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Fehr M, Köhler S, Roth-Sackenheim C, Geschke K, Tüscher O, Adorjan K, Lieb K, Hölzel LP, Wiegand HF. Outpatient mental health care during high incidence phases of the COVID-19 pandemic in Germany - changes in utilization, challenges and post-COVID care. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01886-w. [PMID: 39218918 DOI: 10.1007/s00406-024-01886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND As only a few studies have examined the impact of the COVID-19 pandemic on the mental health outpatient system so far, the aim of the COVID Ψ Outpatient Survey was to gain insight from outpatient providers in Germany regarding changes in utilization; associated problems and challenges; telemedicine services; interactions with inpatient and nursing home services; and experiences with post-COVID syndromes. METHODS Between July and September 2021, we invited 351 randomly selected outpatient mental health specialists to take part in the online survey via e-mail. Additionally, we extended an invitation to professional associations to encourage their members to participate. N = 105 physicians of most regions of Germany took part in the survey. RESULTS Survey participants reported changes in utilization during the high incidence phases (HIP) of the pandemic using pre-formulated categories: For the first HIP in spring 2020, 31% of the survey participants reported a decrease > 20% and 5% an increase > 20% of patient contacts. For the third HIP in spring 2021, 4% reported a decrease > 20% of contacts, while 30% an increase > 20%. Participants chose "patient's fears of infection" and "providers protection measures" as reasons for decreases, and "pandemic related anxieties", "economic stressors", and "capacity reductions of the inpatient system" as reasons for increases of patient contact. Many providers introduced telemedicine services. A majority reported consultations for post-COVID syndromes already in spring 2021. CONCLUSIONS The survey hinted at changes in utilization, multiple problems but as well good-practice-solutions in the mental health outpatient system during the COVID-19 pandemic.
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Affiliation(s)
- Mandy Fehr
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Sabine Köhler
- Berufsverband Deutscher Nervenärzte, Berlin, Germany
- Berufsverband Deutscher Psychiater, Berlin, Germany
| | - Christa Roth-Sackenheim
- Berufsverband Deutscher Nervenärzte, Berlin, Germany
- Berufsverband Deutscher Psychiater, Berlin, Germany
| | - Katharina Geschke
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Medicine Halle, Halle, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Lars P Hölzel
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
- Oberberg Parkklinik Wiesbaden Schlangenbad, Schlangenbad, Germany
| | - Hauke F Wiegand
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany.
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Engels A, Stein J, Riedel-Heller SG, Konnopka C, König HH. The development of suicide risk in people with severe mental disorders during the first year of the COVID-19 pandemic: a claims-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1193-1200. [PMID: 37996604 PMCID: PMC11178617 DOI: 10.1007/s00127-023-02584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE In this study, we assess how the first and second waves of the COVID-19 pandemic influenced the suicide risk of patients with severe mental disorders in Germany. METHODS We analyzed German health insurance claims data to compare the suicide risk of patients with severe mental disorders before and during the pandemic. We included n = 690,845 patients between October 2019 and March 2020 and n = 693,457 patients the corresponding period of the previous year and applied entropy balancing to adjust for confounding covariates. Given that the cause of death was unknown, we defined potential suicides as deaths of patients with a history of intentional self-harm whose passing could not be explained by COVID-19. Potential suicides were tracked in both cohorts over one year and compared using logistic regression. RESULTS 128 potential suicides were identified in the period during and 101 before the pandemic. This corresponded to a significant increase in the risk for potential suicide of 27.4% compared to the control period (β = 0.24, z = 1.82, p < 0.05). CONCLUSION The noticeable increase in the risk for potential suicide for patients with severe pre-existing mental disorders emphasizes the call for additional efforts to prevent suicide and to help patients cope with their mental illness in the aftermath of the COVID-19 crisis.
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Affiliation(s)
- Alexander Engels
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246, Hamburg, Germany.
| | - Janine Stein
- Institute for Social Medicine, Occupational Medicine and Public Health, University Medical Center Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute for Social Medicine, Occupational Medicine and Public Health, University Medical Center Leipzig, Leipzig, Germany
| | - Claudia Konnopka
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246, Hamburg, Germany
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Hansen SJ, McLay J, Menkes DB. Eating Disorder and Other Psychiatric Hospitalizations in New Zealand During the COVID-19 Pandemic. Int J Eat Disord 2024. [PMID: 38946135 DOI: 10.1002/eat.24237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE An unprecedented rise in eating disorder presentations has been documented in several countries during the COVID-19 pandemic. We explored this phenomenon by analyzing nationwide psychiatric admissions over 5 years, controlling for demographic variables. METHODS We retrospectively analyzed all hospitalizations in New Zealand with a primary psychiatric diagnosis from 2017 to 2021, using Poisson regression to calculate admission rates by diagnosis, before and during the pandemic. Using Fisher's exact test and Poisson modeling, national data were validated against a manually collected sample of eating disorder admissions. RESULTS Eating disorder admissions rose significantly during the pandemic (RR 1.48, p < 0.0001), while other diagnoses remained unchanged or decreased slightly. Anorexia nervosa in 10 to 19-year-old females drove increases, with persistent elevations noted in the 10-14 age group. Pandemic-associated increases were more striking for Māori (RR 2.55), the indigenous Polynesian population, compared with non-Māori (RR 1.43). CONCLUSIONS Eating disorder hospital presentations increased during the COVID-19 pandemic, while other psychiatric presentations to hospital remained relatively unchanged. Possible drivers include disrupted routines, barriers to healthcare access, altered social networks, and increased social media use. Clinical services require additional resources to manage the increased disease burden, especially in vulnerable pediatric and indigenous populations. Ongoing monitoring will be required to establish the time-course of pandemic-related clinical demand.
