second year of the pandemic, respectively; however, among the major diagnostic categories, we found that the rates of anxiety, depressive disorders, and obsessive-compulsive disorder increased significantly in the first year, while psychotic disorders declined and bipolar disorders remained the same. In the second year, there was a trend toward prepandemic year ratios. These findings show that the pandemic affects PED admissions in different ways at different periods. These data may also help shaping the public policies necessary to meet the evolving needs in the field of mental health of society at different public crises in the future.

Impact of Telemedicine on Utilization of Psychiatric Resources in New York City during the COVID-19 Pandemic

This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.

Symptom Exacerbations of Patients Attending a Community Mental Health Center During the COVID-19 Pandemic

OBJECTIVE

The aim of this study was to examine the effect of the COVID-19 pandemic on the clinical conditions of the patients with bipolar disorder (BD) and schizophrenia spectrum disorders (SSD) in a community mental health center (CMHC).

METHOD

Symptom exacerbations, emergency service admissions, drug dose increases, additional medication prescriptions, and psychiatric hospitalizations of patients with BD and SSD in the CMHC were evaluated retrospectively. The data from the 1-year prior, 6-months prior, 6-months after the onset and 1-year after the onset of the pandemic were compared. Hospital and CMHC medical records were used for outcomes. Personal and Social Performance (PSP) Scale was used to assess the level of functioning.

RESULTS

107 patients with the diagnosis of BD and 121 patients with the diagnosis of SSD were recruited. In the BD group, there was increase in the frequency of symptom exacerbations (p=0.001) and additional medication prescriptions or increased dose (p=0.007), with decrease in emergency service admissions (p=0.039) during the pandemic. In the patients with SSD, the number of patients with exacerbation of symptoms (p=0.001) and with increased dose or additional medication prescriptions (p=0.004) were higher during the pandemic. There was no increase in the rate of hospitalized patients in the period of first 6 months and first one year. Symptom exacerbations were more frequent in the SSD group with Covid (+) in family (p=0.016).

CONCLUSION

The fact that the hospitalization rates remained the same despite an increase in the acute exacerbations provides info on the role of CMHCs and how mental health system functioned during the pandemic.

A country report: impact of COVID-19 lockdowns on involuntary psychiatric treatment in Austria

BACKGROUND

Coercive measures such as involuntary psychiatric admission are considered a last resort in the treatment of people with psychiatric disorders. So far, numerous factors have been identified that influence their use. However, the link between a pandemic - in particular, restrictions such as lockdowns - and the use of involuntary psychiatric admission is unclear.

AIM

To examine the association between COVID-19 lockdowns and involuntary psychiatric admissions in Austria.

METHOD

This retrospective exploratory study assessed all involuntary psychiatric admissions and use of mechanical restraint in Austria, except for the federal state of Vorarlberg, between 1 January 2018 and 31 December 2020. Descriptive statistics and regression models were used.

RESULTS

During the 3-year study period, 40 012 individuals (45.9% females, mean age 51.3 years) had 66 124 involuntary psychiatric admissions for an average of 10.9 days. Mechanical restraint was used during 33.9% of these admissions. In weeks of nationwide COVID-19 lockdowns (2020 v. 2018/2019), involuntary psychiatric admissions were significantly fewer (odds ratio = 0.93, P = 0.0001) but longer (11.6 (s.d.: 16) v. 10.9 (s.d.: 15.8) days). The likelihood of involuntary admission during lockdowns was associated with year (2020 v. 2018-2019; adjusted odds ratio = 0.92; P = 0.0002) but not with sex (P = 0.814), age (P = 0.310), use of mechanical restraint (P = 0.653) or type of ward (P = 0.843).

CONCLUSIONS

Restrictions such as lockdowns affect coercive measures and resulted in fewer but longer involuntary psychiatric admissions during weeks of lockdown in Austria. These results strengthen previous findings that showed the dependence of coercive measures on external factors, highlighting the need to further clarify causality and desired prevention effects when using coercive measures.

Shifts in Mental Health Needs in Portugal during the COVID-19 Pandemic: What Do Mental Health Warrants Tell Us?

N/a.

Impact of Severe Acute Respiratory Syndrome, Coronavirus Disease 2019, and Social Unrest on Adult Psychiatric Admissions in Hong Kong: A Comparative Population-Based Study

ABSTRACT

In Hong Kong, two infectious disease outbreaks occurred in 2003 (SARS) and 2020 (COVID-19), and a large-scale social unrest happened in 2019. These were stressful societal events that influenced the mental well-being of the public. We aimed to explore the impact of these events on psychiatric admissions in Hong Kong. Socioeconomic and population-based psychiatric hospital admission data were retrieved from the government and Hospital Authority. Negative binomial time-series regression analysis was applied and we found overall significant reductions of psychiatric admissions during both the SARS and COVID-19 periods (-7.4% to -16.8%). Particularly, the admissions for unipolar disorders (-16.2% to -39.7%) and neuroses (-20.9% to -31.9%) were greatly reduced during the infection outbreaks. But an increase of admissions for schizophrenia (12.0%) was seen during the social unrest period. These findings support introducing early and targeted community mental health care strategies to the vulnerable people during the stressful societal events.

The impact of COVID-19 on acute psychiatric admissions for first and repeated episode psychosis

BACKGROUND

There is limited evidence of the longer-term impact of the COVID-19 pandemic on acute admissions for psychosis in the UK.

AIMS

We examined the impact of COVID-19 on rates of admissions for first and repeated episode psychosis, and changes in patient profile and seasonal patterns, over a period of 12 months.

METHOD

We conducted a retrospective case note review of all patients admitted with a primary psychosis (F20-29 ICD 10 diagnosis) to an NHS psychiatric inpatient unit. We compared the 12 months pre-COVID-19 period between 1 March 2019 and 28 February 2020, and the 12 months post-COVID-19 period between 1 March 2020 and 28 February 2021.

RESULTS

The results showed increase rates of admissions post-COVID-19 in both first and repeated episode psychosis, the patient profile had more females and older age in the repeated episode group, with increased employment rates. Combined group data for both pre- and post-COVID-19 periods showed an increased trend in spring and summer admissions, and even though not statistically significant, more pronounced post-COVID-19.

CONCLUSIONS

Our findings highlight the effect of the COVID-19 pandemic on acute psychosis admissions over a 12-month period. The results provide evidence for the 'stress-pathogenesis' in the context of genetic vulnerability in psychosis. Preventative strategies in the context of the 'stress-pathogenesis model', improved access to and responsiveness within NHS transformation efforts needs to be adjusted to fit local need and environmental changes.

Adult Psychiatric Hospitalizations in Ontario, Canada Before and During the COVID-19 Pandemic

OBJECTIVE

The impacts of the COVID-19 pandemic on psychiatric hospitalizations in Ontario are unknown. The purpose of this study was to identify changes to volumes and characteristics of psychiatric hospitalizations in Ontario during the COVID-19 pandemic.

METHODS

A time series analysis was done using psychiatric hospitalizations with admissions dates from July 2017 to September 2021 identified from provincial health administrative data. Variables included monthly volumes of hospitalizations as well as proportions of stays <3 days and involuntary admissions, overall and by diagnosis (mood, psychotic, addiction, and other disorders). Changes to trends during the pandemic were tested using linear regression.