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Affiliation(s)
- Sara J Hansen
- Faculty of Medical and Health Sciences, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Te Whatu Ora, Wellington, New Zealand
| | - Jessica McLay
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - David B Menkes
- Faculty of Medical and Health Sciences, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Danielsen S, Strandberg-Larsen K, Hawton K, Nordentoft M, Erlangsen A, Madsen T. The iceberg model of suicidal ideation and behaviour in Danish adolescents: integration of national registry and self-reported data within a national birth cohort. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02503-w. [PMID: 38916768 DOI: 10.1007/s00787-024-02503-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
Hospital records are used to identify suicide attempts in many countries but not all individuals present to hospital after a suicide attempt i.e., suggesting a 'hidden number'. Our aim was to present the prevalence of suicide ideation, plans, attempts, and suicides among Danish adolescents, including attempts not resulting in hospital contact. The study population consisted of participants in the Danish National Birth Cohort participating in an 18-year follow-up, with individual-level linkage to national register data. Prevalence was estimated with a variable with mutually exclusive categories ranging from no suicidality to self-reported suicide ideation, -plans, -attempt and hospital-recorded suicide attempt and stratified on sex and parental income. The 'hidden number' was estimated as the ratio between suicide attempts with and without hospital contact. Among 47 858 participants, all aged 18-years, 36% girls and 28% boys reported suicide ideation at least once in their life. In addition, 6% girls and 3% boys had either reported or been recorded with a suicide attempt. For every attempt recorded in the hospital setting, two girls (ratio, 1:2) and six boys (ratio, 1:6) reported having attempted suicide without hospital contact. The prevalence of any suicide attempt was 8% and 3% in the lowest and highest income group, respectively. Before age 18, 0·011% girls and 0·016% boys had died by suicide. In conclusion, suicidal ideation and behaviour are common in adolescents and there is a substantial 'hidden number' of adolescents with suicide attempt. These results emphasize the need for early age suicide preventive interventions in community-settings e.g., school environments.
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Affiliation(s)
- Stine Danielsen
- Danish Research Institute for Suicide Prevention - DRISP, Mental Health Center Copenhagen, University of Copenhagen, Gentofte Hospitalsvej 15, Opg. 15, 4. floor, Hellerup, DK - 2900, Denmark.
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, bd. 24, PO Box 2099, Copenhagen, DK - 1014, Denmark
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of OxfordWarneford Hospital, Oxford, OX3 7JX, England
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention - DRISP, Mental Health Center Copenhagen, University of Copenhagen, Gentofte Hospitalsvej 15, Opg. 15, 4. floor, Hellerup, DK - 2900, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention - DRISP, Mental Health Center Copenhagen, University of Copenhagen, Gentofte Hospitalsvej 15, Opg. 15, 4. floor, Hellerup, DK - 2900, Denmark
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention - DRISP, Mental Health Center Copenhagen, University of Copenhagen, Gentofte Hospitalsvej 15, Opg. 15, 4. floor, Hellerup, DK - 2900, Denmark
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Juárez-Domínguez DA, Arteaga-Contreras KM, Rangel HC. Suicide Attempt Violence: Gender Differences, Diagnosis and Psychiatric Care Seeking in Mexico City. CONSORTIUM PSYCHIATRICUM 2024; 5:5-12. [PMID: 39023109 PMCID: PMC11249396 DOI: 10.17816/cp13457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/19/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Suicide cases in Mexico have increased during the last two years and are the second-leading cause of death in the young adult population. AIM To describe gender differences in violent suicide attempts as relates to diagnosis and the seeking of psychiatric care. METHODS A descriptive retrospective study was conducted. The referral forms of 241 patients who had attempted suicide were analyzed. RESULTS The mean age of the patients was 29.1 (SD=10.8) years, n=140 (58.1%) of the sample were women. Affective disorders were the most frequent diagnoses for both sexes. Women were more likely to delay seeking psychiatric care: 60 days versus 30 days of delay for men (p=0.009). Men were shown to more frequently resort to violent suicide methods. Both women and men who used violent suicide methods were shown to delay by more days the seeking of psychiatric care than those who were found to have used non-violent suicide methods. CONCLUSION We found that patients who use more violent methods of suicide took longer before seeking psychiatric care. This delay in accessing psychiatric care can be thought to contribute to the fact that completed suicides are more frequent within that category of patients. The majority of suicide attempts occurred in the 17-24 years age group; therefore, it seems reasonable to analyze the existing barriers to seeking psychiatric care, mainly in the young adult population, and to design strategies to bring mental health services closer to this population group.
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Aksoy Poyraz C, Uçar Bostan B, Ersungur Çelik EB, Kara Esen B. The impact of COVID-19 pandemic and lockdown on emergency psychiatry department admissions. Medicine (Baltimore) 2024; 103:e36878. [PMID: 38241534 PMCID: PMC10798784 DOI: 10.1097/md.0000000000036878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024] Open
Abstract
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.
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Affiliation(s)
- Cana Aksoy Poyraz
- Department of Psychiatry, İstanbul University-Cerrahpaşa Cerrahpaşa Medical School, Istanbul, Turkey
| | - Büşra Uçar Bostan
- Department of Psychiatry, İstanbul University-Cerrahpaşa Cerrahpaşa Medical School, Istanbul, Turkey
| | - Elif Burcu Ersungur Çelik
- Department of Psychiatry, İstanbul University-Cerrahpaşa Cerrahpaşa Medical School, Istanbul, Turkey
| | - Beril Kara Esen
- Department of Public Health, İstanbul University-Cerrahpaşa Cerrahpaşa Medical School, Istanbul, Turkey
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Deng H, Zhang X, Zhang Y, Yan J, Zhuang Y, Liu H, Li J, Xue X, Wang C. The pooled prevalence and influential factors of non-suicidal self-injury in non-clinical samples during the COVID-19 outbreak: A meta-analysis. J Affect Disord 2023; 343:109-118. [PMID: 37802326 DOI: 10.1016/j.jad.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND COVID-19 has had an enormous impact on the mental health of people around the world, particularly adolescents. Non-suicidal self-injury (NSSI) is one of the most prominent and dangerous behaviors associated with suicide. However, few meta-analyses of the NSSI prevalence have ever been conducted since the COVID-19 outbreak. Here, we conducted a meta-analysis to estimate the pooled prevalence and elucidate the influencing factors for NSSI. METHODS We searched PubMed, Web of Science, Embase, APA PsycINFO, CNKI and Wanfang Database for relevant literature published before April 2022. Pooled prevalence and 95 % confidence interval (CI) were used to assess NSSI prevalence. Subgroup and meta-regression analyses were performed to clarify the potential influencing factors. RESULTS A total of 15 studies with 24,055 participants were eventually included. The results showed that the pooled overall prevalence of NSSI among overall samples during the COVID-19 pandemic was 22.5 % (95 % CI: 17.2 % to 28.9 %). Subgroup and meta-regression analyses revealed that the crucial influencing factors for NSSI included gender, age, regional distribution, and suicidal ideation. Specifically, the NSSI prevalence among adolescents and adults during the pandemic was 32.40 % and 15.70 %, respectively. Most importantly, gender is a significant influencing factor for NSSI among adolescents. CONCLUSIONS The pooled prevalence of NSSI during the COVID-19 outbreak has surged to alarming heights, especially among adolescents. The prevalence of NSSI may be influenced by complex factors such as gender and age. Therefore, it is critical to pay attention to NSSI behaviors in the adolescent population, particularly male adolescents who appear to be susceptible.
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Affiliation(s)
- Hu Deng
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China.
| | - Xueqian Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China; Department of Psychology, Chengde Medical University, Chengde, China
| | - Yiyue Zhang
- Department of Psychology, School of Humanities and Social Sciences, Beihang University, Beijing, China
| | - Jingyi Yan
- Department of Psychology, Chengde Medical University, Chengde, China
| | - Yunyue Zhuang
- Department of Psychology, Chengde Medical University, Chengde, China
| | - Huaqing Liu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Jiuju Li
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Xiao Xue
- Department of Psychiatry, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Chundi Wang
- Department of Psychology, School of Humanities and Social Sciences, Beihang University, Beijing, China.
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Tanner B, Kurdyak P, de Oliveira C. Adult Psychiatric Hospitalizations in Ontario, Canada Before and During the COVID-19 Pandemic. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:925-932. [PMID: 37006178 PMCID: PMC10657583 DOI: 10.1177/07067437231167386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
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.
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Affiliation(s)
- Bryan Tanner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Canada
- Institute of Mental Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Canada
- Institute of Mental Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
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Baminiwatta A, Kulathunge M, Abeysinghe CU, Alahakoon H, Kodithuwakku KM, Nanayakkara T, Ranasinghe R, Sampath WE. Access to inpatient psychiatric care during the COVID-19 pandemic: Observations from Sri Lanka and implications for future crises. Asian J Psychiatr 2023; 89:103765. [PMID: 37748228 DOI: 10.1016/j.ajp.2023.103765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Anuradha Baminiwatta
- Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Sri Lanka; Psychiatry Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
| | | | | | - Helani Alahakoon
- Psychiatry Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Sahoo S, Patra S. A Rapid Systematic Review of the Prevalence of Suicide and Self-Harm Behaviors in Adolescents During the COVID-19 Pandemic. CRISIS 2023; 44:497-505. [PMID: 37194641 DOI: 10.1027/0227-5910/a000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Background: COVID-19 has caused psychological, social, and physical isolation in adolescents resulting in varying rates of suicidal behavior and self-harm. Aims: We investigated the pandemic's impact on adolescent suicidal behavior and self-harm by reviewing the existing literature. Methods: We searched PubMed using keywords: adolescent, suicide, suicidal behavior, self-harm, prevalence, and COVID-19 and included studies reporting primary data only. Results: Of the 551 studies identified, we included 39 studies in the final analysis. Two of the six high-quality population-based suicide registry studies reported increased suicide rates during the pandemic. Seven of fifteen emergency department-based studies out of which four were of high quality and three high-quality population-based health registry studies reported increased self-harm. A few school and community-based surveys and national helpline data also reported an increase in suicidal behavior or self-harm. Limitations: Methodological heterogeneity of the included studies. Conclusions: There is wide variation in study methodology, population, settings, and age groups in the included studies. Suicidal behavior and self-harm were increased in specific study settings and adolescent populations during the pandemic. More methodologically rigorous research is needed to evaluate the impact of COVID-19 on adolescent suicidal behavior and self-harm.
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Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suravi Patra
- Department of Psychiatry, All India Institute of Medical Sciences Bhubaneswar, India
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11
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Taxiarchi VP, Senior M, Ashcroft DM, Carr MJ, Hope H, Hotopf M, Kontopantelis E, McManus S, Patalay P, Steeg S, Webb RT, Abel KM, Pierce M. Changes to healthcare utilisation and symptoms for common mental health problems over the first 21 months of the COVID-19 pandemic: parallel analyses of electronic health records and survey data in England. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100697. [PMID: 37671125 PMCID: PMC10477036 DOI: 10.1016/j.lanepe.2023.100697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 09/07/2023]
Abstract
Background Few studies have investigated the effect of the COVID-19 pandemic on mental health beyond 2020. This study quantifies changes to healthcare utilisation and symptoms for common mental health problems over the pandemic's first 21 months. Methods Parallel cohort studies using primary care database and survey data for adults (≥16 years) in England from January 2015 to December 2021: 16,551,842 from the Clinical Practice Research Datalink (CPRD) and 40,699 from the UK Household Longitudinal Survey (UKHLS). Interrupted time-series models estimated changes in monthly prevalence of presentations and prescribed medications for anxiety and depression (CPRD); and self-reported psychological distress (UKHLS). The pandemic period was divided into five phases: 1st Wave (April-May 2020); post-1st Wave (June-September 2020); 2nd Wave (October 2020-February 2021); post 2nd Wave (March-May 2021); 3rd Wave (June-December 2021). Findings Primary care presentations for depression or anxiety dropped during the first wave (4.6 fewer monthly appointments per 1000 patients, 4.4-4.8) and remained lower than expected throughout follow-up. Self-reported psychological distress exceeded expected levels during the first (Prevalence Ratio = 1.378, 95% CI 1.289-1.459) and second waves (PR = 1.285, 1.189-1.377), returning towards expected levels during the third wave (PR = 1.038, 0.929-1.154). Increases in psychological distress and declines in presentations were greater for women. The decrease in primary care presentations for depression and anxiety exceeded that for physical health conditions (rheumatoid arthritis, diabetes, urinary tract infections). Anxiety and depression prescriptions returned to pre-pandemic levels during the second wave due to increased repeat prescriptions. Interpretation Despite periods of distress during the pandemic, we did not find an enduring effect on common mental health problems. The fall in primary care presentations for anxiety or depression suggests changing healthcare utilisation for mental distress and a potential treatment gap. Funding National Institute for Health and Care Research (NIHR).