RESULTS

A total of 236,634 psychiatric hospitalizations were identified. Volumes decreased in the first few months of the pandemic before returning to prepandemic volumes by May 2020. However, monthly hospitalizations for psychotic disorders increased by ∼9% compared to the prepandemic period and remained elevated thereafter. Short stays and involuntary admissions increased by approximately 2% and 7%, respectively, before trending downwards.

CONCLUSION

Psychiatric hospitalizations quickly stabilized in response to the COVID-19 pandemic. However, evidence suggested a shift towards a more severe presentation during this period.

Prevalence of COVID-19 and Psychotropic Drug Treatment in Psychiatric In-patients in Germany in 2020: Results from a Nationwide Pilot Survey

INTRODUCTION

In patients with a pre-existing mental disorder, an increased risk for a first manifestation of a psychiatric disorder in COVID-19 patients, a more severe course of COVID-19 and an increased mortality have been described. Conversely, observations of lower COVID-19 incidences in psychiatric in-patients suggested protective effects of psychiatric treatment and/or psychotropic drugs against COVID-19.

METHODS

A retrospective multi-center study was conducted in 24 German psychiatric university hospitals. Between April and December 2020 (the first and partly second wave of COVID-19), the effects of COVID-19 were assessed on psychiatric in-patient care, the incidence and course of a SARS-CoV-2 infection, and treatment with psychotropic drugs.

RESULTS

Patients (n=36,322) were admitted to the hospitals. Mandatory SARS-CoV-2 tests before/during admission were reported by 23 hospitals (95.8%), while 18 (75%) conducted regular testing during the hospital stay. Two hundred thirty-two (0.6%) patients were tested SARS-CoV-2-positive. Thirty-seven (16%) patients were receiving medical treatment for COVID-19 at the psychiatric hospital, ten (4.3%) were transferred to an intermediate/intensive care unit, and three (1.3%) died. The most common prescription for SARS-CoV-2-positive patients was for second-generation antipsychotics (n=79, 28.2%) and antidepressants (SSRIs (n=38, 13.5%), mirtazapine (n=36, 12.9%) and SNRIs (n=29, 10.4%)).

DISCUSSION

Contrary to previous studies, our results showed a low number of infections and mortality in SARS-CoV-2-positive psychiatric patients. Several preventive measures seem effective to protect this vulnerable group. Our observations are compatible with the hypothesis of a protective effect of psychotropic drugs against COVID-19 as the overall mortality and need for specific medical treatment was low.

Zero Tolerance for Coercion? Historical, Cultural and Organisational Contexts for Effective Implementation of Coercion-Free Mental Health Services around the World

Coercion of service users/patients when receiving care and treatment has been a serious dilemma for mental health services since at least the 18th century, and the debate about how best to minimise or even eradicate compulsion remains intense. Coercion is now, once again and rightly, at the top of the international policy agenda and the COST Action 'FOSTREN' is one example of a renewed commitment by service user advocates, practitioners and researchers to move forward in seriously addressing this problem. The focus of service improvement efforts has moved from pure innovation to practical implementation of effective interventions based on an understanding of the historical, cultural and political realities in which mental health services operate. These realities and their impact on the potential for change vary between countries across Europe and beyond. This article provides a novel overview by focusing on the historical, cultural and political contexts which relate to successful implementation primarily in Europe, North America and Australasia so that policy and practice in these and other regions can be adopted with an awareness of these potentially relevant factors. It also outlines some key aspects of current knowledge about the leading coercion-reduction interventions which might be considered when redesigning mental health services.

Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study

Background

There is a lack of real-life population-based study examining the effect of community mental health services on psychiatric emergency admission. In Hong Kong, Integrated Community Center for Mental Wellness (ICCMW) and telecare service were introduced in 2009 and 2012, respectively. We examined the real-life impact of these services on psychiatric emergency admissions over 20 years.

Methods

Number of psychiatric emergency admissions between 2001 and 2020 was retrieved from the Hong Kong Clinical Data Analysis & Reporting System. We used an interrupted time series analysis to examine monthly psychiatric admission trend before and after service implementation, considering socioeconomic and environmental covariates.

Findings

A total of 108,492 psychiatric emergency admissions (47.8% males; 64.9% aged 18-44 years) were identified from the study period, of which 56,858, 12,506, 12,295, 11,791, and 15,051 were that for schizophrenia-spectrum disorders, bipolar affective disorders, unipolar mood disorders, neuroses, and substance use disorders. ICCMW introduction has an immediate effect on psychiatric emergency admission (adjusted estimate per 100,000: -10.576; 95% CI, -16.635 to -4.518, p < 0.001), particularly among adults aged 18-44 years (-8.543; 95% CI, -13.209 to -3.877, p < 0.001), females (-5.843; 95% CI, -9.647 to -2.039, p = 0.003), and with neuroses (-3.373; 95% CI, -5.187 to -1.560, p < 0.001), without a significant long-term effect. Unemployment, seasonality, and infectious disease outbreak were significant covariates.

Interpretation

ICCMW reduced psychiatric emergency admission, but no further reduction following full implementation. Community mental health services should be dynamically tailored for different populations and socioeconomic variations over time.

Funding

None.

A study report on the effect of COVID-19 pandemic in providing in-and-out-patient psychiatric services in a level-3 COVID hospital

Background

COVID-19 pandemic disrupted all routine and emergency hospital services, including our out-and-in-patient psychiatric services.

Aim

To study the effect of the COVID-19 pandemic and subsequent lockdown in providing in-and-out-patient psychiatric services and the experience of tele-consultation services in our level-3 COVID hospital.

Materials and Methods

We conducted a retrospective observational study using an administrative database at psychiatry in-and-out-patient department. All the cases that were reported to us, through emergency Out-Patient Department (OPD) and tele-consultation OPD, from April 2020 to October 2020, were included in the study. Data, thus obtained, were compared with the out-and-in-patient data during the same period on the previous year.

Results

During the study period, there was a decline in out-patient registration of patients by 94.5%, and a reduction in admission rate was 75.5%, in comparison with the previous year. During 3 months of tele-consultation service provided, 23.5% of patients had the diagnosis of depression, 21.4% of them had various types of headaches, 15.9% of patients had psychosis, 15.3% had anxiety disorders, and 8.8% had a bipolar-affective disorder.

Conclusion

Being a level-3 COVID hospital, our hospital suffered significantly in relation to psychiatric in-and-out-patients attendance and service recipients during the study period of COVID-19 pandemic.

Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care

Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change.

Mental health in Europe during the COVID-19 pandemic: a systematic review

The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.

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.

Psychometric properties of the Italian version of the staff attitude to coercion scale: an exploratory factor analysis

Aims

The current study aimed to validate the Italian version of the Staff Attitude to Coercion Scale (SACS), which assesses mental health care staff's attitudes to the use of coercion in treatment.

Methods

The original English version of the SACS was translated into Italian, according to the back-translation procedure. Subsequently, it was empirically validated by performing an exploratory factor analysis on a sample of 217 mental health professionals (Mean = 43.40 years, SD = 11.06) recruited form Italian general hospital (acute) psychiatric wards (GHPWs), with at least 1 year of work experience (i.e., inclusion criteria).