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Affiliation(s)
- Vicky P. Taxiarchi
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Morwenna Senior
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Darren M. Ashcroft
- Faculty of Biology, Medicine and Health, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester, UK
| | - Matthew J. Carr
- Faculty of Biology, Medicine and Health, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester, UK
| | - Holly Hope
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Sally McManus
- Violence and Society Centre, City, University of London, London EC1V 0HB, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies and MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Sarah Steeg
- Division of Psychology & Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, UK
| | - Roger T. Webb
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester, UK
- Division of Psychology & Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
| | - Kathryn M. Abel
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Matthias Pierce
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
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12
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Wullschleger A, Gonçalves L, Royston M, Sentissi O, Ambrosetti J, Kaiser S, Baggio S. Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric department: An interrupted time-series analysis. PLoS One 2023; 18:e0289310. [PMID: 37498908 PMCID: PMC10374153 DOI: 10.1371/journal.pone.0289310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The CoVID pandemic and the associated lockdown had a significant impact on mental health services. Inpatient services faced the challenge of offering acute psychiatric while implementing strict infection control measures. There is, however, a lack of studies investigating the use of coercive measures during the pandemic and their relation to hospitalizations and symptom severity. AIMS To investigate the effects of the CoVID outbreak on psychiatric admissions, use of seclusion and symptom severity. METHOD Using routine data from 2019 and 2020 gathered in the Department of Psychiatry at the Geneva University Hospitals, we performed an interrupted time series analysis. This included the number of psychiatric hospitalizations, the proportion of people who experienced seclusion and the average severity of symptoms as measured by the Health of Nations Outcome Scale (HoNOS). Dependent variables were regressed on the time variable using regression model with bootstrapped standard errors. RESULTS Hospitalizations decreased over time (b = -0.57, 95% CI: -0.67; -0.48, p < .001). A structural break in the data (supremum Wald test: p < .001) was observed in the 12th week of 2020. There was an inverse relationship between the number of admissions and the proportions of people subject to seclusion (b = 0.21, 95% CI: -0.32; -0.09, p < .001). There was a statistically marginally significant inverse relationship between HoNOS scores at admission and the number of psychiatric hospitalizations (b = -1.28, 95% CI: -2.59, 0.02, p = .054). CONCLUSION Our results show that the CoVID pandemic in 2020 was associated with a significant decrease in the number of hospital admissions. This decrease was correlated with a greater use of seclusion. The higher burden of symptoms and the difficult implementation of infection control measures might explain this higher use of coercion.
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Affiliation(s)
| | - Leonel Gonçalves
- Division of Prison Health, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - Maya Royston
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Othman Sentissi
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Julia Ambrosetti
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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13
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Ahmed N, Barnett P, Greenburgh A, Pemovska T, Stefanidou T, Lyons N, Ikhtabi S, Talwar S, Francis ER, Harris SM, Shah P, Machin K, Jeffreys S, Mitchell L, Lynch C, Foye U, Schlief M, Appleton R, Saunders KRK, Baldwin H, Allan SM, Sheridan-Rains L, Kharboutly O, Kular A, Goldblatt P, Stewart R, Kirkbride JB, Lloyd-Evans B, Johnson S. Mental health in Europe during the COVID-19 pandemic: a systematic review. Lancet Psychiatry 2023; 10:537-556. [PMID: 37321240 PMCID: PMC10259832 DOI: 10.1016/s2215-0366(23)00113-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Nafiso Ahmed
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK.
| | - Phoebe Barnett
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK; Centre for Outcomes Research and Effectiveness, University College London, London, UK; National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Anna Greenburgh
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Tamara Pemovska
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Theodora Stefanidou
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Natasha Lyons
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sarah Ikhtabi
- Division of Psychiatry, University College London, London, UK
| | - Shivangi Talwar
- Division of Psychiatry, University College London, London, UK
| | - Emma R Francis
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Samantha M Harris
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Prisha Shah
- Lived Experience Working Group, University College London, London, UK
| | - Karen Machin
- Lived Experience Working Group, University College London, London, UK
| | - Stephen Jeffreys
- Lived Experience Working Group, University College London, London, UK
| | - Lizzie Mitchell
- Lived Experience Working Group, University College London, London, UK
| | - Chris Lynch
- Lived Experience Working Group, University College London, London, UK
| | - Una Foye
- National Institute of Health and Care Research Mental Health Policy Research Unit, King's College London, London, UK
| | - Merle Schlief
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Rebecca Appleton
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Katherine R K Saunders
- National Institute of Health and Care Research Mental Health Policy Research Unit, King's College London, London, UK
| | - Helen Baldwin
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sophie M Allan
- Cambridgeshire and Peterborough National Health Service Foundation Trust, South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Luke Sheridan-Rains
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | | | - Ariana Kular
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Peter Goldblatt
- Institute of Health Equity, University College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, London, UK
| | | | - Brynmor Lloyd-Evans
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sonia Johnson
- National Institute of Health and Care Research Mental Health Policy Research Unit, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, London, UK
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14
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Sowa NA, Zeng X. A Comprehensive Examination of Pediatric Behavioral Health Service Demand and Utilization in a Large, Academic Health System from 2019 to 2021. Psychiatr Q 2023:10.1007/s11126-023-10030-1. [PMID: 37219750 DOI: 10.1007/s11126-023-10030-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
Studies of the effects of COVID-19 on youth suggest a worsening in mental health globally. We performed a retrospective analysis of data from January 2019-November 2021 for all outpatient referrals, as well as outpatient, inpatient, and emergency department (ED) encounters for behavioral health (BH) reasons in children aged < 18 in a large academic health system in the United States. Mean weekly rates of outpatient psychiatry referrals, outpatient psychiatry visits, ED visits, and inpatient admissions for BH reasons were compared between pre-pandemic and pandemic periods. The average weekly rate of ambulatory referrals (8.0 ± 0.33 to 9.4 ± 0.31) and completed appointments (194.2 ± 0.72 to 213.1 ± 0.71) significantly increased during the pandemic, driven largely by teenagers. The weekly average of ED pediatric encounters for BH did not increase during the pandemic, although the percentage of all pediatric ED encounters that were for BH did increase from 2.6 to 4.1% (p < 0.001). Length of stay for pediatric BH ED patients increased from 1.59 ± 0.09 days pre-pandemic to 1.91 ± 0.11 days post-pandemic (p < 0.0001). Inpatient admissions for BH reasons overall decreased during the pandemic, due to a decrease in inpatient psychiatric bed capacity. However, the weekly percentage of inpatient hospitalizations for BH reasons that occurred on medical units increased during the pandemic (15.2% ± 2.8-24.6% ± 4.1% (p = 0.0006)). Taken together, our data suggest the COVID-19 pandemic had varying degrees of impact, depending on the setting of care.
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Affiliation(s)
- Nathaniel A Sowa
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA.
| | - Xiaoming Zeng
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA
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15
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Yeh CC, Lee YT, Chien CY, Chen PC, Chen JH, Liu CH. Factors Affecting Self-Harm- or Violence-Related Urgent Psychiatric Consultation During the COVID-19 Pandemic in Taiwan. Psychol Res Behav Manag 2023; 16:1755-1762. [PMID: 37187781 PMCID: PMC10178994 DOI: 10.2147/prbm.s399242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Purpose People's health-care-seeking behaviors considerably changed during the COVID-19 pandemic. This study evaluated the changes in self-harm- and violence-related urgent psychiatric consultation (UPC) in the emergency department (ED) during different stages of the pandemic and at different levels of hospitals. Patients and Methods We recruited patients who received UPC during the baseline (2019), peak (2020), and slack (2021) periods of the same time window (calendar weeks 4-18) during the COVID-19 pandemic. Demographic data such as age, sex, and referral type (by the police/emergency medical system) were also recorded. Results We found female gender and younger age associated with higher risk of self-harm-related UPCs, whereas patients visiting regional hospitals, male patients, and patients referred by the policy/emergency medical system, had a higher risk of violence-related UPCs. After adjustment, the different pandemic stages were not significantly associated with self-harm- or violence-related UPCs. Conclusion Patient's demographic data, but not the pandemic itself, may be responsible for the changes in self-harm- and violence-related UPCs during the pandemic.
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Affiliation(s)
- Chung-Chen Yeh
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Tung Lee
- Department of Psychiatry, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Cheng-Yu Chien
- Graduate Institute of Management, Chang Gung University, Taoyuan City, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Hsinchu County, Taiwan
| | - Po-Cheng Chen
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Jian-Hong Chen
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung City, Taiwan
- National Taiwan Sport University, Taoyuan City, Taiwan
| | - Chun-Hao Liu
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Child & Adolescent Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
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16
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Băcilă C, Ștef L, Bucuță M, Anghel CE, Neamțu B, Boicean A, Mohor C, Ștețiu AA, Roman M. The Impact of the COVID-19 Pandemic on the Management of Mental Health Services for Hospitalized Patients in Sibiu County-Central Region, Romania. Healthcare (Basel) 2023; 11:healthcare11091291. [PMID: 37174833 PMCID: PMC10178149 DOI: 10.3390/healthcare11091291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
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.
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Affiliation(s)
- Ciprian Băcilă
- Dental and Nursing Medical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
- Collective of Scientific Research in Neurosciences of the Clinical Psychiatry Hospital "Dr. Gheorghe Preda", 550082 Sibiu, Romania
| | - Laura Ștef
- Dental and Nursing Medical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Mihaela Bucuță
- Department of Psychology, Faculty of Social and Human Sciences, "Lucian Blaga" University of Sibiu, 550024 Sibiu, Romania
| | - Claudia Elena Anghel
- Dental and Nursing Medical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
- Collective of Scientific Research in Neurosciences of the Clinical Psychiatry Hospital "Dr. Gheorghe Preda", 550082 Sibiu, Romania
| | - Bogdan Neamțu
- Clinical Medical Department, Faculty of Medicine, The "Lucian Blaga" University Sibiu, 550169 Sibiu, Romania
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania
| | - Adrian Boicean
- Clinical Medical Department, Faculty of Medicine, The "Lucian Blaga" University Sibiu, 550169 Sibiu, Romania
| | - Cosmin Mohor
- Preclinical Department, Faculty of Medicine, The "Lucian Blaga" University Sibiu, 550169 Sibiu, Romania
| | - Andreea Angela Ștețiu
- Dental and Nursing Medical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Mihai Roman
- Clinical Department of Surgery, Faculty of Medicine, The "Lucian Blaga" University Sibiu, 550169 Sibiu, Romania
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17
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Guil Sànchez J. [Suicide attempt before and during the COVID-19 pandemic: A comparative study from the emergency department]. Semergen 2023; 49:101922. [PMID: 36807986 PMCID: PMC9816082 DOI: 10.1016/j.semerg.2023.101922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To study the prevalence and characteristics of the patients who consulted in the emergency department for attempted suicide in 2021 and to compare them with those carried out in the pre-Covid period in 2019. METHODS Retrospective cross-sectional study between January 1 and December 31, 2019 and 2021. Demographic, clinical variables (history, psychiatric medication, toxic abuse, mental health follow-up, and previous suicide attempt) and characteristics of the current suicide episode (mechanism, triggering reason, and patient destination) were included. RESULTS They consulted 125 patients in 2019 and 173 in 2021, mean age 38.8±15.2 and 37.9±18.5 years, women 56.8% and 67.6%. They presented: previous suicide attempt, men 20.4% and 19.6%, women 40.8% and 31.6%; substance use disorder, men 51.8% and 46.4%, women 39.4% and 17.1%, due to alcohol, men 78.6% and 88.5%, women 82.1% and 70%. Characteristics of the autolytic episode: pharmacological cause, 68.8% in 2019, 70.5% in 2021, benzodiazepines (81.3% and 70.2%); toxic (30.4% and 16.8%), alcohol (78.9% and 86.2%), medication more associated with alcohol (benzodiazepines, 56.2% and 59.1%); self-harm (11.2% and 8.7%). Destination of the patients: outpatient psychiatric follow-up (84% and 71.7%), hospital admission (8.8% and 11%). CONCLUSIONS There was an increase in consultations of 38.4%, the majority were women, who also presented a higher prevalence of previous suicide attempt; men presented more substance use disorder. The most frequent autolytic mechanism was drugs, especially benzodiazepines. The most used toxicant was alcohol, most of the time associated with benzodiazepines. Upon discharge, most patients were referred to the mental health unit.