Results

Results confirmed the three-factor solution of the original version for the Italian version of the SACS, though three items loaded on different factors, compared to the original. The three extracted factors, explained 41% of total variance, and were labeled similarly to the original scale and according to their respective item content, i.e., Factor 1 "Coercion as offending" (items: 3, 13, 14, and 15), Factor 2 "Coercion as care and security" (items: 1, 2, 4, 5, 7, 8, and 9), and Factor 3 "Coercion as treatment" (items: 6, 10, 11, and 12). The internal consistency of the three-factor model of the Italian version of the SACS was assessed through Cronbach's α and yielded acceptable indexes, ranging from 0.64 to 0.77.

Conclusion

The present findings suggest that the Italian version of the SACS is a valid and reliable tool that can be used to assess healthcare professionals' attitudes toward coercion.

The Impact of the COVID-19 Pandemic on the Management of Mental Health Services for Hospitalized Patients in Sibiu County-Central Region, Romania

INTRODUCTION

The COVID-19 pandemic brought a burden and represented a challenge for the Romanian medical system. This study explored the consequences that COVID epidemiological measures had on the quality of the mental health care provided to hospitalized patients in a regional psychiatric hospital in Romania.

MATERIALS AND METHODS

Both patient-level and hospital-level indicators were considered for this comparative retrospective study. On the one hand, we extracted patient-level indicators, such as sociodemographics, diagnosis, admission, and discharge dates for 7026 hospitalized patients (3701 women, average age = 55.14) from hospital records. On the other hand, for the hospital-level indicators, we included indicators referring to the aggregated concept of mental health services, such as case mix index, length of stay, bed occupancy rate and patients' degree of satisfaction. Data extracted covered a period of two years (1 March 2019-28 February 2021) before and during the first year of the COVID-19 pandemic.

RESULTS

We found that, compared to the pre-pandemic period, the pandemic period was marked by a drastic decrease in hospitalized patient admissions, coupled with an increase in emergency-based admissions. Other management indicators, such as the case mix index, the number of cases contracted/performed, and the degree of patient satisfaction, decreased. In contrast, the average length of stay and bed occupancy rate increased.

CONCLUSIONS

The COVID-19 pandemic, especially in the first year, raised multiple difficult issues for the management of psychiatric hospitals. It imposed an application of strict measures designed to face these new and unprecedented challenges. Our findings offer a detailed snapshot of the first year of the COVID-19 pandemic in terms of its impact on mental health services and suggest some future directions. Implications for hospital management are discussed.

Impact of the COVID-19 Pandemic on Children and Adolescents Presenting With a Psychiatric Emergency

This mixed-methods survey study aims to describe the effects of the COVID-19 pandemic on the mental health of a sample of 571 children and adolescent seeking psychiatric emergency care. The study was conducted from July to October 2020 at a large Midwestern academic center. Among the respondents, there were significant increases in mental health symptoms attributed to the COVID-19 pandemic, including anxiety (71% of respondents), depression (66%), suicidal thoughts or behaviors (45%), and aggression (31%). There were significant differences in reported increases in symptoms by age and gender. In addition, 38% of participants reported that the pandemic led to a change or closure of their health care treatment, including mental health providers, with 22% reporting that reduced treatment access led to their emergency visit. Further research is indicated to assess other, more diverse populations, as well as the longer-term mental health impacts of the pandemic.

Psychiatric Admissions in a Large Hospital in Madrid during COVID-19 Lockdown: Was There a Change in Patient Profile?

COVID-19 led to a reorganization of health care in Madrid. The objective of this study is to describe the sociodemographic and clinical profile of psychiatric patients admitted to Gregorio Marañón Hospital during lockdown.

Retrospective Study of Psychiatric Hospitalizations in a West Texas Mental Health Treatment Facility during the COVID-19 Pandemic

OBJECTIVES

The association between the coronavirus disease (COVID-19) pandemic and adverse mental health outcomes has been well documented; however, little is known about its impact in rural areas of the United States. This study aims to characterize and compare inpatient psychiatric admissions in West Texas before and during the initial months of the COVID-19 pandemic.

METHODS

A retrospective study was conducted using the electronic health records of 1392 inpatient psychiatric admissions from period A (March 13, 2019-July 3, 2019) to period B (March 13, 2020-July 3, 2020).

RESULTS

During period B, there was a significant increase in the length of stay (P < 0.01) compared with period A. The pandemic was associated with an increased history of psychiatric medication use (P < 0.01), substance use (P ≤ 0.01), and suicide risk at the time of admission (P < 0.01). Significant differences were found in employment status (P < 0.01), living situation (P < 0.01), and ethnicity (P = 0.03).

CONCLUSIONS

Rural communities in West Texas experienced a decrease in psychiatric hospitalizations during the beginning of the COVID-19 pandemic, followed by an increase as lockdown restrictions began to lift; this warrants further investigation into healthcare service utilization during the pandemic.

[What Influence did the Lockdown 2020 have on the Use of a Central Emergency Room by Psychiatric Emergency Patients]

OBJECTIVE

The current coronavirus pandemic (Covid-19 disease) poses major challenges to healthcare systems worldwide. The aim of this work was to identify the impact on psychiatric emergency presentations in an ED during the implemented lockdown.

METHODS

A retrospective survey of all psychiatric emergency presentations in the ED during the lockdown was conducted. The same period in 2019 served as the reference year.

RESULTS

There was a decrease in psychiatric patients. Changes were observed in the age and diagnoses.

CONCLUSION

Some clear effects of the lockdown on psychiatric emergencies in an ED setting can be described. However, the changes were smaller than in other countries with other health care systems.

Relationship Between a State-Directed Lockdown on Non-COVID-19-related ICU Admissions and Mortality in a Multicenter Colorado Healthcare System

Colorado issued a month long statewide lockdown on March 26, 2020, during the initial surge of the COVID-19 pandemic. The impact of this mandate on non-COVID-19 ICU admission rates and outcomes is unclear.

DESIGN

We performed a retrospective analysis of all medical ICU admissions in the University of Colorado Health System in four predefined periods: 1) prepandemic (2 mo prior to lockdown period 1); 2) mandated lockdown from March 26 to April 26, 2020 (period 2); 3) between surges (period 3); and 4) nonmandated lockdown surge (between November 1, 2020, and March 31, 2021, period 4).

SETTING

Nonsurgical ICU admissions at the University of Colorado Health Systems, including 10 hospitals throughout Colorado.

SUBJECTS

All ICU admissions in four predefined time periods.

MEASUREMENTS AND MAIN RESULTS

We included 13,787 patients who were admitted during the four study periods. The 28-day mortality rates for non-COVID-19 ICU admissions following index ICU admission were 13.6%, 18.0%, 13.5%, and 16.0% across periods 1-4, respectively. However, the increased odds in non-COVID-19 ICU mortality during the mandated lockdown period relative to prepandemic 1 (odds ratio [OR], 1.39; 95% CI, 1.11-1.72; p = 0.0.04) was attenuated and nonsignificant after adjustment for demographics, comorbidities, diagnosis flags, and severity (OR, 1.15; 95% CI, 0.89-1.48; p = 0.27). Similar results were found in time-to-event analyses. The most common diagnosis in each time period was acute respiratory failure (ARF), and we found it to have increased during lockdown (p < 0.001), whereas sepsis admissions increased during and decreased after lockdown (p = 0.004). Admissions for alcohol withdrawal syndrome (AWS) increased during lockdown and 6 months afterwards (p = 0.005).