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Affiliation(s)
- J Guil Sànchez
- Servicio de Urgencias, Hospital Universitario de Mollet, Fundació Sanitària de Mollet, Mollet (Barcelona), España.
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18
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Beghi M, Alamia A, Alippi M, Colombo RA, Fraticelli C. Psychiatric ward admissions during the COVID-19 pandemic in Canton of Ticino (Swiss Confederation) and the province of Como (Italy): a comparison between two different systems of care and outbreak response strategies. EMERGENCY CARE JOURNAL 2023. [DOI: 10.4081/ecj.2023.11000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
The aim of the study was to estimate the effect of the COVID- 19 pandemic and response policies on the psychiatric ward admissions in the hospitals referring to the ASST Lariana (province of Como, Italy) and the Hospital of Mendrisio (Canton of Ticino, Switzerland), two similar territories that belong to countries that dealt differently with the pandemic. We compared the two territories for type of admission (voluntary vs. compulsory), the Stringency Index (SI) and the country’s number of admission in Intensive Care Units (ICU). We found a significant reduction in the psychiatric ward admission in the lockdown period in both territories, even in periods with milder lockdown measures. The admission rate’s reduction in the ASST Lariana was significantly associated with the ICU admissions (p<0.001). In the Hospital of Mendrisio, admissions included a weekly seasonality, were significantly correlated with SI (p=0.001) and period (pre-pandemic and pandemic; p<0.001) and we observed also a significant reduction of compulsory admission that is influenced both by the stringency index (p<0.001) and period (p<0.001). The differences between the two territories seem influenced by the different mental health systems.
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Barlattani T, D'Amelio C, Capelli F, Mantenuto S, Rossi R, Socci V, Stratta P, Di Stefano R, Rossi A, Pacitti F. Suicide and COVID-19: a rapid scoping review. Ann Gen Psychiatry 2023; 22:10. [PMID: 36932453 PMCID: PMC10020759 DOI: 10.1186/s12991-023-00441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
There is considerable interest in exploring effects of coronavirus disease 2019 (COVID-19) pandemic on mental health. Suicide is one of the leading causes of mortality worldwide and changes in daily life brought by the pandemic may be additional risk factors in people with pre-existing mental disorders. This rapid PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between COVID-19 pandemic outbreak, along with COVID-19 disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, and suicide in individuals with previously diagnosed mental disorders. First, we conducted a comprehensive review of the literature, then proceeded to discuss findings in a narrative way. Tables were constructed and articles sorted according to the studies' methodologies. 53 papers were eventually identified as eligible, among which 33 are cross-sectional studies, 9 are longitudinal studies, and 11 studies using other methodologies. Despite suffering from a mental disorder is a risk factor for suicidal behavior per se, the advent of COVID-19 pandemic may exacerbate this relation. Nevertheless, data addressing a clear correlation between suicidal behavior and the pandemic outbreak are still controversial. Longitudinal analysis using validated suicide scales and multicenter studies could provide deeper insight and knowledge about this topic.
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Affiliation(s)
- Tommaso Barlattani
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy.
| | - Chiara D'Amelio
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Francesco Capelli
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Simonetta Mantenuto
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | - Valentina Socci
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Paolo Stratta
- Department of Mental Health Sulmona-Avezzano-L'Aquila, ASL 1, Abruzzo, Italy
| | - Ramona Di Stefano
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
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20
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Hjorthøj C, Madsen T. Mental health and the covid-19 pandemic. BMJ 2023; 380:435. [PMID: 36889801 DOI: 10.1136/bmj.p435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health-CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Trine Madsen
- Copenhagen Research Centre for Mental Health-CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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21
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de Diego Ruiz H, García LS, Rodríguez Girón M, Carpintero BL, Morán TV, Cabeza IG. Psychiatric Admissions in a Large Hospital in Madrid during COVID-19 Lockdown: Was There a Change in Patient Profile? ACTAS ESPANOLAS DE PSIQUIATRIA 2023; 51:76-83. [PMID: 37218102 PMCID: PMC10803839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 05/24/2023]
Abstract
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.
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Affiliation(s)
- Héctor de Diego Ruiz
- Department of Psychiatry and Mental Health. Hospital Universitario Infanta Leonor
| | - Laura Santos García
- Institute of Psychiatry and Mental Health. Hospital General Universitario Gregorio Marañón
| | - Martín Rodríguez Girón
- Institute of Psychiatry and Mental Health. Hospital General Universitario Gregorio Marañón
| | | | - Teresa Velasco Morán
- Institute of Psychiatry and Mental Health. Hospital General Universitario Gregorio Marañón
| | - Ignacio García Cabeza
- Institute of Psychiatry and Mental Health. Hospital General Universitario Gregorio Marañón. Professor at the Complutense University of Madrid
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22
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Danielsen S, Joensen A, Andersen PK, Madsen T, Strandberg-Larsen K. Self-injury, suicidality and eating disorder symptoms in young adults following COVID-19 lockdowns in Denmark. Nat Hum Behav 2023; 7:411-419. [PMID: 36658210 DOI: 10.1038/s41562-022-01511-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/07/2022] [Indexed: 01/21/2023]
Abstract
An aggravation in mental health during the COVID-19 lockdown has been suggested but the impact on self-injury, suicidality and eating disorders (EDs) are less elucidated. Using linear regression in different data set-ups that is longitudinal (n = 7,579) and repeated cross-sectional data (n = 24,625) from the Danish National Birth Cohort, we compared self-reported self-injury, suicidality and symptoms of EDs from before through different pandemic periods until spring 2021. The longitudinal data indicate a reduction in the proportion of self-injury in men (-3.2% points, 95% confidence interval (CI) = -4.3%; -2.2%, P < 0.001, d.f. = 2) and women (5.7% points, 95% CI = -6.6%; -4.8%, P < 0.001, d.f. = 2) and of suicide ideation in men (-3.0% points, 95% CI = -4.6%; -1.4%, P = 0.002, d.f. = 2) and women (-7.4% points, 95% CI = -8.7%; -6.0%, P < 0.001, d.f. = 2), as well as symptoms of EDs in women (-2.3% points, 95% CI = -3.2%; -1.4%, P < 0.001, d.f. = 2). For suicide attempt, indication of an increase was observed in men only (0.4% points, 95% CI = 0.1%; 0.7%, P = 0.019, d.f. = 2). In the repeated cross-sectional data, we observed no changes in any of the outcomes. Our findings provide no support for the increase in self-injury, suicidality and symptoms of EDs after the lockdowns. Key limitations are differential attrition and varying age in pre- and post-lockdown measures in the longitudinal data.
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Affiliation(s)
- Stine Danielsen
- Danish Research Institute for Suicide Prevention, Mental Health Center Copenhagen, Copenhagen, Denmark.
| | - Andrea Joensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per K Andersen
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Center Copenhagen, Copenhagen, Denmark
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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23
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Gyllenberg D, Bastola K, Wan Mohd Yunus WMA, Mishina K, Liukko E, Kääriälä A, Sourander A. Comparison of new psychiatric diagnoses among Finnish children and adolescents before and during the COVID-19 pandemic: A nationwide register-based study. PLoS Med 2023; 20:e1004072. [PMID: 36848384 PMCID: PMC10089356 DOI: 10.1371/journal.pmed.1004072] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/11/2023] [Accepted: 07/11/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) restrictions decreased the use of specialist psychiatric services for children and adolescents in spring 2020. However, little is known about the pattern once restrictions eased. We compared new psychiatric diagnoses by specialist services during pandemic and pre-pandemic periods. METHODS AND FINDINGS This national register study focused on all Finnish residents aged 0 to 17 years from January 2017 to September 2021 (approximately 1 million a year). The outcomes were new monthly diagnoses for psychiatric or neurodevelopmental disorders in specialist services. These were analyzed by sex, age, home location, and diagnostic groups. The numbers of new diagnoses from March 2020 were compared to predictive models based on previous years. The predicted and observed levels in March to May 2020 showed no significant differences, but the overall difference was 18.5% (95% confidence interval 12.0 to 25.9) higher than predicted in June 2020 to September 2021, with 3,821 more patients diagnosed than anticipated. During this period, the largest increases were among females (33.4%, 23.4 to 45.2), adolescents (34.4%, 25.0 to 45.3), and those living in areas with the highest COVID-19 morbidity (29.9%, 21.2 to 39.8). The largest increases by diagnostic groups were found for eating disorders (27.4%, 8.0 to 55.3), depression and anxiety (21.0%, 12.1 to 51.9), and neurodevelopmental disorders (9.6%, 3.0 to 17.0), but psychotic and bipolar disorders and conduct and oppositional disorders showed no significant differences and self-harm (-28.6, -41.5 to -8.2) and substance use disorders (-15.5, -26.4 to -0.7) decreased in this period. The main limitation is that data from specialist services do not allow to draw conclusions about those not seeking help. CONCLUSIONS Following the first pandemic phase, new psychiatric diagnoses in children and adolescents increased by nearly a fifth in Finnish specialist services. Possible explanations to our findings include changes in help-seeking, referrals and psychiatric problems, and delayed service access.
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Affiliation(s)
- David Gyllenberg
- Department of Child Psychiatry and INVEST Research Flagship Center, University of Turku and Turku University Hospital, Turku, Finland
- Finnish Institute of Health and Welfare, Helsinki, Finland
- Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- * E-mail:
| | - Kalpana Bastola
- Department of Child Psychiatry and INVEST Research Flagship Center, University of Turku and Turku University Hospital, Turku, Finland
- Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Wan Mohd Azam Wan Mohd Yunus
- Department of Child Psychiatry and INVEST Research Flagship Center, University of Turku and Turku University Hospital, Turku, Finland
- Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Malaysia
| | - Kaisa Mishina
- Department of Child Psychiatry and INVEST Research Flagship Center, University of Turku and Turku University Hospital, Turku, Finland
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Emmi Liukko
- Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Antti Kääriälä
- Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Andre Sourander
- Department of Child Psychiatry and INVEST Research Flagship Center, University of Turku and Turku University Hospital, Turku, Finland
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Peraire M, Guinot C, Villar M, Benito A, Echeverria I, Haro G. Profile changes in admissions to a psychiatric hospitalisation unit over 15 years (2006-2021), considering the impact of the pandemic caused by SARS-CoV-2. Psychiatry Res 2023; 320:115003. [PMID: 36571896 PMCID: PMC9759458 DOI: 10.1016/j.psychres.2022.115003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
The objective of this current work was to explore whether modification of the diagnostic criteria upon the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the impact of the COVID-19 pandemic had influenced the diagnostic and sociodemographic profiles of mental health admissions. For that purpose, we designed an observational, longitudinal, and retrospective study of the data recorded in the discharge reports of the Brief Hospitalization Unit at Castellon (Spain), between January 2006 and December 2021. The sample consisted of 7,037 participants, with a mean age of 42.1 years. The mean age of admissions, number of women, and presentation of affective disorders, addictions, and dementias all increased significantly during the DSM-5 period. Beyond diagnoses, the reduction in readmissions before the pandemic could be attributed to the use of long-acting injectable antipsychotics. In contrast, the pandemic did not change the percentage of readmissions or the volume of admissions. Also, during the pandemic period, the significant results obtained indicate that the average stay was reduced, affective disorders decreased, and addictions increased. Therefore, clinicians should consider these diagnostic and sociodemographic fluctuations when adapting clinical care, taking into account gender perspective, ageing of patients and increasing of dual and affective disorders.