CONCLUSIONS

For non-COVID-19-related ICU admissions, mortality rate was similar before, during, and after Colorado's month long lockdown after confounder adjustment, including typical ICU admission flags. Primary admission diagnoses shifted throughout the predefined study periods with more admissions for severe critical diagnoses (i.e., ARF, sepsis, AWS) occurring during the mandated lockdown and nonmandated lockdown periods compared with the prepandemic and between surge period. This would suggest that the perceived increase in mortality during the lockdown for non-COVID-19 ICU admissions may be related to a shift inpatient demographics.

Effects of a multilayered crisis on psychiatric hospitalizations in a university hospital in Lebanon; a retrospective study

Lebanon is struggling with a multilayered crisis following the COVID-19 breakout, the economic crisis, and the Beirut port explosion. The aim of this article is to assess the effect of these crisis on the characteristics of patients hospitalized in psychiatry. This is a retrospective study conducted at the psychiatric ward of Hotel Dieu de France in Beirut between January 2017 and march 2022. The population was divided into three groups according to specific time events indicating the start of a certain crisis. Data regarding patients' demographics, psychiatric history and their present hospitalization was collected. A total of 1655 patient files were included in the study. Overall, the rate of hospitalized women increased following the Beirut port explosion, together with the rate of patients younger than 18 years old. Moreover, during the COVID-19 breakout and the start of the economic crisis, alcohol use decreased, as well as the length of stay in the hospital. In conclusion, in the event of a multilayered crisis children and adolescents, as well as women are the most at risk of being affected in terms of mental health.

Have the COVID-19 outbreak and related restrictions affected the right to mental health of people with severe mental health conditions?

The Coronavirus disease (COVID-19) outbreak, and the restrictions implemented by governments to limit its public health impact, may have determined a reduction of the right to mental health of people with severe mental health conditions, that is a limitation to adequate, human, and value-based mental healthcare, with rising inequalities in comparison with the general population. This systematic review was, therefore, conducted to collate evidence on the impact of the pandemic period on the mental health of individuals with pre-existing severe mental health conditions. Of 3,774 retrieved citations, we selected 21 studies meeting the inclusion criteria. The majority of the included studies assessed trends in psychological symptoms over the pandemic period, then arguing that symptoms worsened for a number of reasons, including the risk of contracting the virus, the disruption of mental health services, and the feelings of loneliness and isolation associated with the restriction measures. Even though studies provided somewhat contradictory results, the majority of evidence indicates that people with pre-existing mental health conditions were more likely to report greater self-isolation distress, anxiety, depression, COVID-19-related perceived stress, and were more likely to voluntarily self-isolate than those without a mental health condition. These findings appeared to suggest that a combination of factors related to the pandemic itself and to the prevention and mitigation strategies were responsible for a reduction of the right to mental health of people with mental health conditions, with increased inequalities in comparison with the general population.

Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from 4 centres in Italy

Objectives: An observation of the Emergency Room (ER) admissions during the lockdown.Methods: We monitored admissions to the ER requiring psychiatric evaluation during the 2020 lockdown (March 9^th-May 3^rd, 2020) compared to the same period of 2019, in four sites of Northern Italy (ASST Lariana, AUSL Modena, ASU Friuli Centrale and AUSL Romagna). Number of admissions, baseline demographic and clinical variables were extracted from the clinical databases.Results: A 20.0% reduction of psychiatric referrals was observed across the sites (24.2% in ASST Lariana, 30.5% in AUSL Modena, 12.0% in ASU Friuli Centrale and 14.5% in AUSL Romagna). This reduction peaked at 41.5% in the first month of the lockdown. Being homeless as well as with a dual diagnosis (OR 1,67, CI: 1.02-2.74), while living in a residential facility and admission for a depressive episode Being homeless (OR 2.50, CI: 1.36-4.61) and having a dual diagnosis (OR 1,67, CI: 1.02-2.74) were significantly associated with an increase in ER admission, while living in a residential facility (OR 0.48, CI: 0.31-0.74), having a depressive episode (OR 0.36, CI: 0.18-0.73) and a diagnosis of anxiety disorder (OR 0.60, CI: 0.36-0.99) were significantly associated with a decrease.Conclusions: During lockdown, a decrease in psychiatric referrals was observed.

Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review

BACKGROUND

The COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contact became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what extent service provision transitioned to telemental health worldwide.

OBJECTIVE

We aimed to systematically review the global research literature on how mental health service provision adapted during the first year of the pandemic.

METHODS

We searched systematically for quantitative papers focusing on the impact of the COVID-19 pandemic on mental health services published until April 13, 2021, in the PubMed, Embase, medRxiv, and bioXriv electronic bibliographic databases, using the COVID-19 Open Access Project online platform. The screening process and data extraction were independently completed by at least two authors, and any disagreement was resolved by discussion with a senior member of the team. The findings were summarized narratively in the context of each country's COVID-19 Stringency Index, which reflects the stringency of a government's response to COVID-19 restrictions at a specific time.

RESULTS

Of the identified 24,339 records, 101 papers were included after the screening process. Reports on general services (n=72) showed that several countries' face-to-face services reduced their activities at the start of the pandemic, with reductions in the total number of delivered visits and with some services forced to close. In contrast, telemental health use rapidly increased in many countries across the world at the beginning of the pandemic (n=55), with almost complete virtualization of general and specialistic care services by the end of the first year. Considering the reported COVID-19 Stringency Index values, the increased use of virtual means seems to correspond to periods when the Stringency Index values were at their highest in several countries. However, due to specific care requirements, telemental health could not be used in certain subgroups of patients, such as those on clozapine or depot treatments and those who continued to need face-to-face visits.

CONCLUSIONS

During the pandemic, mental health services had to adapt quickly in the short term, implementing or increasing the use of telemental health services across the globe. Limited access to digital means, poor digital skills, and patients' preferences and individual needs may have contributed to differences in implementing and accessing telemental health services during the pandemic. In the long term, a blended approach, combining in-person and virtual modalities, that takes into consideration the needs, preferences, and digital skills of patients may better support the future development of mental health services. It will be required to improve confidence with digital device use, training, and experience in all modalities for both clinicians and service users.

The Impact of the COVID-19 Pandemic on Inpatient Admissions for Psychotic and Affective Disorders: The Experience of a Large Psychiatric Teaching Hospital in Romania

The COVID-19 pandemic resulted in a global sanitary crisis and, in addition, elicited serious mental health consequences. The utilization of psychiatric hospital-based services acts as an indicator of public mental health. Therefore, this research sought to investigate differences in the numbers and characteristics of inpatient admissions for psychotic and affective disorders at the largest Romanian psychiatric hospital between the period of lockdown (16 March−15 May 2020) and another three corresponding periods: the same year in the pre-lockdown period (16 January−15 March 2020), the immediate post-lockdown period (16 May−15 July 2020), and two years later (16 March−15 May 2022). A retrospective analysis was performed. The study included a total of 6604 patients. Inpatient admissions decreased during lockdown in comparison with the pre-lockdown period and immediate post-lockdown period for psychotic disorders (p < 0.001 and p < 0.001, respectively) and affective disorders (p < 0.001 and p < 0.001, respectively). For both psychotic and affective disorders, a decrease in the age of the patients admitted during lockdown, as compared with the pre-lockdown period (p < 0.05 and p < 0.001, respectively), was observed. The length of the hospital stay for affective disorders was higher immediately post-lockdown in comparison with the lockdown period (p < 0.001). Collectively, the present findings provide a glimpse of the immediate and long-term consequences of the COVID-19 pandemic and lockdown measures on patients’ access to mental healthcare in the form of hospitalization, and these findings could provide the basis for the development of a different approach to times of crisis.

Effects of the COVID-19 pandemic on acute coronary syndromes in Germany during the first wave: the COVID-19 collateral damage study

BACKGROUND

Reports about the influence of the COVID-19 pandemic on the number of hospital admissions and in-hospital mortality during the first wave between March and May 2020 showed conflicting results and are limited by single-center or limited regional multicenter datasets. Aim of this analysis covering all German federal states was the comprehensive description of hospital admissions and in-hospital mortality during the first wave of the COVID-19 pandemic.

METHODS AND RESULTS

We conducted an observational study on hospital routine data (§21 KHEntgG) and included patients with the main diagnosis of acute myocardial infarction (ICD 21 and ICD 22). A total of 159 hospitals included 36,329 patients in the database, with 12,497 patients admitted with ST-elevation myocardial infarction (STEMI) and 23,832 admitted with non-ST-elevation myocardial infarction (NSTEMI). There was a significant reduction in the number of patients admitted with STEMI (3748 in 2020, 4263 in 2019 and 4486 in 2018; p < 0.01) and NSTEMI (6957 in 2020, 8437 in 2019 and 8438 in 2020; p < 0.01). These reductions were different between the Federal states of Germany. Percutaneous coronary intervention was performed more often in 2020 than in 2019 (odds ratio 1.13, 95% confidence interval [CI] 1.06-1.21) and 2018 (odds ratio 1.20, 95% CI 1.12-1.29) in NSTEMI and more often than in 2018 (odds ratio 1.26, 95% CI 1.10-1.43) in STEMI. The in-hospital mortality did not differ between the years for STEMI and NSTEMI, respectively.

CONCLUSIONS

In this large representative sample size of hospitals in Germany, we observed significantly fewer admissions for NSTEMI and STEMI during the first COVID-19 wave, while quality of in-hospital care and in-hospital mortality were not affected. Admissions for STEMI and NSTEMI during the months March to May over 3 years and corresponding in-hospital mortality for patients with STEMI and NSTEMI in 159 German hospitals. (p-value for admissions 2020 versus 2019 and 2018: < 0.01; p-value for mortality: n.s.).

Patterns of adult and youth inpatient admissions before and after the COVID-19 pandemic in a psychiatric ward: an observational study

Background

The current pandemic situation led to deep changes not only in social relationships, but also on clinical care and access to healthcare facilities. The authors aimed to understand whether this context affected the main characteristics of psychiatric hospitalizations, measured by admissions in a portuguese acute psychiatric ward.

Methods

Retrospective data collection of all patients admitted in Centro Hospitalar Psiquiátrico de Lisboa, in two different time periods: pre-COVID-19 (march 11th, 2019 to march 10th, 2020, n = 1845) and COVID-19 (march 11th, 2020 to march 10th, 2021, n = 1278); comparing the number of total admissions, compulsory ones, age, sex, median days of admission, median days to readmission and diagnosis at discharge. Distribution of disorders in both groups, as well as in compulsory admissions were also evaluated. The same comparisons were evaluated in the 15–25-year-old patient group.

Results

Statistical significance was found regarding total number of admissions (reduction of around 30.7%), as well as compulsory ones (reduction of 14%, although the relative frequency had increased), days of admission and distribution between admissions (with lower reductions regarding dementias, schizophrenia and affective disorders, while substance use disorders and intellectual disabilities presented reductions of over 50%), with no differences between gender, median age, previous admissions or readmissions. Distribution between compulsory admissions did not present differences before and during COVID periods.

For patients between 15 and 25 years of age, statistical significance was found regarding total number of compulsory ones (94 versus 44, p-value = 0.01), and in all groups of diagnoses (all with p-value = 0.001).

Conclusions

While there was a general reduction in the overall number of patients admitted, in the most severe conditions (compulsory admissions and schizophrenia diagnosis) did not present such a reduction. Difficulties in social, clinical and family networks can explain the reduction of the time to readmission. Future research could show whether there is a rebound increase number of admissions in the other diagnoses.

Trial Registration

The current study was approved by the hospital’s scientific and ethics committees (CCP number 0060/2021 and CES 09/2021).

Mental health of patients with mental illness during the COVID-19 pandemic lockdown: a questionnaire-based survey weighted for attrition

BACKGROUND

Individuals with pre-existing mental illness may be particularly vulnerable to the negative impact that the coronavirus disease 2019 (COVID-19) pandemic seems to have on mental health. Accordingly, the objective of the present study was to assess whether patients with mental illness experienced deterioration in mental health during the COVID-19 lockdown of Denmark in the Spring of 2020.

METHODS

We conducted a cross-sectional, questionnaire-based survey coupled with sociodemographic and clinical data from the medical records of all invitees. The latter enabled analysis of attrition and weighting of results. The online questionnaire included the 18-item Brief Symptom Inventory (BSI-18), the five-item World Health Organization Well-Being Index (WHO-5), and 14 questions evaluating worsening or improvement in symptoms during lockdown using the pre-pandemic period as reference.

RESULTS

A total of 992 randomly drawn patients with mental illness from the psychiatric services of the Central Denmark Region responded to the questionnaire (response rate = 21.6%). The weighted mean WHO-5 and BSI-18 scores were 38 and 28, respectively. A total of 52% of the respondents reported that their mental health had deteriorated during the lockdown, while 33% reported no change, and 16% reported improvement. The most commonly reported reasons for deterioration were loneliness, disruption of routines, concerns regarding the coronavirus, less contact with family/friends, boredom, and reduced access to psychiatric care.

CONCLUSION

More than half of the patients reported worsening of their mental health during the pandemic lockdown. There should be an increased emphasis on ensuring both social and clinical support for individuals with mental illness during pandemics.

A year in perspective: The impact of the COVID-19 pandemic on engagement with Jigsaw youth mental health services

AIM

The COVID-19 pandemic has presented significant challenges for young people and youth mental health services. To address a gap in knowledge about the impact of the pandemic and associated restrictions on youth mental health services, this paper examined the nature of young people's engagement with Jigsaw's brief intervention service during the pandemic.

METHOD

Data gathered from young people engaging with Jigsaw's brief intervention service in the 12 months after the official declaration of the COVID-19 pandemic (n = 6161), and 12 months prior (n = 8665) were examined.

RESULTS

There were less referrals to Jigsaw during the pandemic, especially during lockdown periods, but this rebounded when public health restrictions were eased. A higher proportion of females (p < .001) and 12-17 year olds (p < .001) were referred during the pandemic period. There was an increase in the proportion of young people who presented with anxiety (p < .001) and sleep changes (p < .001). Although 12-16 year olds reported significantly higher levels of distress during the pandemic (p < .05), the effect size was small. Young people reported high levels of satisfaction with the new phone/video modes of support offered by Jigsaw, and the overall attendance rate improved during the pandemic period.

CONCLUSIONS

The impact of COVID-19 on young people's mental health needs to be considered as a priority. This paper is helpful for services considering the long-term mental health needs of young people, and the best way of meeting those needs.

Possible impact of COVID-19 pandemic and lockdown on suicide behavior among patients in Southeast Serbia

Individuals with serious mental illness are more affected by emotional reactions, including suicidal behavior due to COVID‐19 and psychosocial consequences of pandemic. The current cross-sectional study aimed to explore the possible association of COVID-19 and suicidal behavior (suicide ideation and attempt) before and during pandemic-associated lockdown in Serbia. We retrospectively reviewed the clinical records of 104 adult psychiatric inpatients admitted at Psychiatric Clinic, University Clinic Center Niš, Serbia, after ending lockdown and compared the obtained results with 181 adult psychiatric inpatients admitted during the same period in 2019 and 2018. Suicide ideation were more frequent in 2020 comparing with 2019 and 2018 (25 vs 12.5%, vs 9.41%; p < 0.05). Around 28% of patients with suicide attempts were exposed daily to the information related to COVID-19 coming from social media, while this frequency was significantly lower, only 7.55% (p < 0.1), among patients with no suicide ideation or attempts. Adjustment disorder was more frequent among patients with suicide attempts in comparison to the patients with suicide ideation (32 vs 11%), especially in patients without suicide ideation and attempts (32 vs 0%, p < 0.001). Of all studied patients with suicide attempts during 2020, 60% were not in the previous psychiatric treatment before admission.

Profile of patients attending psychiatric emergency care during the coronavirus 2019 (COVID 19) pandemic: a comparative cross-sectional study between lockdown and post-lockdown periods in Lombardy, Italy

OBJECTIVE

To assess the long-term impact of early COVID-19 lockdown phase on emergency psychiatric consultations in two psychiatric emergency departments located in Italy.

METHODS

We conducted a cross-sectional study comparing the number and characteristics of emergency psychiatric consultations during post-lockdown with respect to the lockdown period. Sociodemographic data, clinical characteristics, referred symptoms, diagnosis, information on multiple psychiatric consultations and hospitalisation were collected.

RESULTS

A rise of almost 60% in emergency psychiatric consultations during the post-lockdown compared to the lockdown period was observed. Emergency psychiatric consultations in the post-lockdown period were associated with lower rates of cannabis (aOR = 0.42, p = 0.011) and cocaine use (aOR = 0.39, p = 0.011). Despite a lower occurrence of two or more psychiatric consultations was observed during post-lockdown phase (aOR = 0.44, p = 0.008), subjects who had anxiety disorders (aOR = 3.91, p = 0.000) and substance intoxication or withdrawal (aOR = 6.89, p = 0.000) were more likely to present to emergency psychiatric consultations during post-lockdown period compared to the lockdown one.

CONCLUSIONS

Substance intoxication or withdrawal and anxiety disorders increased after the COVID-19 lockdown. The findings of this study suggest to address more economic and professional sources to the mental health areas potentially more affected by the different phases of a pandemic.KEYPOINTSCOVID-19 pandemic and lockdown measures increased mental health unmet needs.According to our findings, a rise in emergency psychiatric consultations during the post-lockdown compared to the lockdown period was observed.Patients with substance intoxication or withdrawal syndrome and anxiety disorders were significantly more likely to present to emergency psychiatric consultations during post-lockdown.Lockdown was associated with higher rates of both cannabis and cocaine use disorders as well as of multiple psychiatric consultations.Alternative strategies to improve mental health such as e-health technologies should be promoted.

Antidepressants Drug Use during COVID-19 Waves in the Tuscan General Population: An Interrupted Time-Series Analysis

In Italy, during the COVID-19 waves two lockdowns were implemented to prevent virus diffusion in the general population. Data on antidepressant (AD) use in these periods are still scarce. This study aimed at exploring the impact of COVID-19 lockdowns on prevalence and incidence of antidepressant drug use in the general population. A population-based study using the healthcare administrative database of Tuscany was performed. We selected a dynamic cohort of subjects with at least one ADs dispensing from 1 January 2018 to 27 December 2020. The weekly prevalence and incidence of drug use were estimated across different segments: pre-lockdown (1 January 2018–8 March 2020), first lockdown (9 March 2020–15 June 2020), post-first lockdown (16 June 2020–15 November 2020) and second lockdown (16 November 2020–27 December 2020). An interrupted time-series analysis was used to assess the effect of lockdowns on the observed outcomes. Compared to the pre-lockdown we observed an abrupt reduction of ADs incidence (Incidence-Ratio: 0.82; 95% Confidence-Intervals: 0.74–0.91) and a slight weekly decrease of prevalence (Prevalence-Ratio: 0.997; 0.996–0.999). During the post-first lockdown AD use increased, with higher incidence- and similar prevalence values compared with those expected in the absence of the outbreak. This pandemic has impacted AD drug use in the general population with potential rebound effects during the period between waves. This calls for future studies aimed at exploring the mid–long term effects of this phenomenon.

Rethinking hospital psychiatry in Italy in light of COVID-19 experience

BACKGROUND

Italy retains a distinctive organization of mental health services according to a community-based model of care with a multidisciplinary team serving a well-defined catchment area under the coordination of the local department of mental health. The coronavirus disease 2019 (COVID-19) pandemic is forcing Italian mental health services to develop new organizational strategies at all levels of care in order to face the associated challenges.

AIM

To explore factors associated with changes in psychiatric admissions to an inpatient psychiatric unit located in Lombardia Region, Italy.

METHODS

All hospital admissions (n = 44) were recorded to an inpatient psychiatric unit during a three month national lockdown in Italy in 2020 and compared with those occurring over the same time period in 2019 (n = 71). For each admission, a 20-item checklist was completed to identify factors leading to admission. Statistical analyses were performed using Statistical Package for Social Sciences for Windows, release 11.0. Chi-square test (or Fisher’s exact test) and Mann-Whitney U-test were applied, where appropriate.

RESULTS

Hospital admissions dropped by 38% during the COVID-19 pandemic. No significant differences were found in demographics, clinical variables associated with hospital admissions and length of stay between 2019 and 2020. Compared with 2019, a significantly greater proportion of hospital admissions in 2020 were related to difficulties in organizing care programs outside the hospital (chi-square = 4.91, df 1, one-way P = 0.035) and in patients’ family contexts (chi-square = 3.71, df 1, one-way P = 0.049). On the other hand, logistic and communication difficulties pertaining to residential facilities and programs were significantly more common in 2019 than in 2020 (chi-square = 4.38, df 1, one-way P = 0.032).

CONCLUSION

Admissions to the inpatient psychiatric unit dropped significantly during the COVID-19 pandemic in 2020, with difficulties in organizing care programs outside the hospital and in patients’ family contexts occurring more frequently compared with 2019.

The impact of COVID-19 on adolescent psychiatric inpatient admissions

COVID-19 has disrupted the lives of individuals and families across the globe. For many, the impacts of this global pandemic have been insurmountable and have resulted in significant stressors. Although medical advances have allowed individuals to slowly begin to restore their sense of normalcy, COVID-19 has resulted in unprecedented mental health impacts for many, especially children and adolescents. The present study examines whether stressors related to COVID-19 and whether subsequent quarantine/isolation were possible contributors to psychiatric crises that led to adolescent psychiatric inpatient admissions. Electronic medical records of those admitted to Strong Memorial Hospital's Child and Adolescent Inpatient Unit between March 13, 2020 and January 1, 2021 were reviewed. Admission and discharge notes were analyzed to determine the presence and context of keywords related to COVID-19. Approximately, 53% of all adolescent psychiatric crises that led to inpatient admission were related to COVID-19 stressors. Results of this study will be used to help understand the extraordinary mental health impacts of a global pandemic and will assist mental health service leaders to better plan for patient flow should there be another wave of quarantine/isolation. Additionally, these results can help inform and develop pandemic-related strategies and interventions that can reduce overall distress in children and adolescents.

The psychopathological impact of the SARS-CoV-2 epidemic on subjects suffering from different mental disorders: An observational retrospective study

SARS-CoV-2 infection causes a pulmonary disease (COVID-19) which spread worldwide generating fear, anxiety, depression in the general population as well as among subjects affected by mental disorders. Little is known about which different psychopathological changes the pandemic caused among individuals affected by different psychiatric disorders, which represents the aim of the present study. Specific psychometric scales were administered at three time points: T0 as outbreak of pandemic, T1 as lockdown period, T2 as reopening. Descriptive analyses and linear regression models were performed. A total of 166 outpatients were included. Overall, psychometric scores showed a significant worsening at T1 with a mild improvement at T2. Only psychopathology in schizophrenia (SKZ) patients and obsessive-compulsive (OC) symptoms did not significantly improve at T2. Subjects affected by personality disorders (PDs) resulted to be more compromised in terms of general psychopathology than depressed and anxiety/OC ones, and showed more severe anxiety symptoms than SKZ patients. In conclusion, subjects affected by PDs require specific clinical attention during COVID-19 pandemic. Moreover, the worsening of SKZ and OC symptoms should be strictly monitored by clinicians, as these aspects did not improve with the end of lockdown measures. Further studies on larger samples are needed to confirm our results. ClinicalTrials.gov Identifier: NCT04694482.

Impact of COVID-19 on the Italian Mental Health System: A Narrative Review

Italy has been severely affected by the COVID-19 pandemic, consequently producing a heavy burden on the Italian National Health Service. From February 2020 until the end of the same year, the Italian Mental Health System (MHS), comprising an extensive network of community services, was subjected to a significant decrease in standards of care followed at the beginning of 2021 by a slow return to usual levels of activity. Data reported in the present article highlight how the Italian MHS – as was the case in the majority of countries—was largely unprepared for this emergency, suggesting an impelling need to develop appropriate supplementary national plans with the aim of preventing similar situations from developing in the future. The upheaval caused by the pandemic has highlighted the need to reinforce, both at a local and national level, the organization and standards of care of the Italian MHS in order to protect and support the mental health of patients with severe mental disorders, health workers, and the general population, thus preventing a potential “pandemic” of mental disorders.

Addiction in the time of COVID-19: Longitudinal course of substance use, psychological distress, and loneliness among a transnational Tyrolean sample with substance use disorders

INTRODUCTION

Next to an increased use of alcohol, the current pandemic has been associated with increased psychological distress among the general population. Research on its effects on individuals suffering from substance use disorders (SUD) is scarce. This study aimed at expanding the existing literature on this topic with a focus on the impact of loneliness and perceived social support.

METHODS

Sixty-eight people diagnosed with SUD according to ICD-10 from the Austrian state of Tyrol and from the Italian Province of South Tyrol who had been treated in a psychiatric hospital in 2019 and one hundred and thirty-six matched reference subjects of the same regional background participated in an online survey. Sociodemographic variables and scores on the Brief Symptom Checklist, the Three-Item Loneliness Scale, and the Multidimensional Scale of Perceived Social Support were collected at baseline and 5 months thereafter. Baseline took place after the first wave, while follow-up largely coincided with the second wave of the pandemic.

RESULTS

Among both patients and the matched reference group, substance use as a means to feel better facing the pandemic rose and predicted higher levels of psychological distress. Patients were less likely to receive specific care at follow-up than at baseline and presented with a significantly higher prevalence of clinically relevant psychological distress and loneliness than the matched reference group at both assessment times. Among both groups, psychological burden remained unchanged over time. Perceived social support was generally significantly higher in the matched reference group than in patients. Loneliness and, to a lesser degree, low perceived social support predicted psychological distress.

CONCLUSION

These findings emphasize the need of preventive and educational measures regarding substance use behavior for both individuals suffering from SUD and those without mental health disorders.

Changes in Psychiatric Inpatient Service Utilization During the First and Second Waves of the COVID-19 Pandemic

The COVID-19 pandemic has caused societal restrictions and public fear which may have impacted the pattern of seeking psychiatric care. There has generally been a decrease in the numbers seeking acute psychiatric care. It is important to investigate which groups seeking psychiatric treatment have decreased in number. The aim of our investigation was to identify which groups have a changed pattern in acute psychiatric service utilization during the first two waves of the COVID-19 pandemic. The study investigated changes in the rate and pattern of visits and hospital admissions for psychiatric disorders at a large Swedish hospital. A register-based study was conducted using administrative data on adult psychiatric emergency department visits (PEVs) and hospital admission rates. Data during the first two COVID-19 waves were compared to corresponding control periods in 2018-2019. Furthermore, a survey was performed among patients visiting the Psychiatric Emergency Department on their views of COVID-19 and acute psychiatric care. During the COVID-19 periods, PEVs were reduced overall by 16 and 15% during the first and second wave, respectively (p < 0.001 in both cases), while the rate of admissions remained unaltered. PEVs were significantly reduced for most psychiatric diagnosis subgroups except for patients with schizophrenia and other related psychotic disorders as well as for those who required ongoing outpatient care. Most of the survey respondents disagreed that the pandemic affected their visit and about a quarter thought a video call with a doctor could have replaced their visit. In conclusion, there was a significant reduction in overall PEVs during both COVID-19 waves but this did not affect the numbers requiring admission for psychiatric inpatient care.

Changes and Challenges in Inpatient Mental Health Care During the First Two High Incidence Phases of the COVID-19 Pandemic in Germany - Results From the COVID Ψ Psychiatry Survey

Psychiatric inpatient treatment, an important pillar of mental health care, is often of longer duration in Germany than in other countries. The COVID-19 pandemic called for infection prevention and control measures and thereby led to shifts in demand and inpatient capacities. The Germany-wide COVID Ψ Psychiatry Survey surveyed department heads of German psychiatric inpatient institutions. It assessed changes in utilization during the first two high incidence phases of the pandemic (spring 2020 and winter 2020/21) and also consequences for care, telemedicine experiences, hygiene measures, treatment of patients with mental illness and co-occuring SARS-CoV-2, and coercive measures in such patients. A total of n = 71 psychiatric departments (of 346 contacted) participated in the survey. The results showed a median decrease of inpatient treatment to 80% of 2019 levels and of day hospital treatment to 50% (first phase) and 70% (second phase). Reductions were mainly due to decreases in elective admissions, and emergency admissions remained unchanged or increased in 87% of departments. Utilization was reduced for affective, anxiety, personality, and addiction disorders but appeared roughly unaffected for psychotic disorders. A lack of integration of patients into their living environment, disease exacerbations, loss of contact, and suicide attempts were reported as problems resulting from reduced capacities and insufficient outpatient treatment alternatives. Almost all departments (96%) treated patients with severe mental illness and co-occurring SARS-CoV-2 infection. The majority established special wards and separate areas for (potentially) infectious patients. Telephone and video consultations were found to provide benefits in affective and anxiety disorders. Involuntary admissions of persons without mental illness because of infection protection law violations were reported by 6% of the hospitals. The survey showed high adaptability of psychiatric departments, which managed large capacity shifts and introduced new services for infectious patients, which include telemedicine services. However, the pandemic exacerbated some of the shortcomings of the German mental health system: Avoidable complications resulted from the lack of cooperation and integrated care sequences between in- and outpatient sectors and limited options for psychiatric hospitals to provide outpatient services. Preventive approaches to handle comparable pandemic situations in the future should focus on addressing these shortcomings.

Psychiatric Admissions, Referrals, and Suicidal Behavior Before and During the COVID-19 Pandemic in Denmark: A Time-Trend Study

OBJECTIVE

To assess the patterns in psychiatric admissions, referrals, and suicidal behavior before and during the COVID-19 pandemic.

METHODS

This study utilized health records from hospitals and Emergency Medical Services (EMS) covering 46% of the Danish population (n = 2,693,924). In a time-trend study, we compared the number of psychiatric in-patients, referrals to mental health services and suicidal behavior in years prior to the COVID-19 pandemic to levels during the first lockdown (March 11 - May 17, 2020), inter-lockdown period (May 18 - December 15, 2020), and second lockdown (December 16, 2020 - February 28, 2021).

RESULTS

During the pandemic, the rate of psychiatric in-patients declined compared to pre-pandemic levels (RR = 0.95, 95% CI = 0.94 - 0.96, p < 0.01), with the largest decrease of 19% observed three weeks into the first lockdown. Referrals to mental health services were not significantly different (RR = 1.01, 95% CI = 0.92 - 1.10, p = 0.91) during the pandemic; neither was suicidal behavior among hospital contacts (RR = 1.04, 95% CI = 0.94 - 1.14, p = 0.48) nor EMS contacts (RR = 1.08, 95% CI = 1.00 - 1.18, p = 0.06). Similar trends were observed across nearly all age groups, sexes, and types of mental disorders examined. In the age group <18, an increase in the rate of psychiatric in-patients (RR = 1.11, 95% CI = 1.07 - 1.15, p < 0.01) was observed during the pandemic; however, this did not exceed the pre-pandemic, upwards trend in psychiatric hospitalizations in the age group <18 (p = 0.78).

CONCLUSION

The COVID-19 pandemic has been associated with a decrease in psychiatric hospitalizations, while no significant change was observed in referrals to mental health services and suicidal behavior. Psychiatric hospitalizations among children and adolescents increased during the pandemic; however, this appears to be a continuation of a pre-pandemic trend.

Inpatient Mental Healthcare before and during the COVID-19 Pandemic

Prior studies have demonstrated disruption to outpatient mental health services after the onset of the COVID-19 pandemic. Inpatient mental health services have received less attention. The current study utilized an existing cohort of 33 Veterans Health Affairs (VHA) acute inpatient mental health units to examine disruptions to inpatient services. It further explored the association between patient demographic, clinical, and services variables on relapse rates. Inpatient admissions and therapeutic services (group and individual therapy and peer support) were lower amongst the COVID-19 sample than prior to the onset of COVID-19 while lengths of stay were longer. Relapse rates did not differ between cohorts. Patients with prior emergent services use as well as substance abuse or personality disorder diagnoses were at higher risk for relapse. Receiving group therapy while admitted was associated with lower risk of relapse. Inpatient mental health services saw substantial disruptions across the cohort. Inpatient mental health services, including group therapy, may be an important tool to prevent subsequent relapse.

The impact of the COVID-19 pandemic on alcohol-related emergency department visits in the Netherlands: The ALCOVID study

INTRODUCTION

The ongoing COVID-19 pandemic has a profound impact on society and healthcare utilisation. Some studies found that alcohol consumption increased. While declines in non-COVID emergency department (ED) visits have been observed worldwide, little is known about the impact of the COVID-19 pandemic on the number of alcohol-related ED visits. We aimed to examine the changes in alcohol-related ED utilisation during the first year of the pandemic in the Netherlands. We assessed whether lockdowns, closure of the catering industry and alcohol bans were associated with changes in ED utilisation for alcohol-related emergencies.

METHODS

We performed a retrospective analysis of alcohol-related ED visits in a Dutch trauma level 2 centre, comparing the pandemic year 2020 and using the year 2019 as a reference. Alcohol-related ED visits were categorised as alcohol intoxication, alcohol-related trauma or a combination of both.

RESULTS

There was an absolute decline of 23.3% in alcohol-related ED visits during 2020 compared to 2019. The decline was most distinct during the second lockdown period (-60%, P ≤ 0.001), which included an alcohol ban. No significant differences were found in the type of alcohol-related ED visits. The proportion of alcohol-related ED visits remained similar (2.2% vs. 2%).

DISCUSSION AND CONCLUSIONS

Despite reports of higher alcohol consumption, we observed a reduction of alcohol-related ED visits during the COVID-19 pandemic. The decline was most distinct during the second lockdown period, which included an alcohol ban. Further prospective studies are warranted to examine this possible association.

Psychiatric hospitalization during the two SARS-CoV-2 pandemic waves: New warnings for acute psychotic episodes and suicidal behaviors

BACKGROUND

The subsequent waves of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have represented a dramatic health emergency characterized by significant consequences on mental health. Diachronic variations in the incidence rates of acute relapse of psychiatric disorders may represent significant "sentinel events" for assessing the mental health response to an unprecedented stressful event.

AIM

To investigate the variation in psychiatric hospitalization rates and differences in sociodemographic and clinical-psychopathological peculiarities at Bologna "Maggiore" General Hospital Psychiatric Ward (GHPW) between the first two waves SARS-CoV-2 pandemic and the same periods of the previous 3 years. The secondary purpose of the study was to suggest a diachronic response pathway to stress by reporting additional literature data on coping strategies.

METHODS

This observational and retrospective study collected information on admission to the GHPW at the "Maggiore" Hospital in Bologna in the index periods defined as follows: the first period between February 24, 2020 and April 30, 2020 (first epidemic wave) and the second period between October 8, 2020, and January 7, 2021 (second pandemic wave). Absolute numbers and proportion of admitted patients, their sociodemographic and clinical-psychopathological characteristics were compared with the same parameters recorded in the two same periods of the previous 3 years. No strict inclusion or exclusion criteria were provided in the data collection to collect information on all patients requiring acute psychiatric hospitalization.

RESULTS

During the first wave, there was a significant reduction in hospitalization rates, although there was a simultaneous increase in compulsory hospitalizations and the acute relapse of schizophrenia spectrum and other psychotic disorders. During the second wave, hospitalization rates reached those recorded during the same period of the previous 3 years, mainly due to the rise of bipolar and related disorders, depressive disorders, anxiety disorders, trauma- and stressor-related disorders and suicidal behaviors.

CONCLUSION

The coping strategies adopted during the first wave of the SARS-CoV-2 pandemic protected the vulnerable population from the general risk of clinical-psychopathological acute relapse, even if they increased the susceptibility to run into schizophrenia spectrum and other psychotic disorder relapses. In the medium-long term (as in the second pandemic wave), the same strategies do not play protective roles against the stress associated with the pandemic and social restriction measures. Indeed, during the second wave of the SARS-CoV-2 pandemic, an increase in total hospitalization rate, suicidal behaviors and the incidence rate of bipolar and related disorders, depressive disorders, anxiety disorders, trauma- and stressor-related disorders was observed.