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Affiliation(s)
- M Peraire
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, Spain; Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, Spain.
| | - C Guinot
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, Spain
| | - M Villar
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, Spain
| | - A Benito
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, Spain; Torrent Mental Health Unit, Spain
| | - I Echeverria
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, Spain; Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, Spain
| | - G Haro
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, Spain; Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, Spain
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Warwicker S, Sant D, Richard A, Cutajar J, Bellizzi A, Micallef G, Refalo D, Camilleri L, Grech A. A Retrospective Longitudinal Analysis of Mental Health Admissions: Measuring the Fallout of the Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1194. [PMID: 36673950 PMCID: PMC9858631 DOI: 10.3390/ijerph20021194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND In this research article, we review the infrequently considered long-term impact of the pandemic on inpatient mental health, by reviewing the clinical parameters of all psychiatric admissions to Mount Carmel Hospital, our region's main psychiatric healthcare facility, from 2019-2021. METHODS 4292 patients were admitted during the research period of this retrospective longitudinal analysis. Taking 2019 as the pre-COVID reference year, we compared mean monthly admissions from 2020 and 2021, looking at patient demographics, status under the Mental Health Act, diagnosis, and self-injurious behaviour. RESULTS While the pandemic was reflected in a moderate increase in mean monthly presentations with suicidal ideation and suicidal self-injury, presentations in 2020 otherwise remained largely stable. This contrasted with a surge in presentations in 2021 with mood disorders, schizophrenia, anxiety, personality disorders, and autism spectrum disorders. Furthermore, presentations involving self-injurious behaviour continued to grow. Involuntary admissions also increased significantly in 2021. CONCLUSIONS This paper highlights the pernicious long-term impact of the pandemic on mental health presentations, demonstrated by an increase in hospital admissions and more serious presentations. These findings should be considered in the guidance for responses to any future pandemic, giving attention to the evidence of the impact of restrictive measures on mental health.
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Affiliation(s)
| | | | | | | | | | | | - Daniel Refalo
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
| | - Liberato Camilleri
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
| | - Anton Grech
- Mount Carmel Hospital, ATD 9033 H’Attard, Malta
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
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Zandy M, El Kurdi S, Samji H, McKee G, Gustafson R, Smolina K. Mental health-related healthcare service utilisation and psychotropic drug dispensation trends in British Columbia during COVID-19 pandemic: a population-based study. Gen Psychiatr 2023; 36:e100941. [PMID: 36875149 PMCID: PMC9971830 DOI: 10.1136/gpsych-2022-100941] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/28/2023] [Indexed: 03/02/2023] Open
Abstract
Background The impact of the COVID-19 pandemic on the population's mental health is vital for informing public health policy and decision-making. However, information on mental health-related healthcare service utilisation trends beyond the first year of the pandemic is limited. Aims We examined mental health-related healthcare service utilisation patterns and psychotropic drug dispensations in British Columbia, Canada, during the COVID-19 pandemic compared with the prepandemic period. Methods We conducted a retrospective population-based secondary analysis using administrative health data to capture outpatient physician visits, emergency department visits, hospital admissions and psychotropic drug dispensations. We examined time trends of mental health-related healthcare service utilisation and psychotropic drug dispensations between January to December 2019 (prepandemic period) and January 2020 to December 2021 (pandemic period). In addition, we calculated age-standardised rates and rate ratios to compare mental health-related healthcare service utilisation before and during the first two years of the COVID-19 pandemic, stratified by year, sex, age and condition. Results By late 2020, except for emergency department visits, utilisation of healthcare services recovered to prepandemic levels. Between 2019 and 2021, the monthly average rate for overall mental health-related outpatient physician visits, emergency department visits and psychotropic drug dispensations increased significantly by 24%, 5% and 8%, respectively. Notable and statistically significant increases were observed among 10-14 year-olds (44% in outpatient physician visits, 30% in emergency department visits, 55% in hospital admissions and 35% in psychotropic drug dispensations) and 15-19 year-olds (45% in outpatient physician visits, 14% in emergency department visits, 18% in hospital admissions and 34% in psychotropic drug dispensations). Additionally, these increases were more prominent among females than males, with some variation for specific mental health-related conditions. Conclusions The increase in mental health-related healthcare service utilisation and psychotropic drug dispensations during the pandemic likely reflects significant societal consequences of both the pandemic and pandemic management measures. Recovery efforts in British Columbia should consider these findings, especially among the most affected subpopulations, such as adolescents.
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Affiliation(s)
- Moe Zandy
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Sylvia El Kurdi
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hasina Samji
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Geoff McKee
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Reka Gustafson
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Kate Smolina
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
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Muacevic A, Adler JR, Alblady E, Ahmad R. Comparison of Psychiatric Service Utilization Prior, During, and After COVID-19 Lockdown: A Retrospective Cohort Study. Cureus 2022; 14:e33099. [PMID: 36721564 PMCID: PMC9884139 DOI: 10.7759/cureus.33099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Background COVID-19 pandemic represents a significant risk factor for developing, relapsing, or exacerbating pre-existing mental health conditions. This negative impact on mental health results in increasing demand for psychiatric services. This study aimed to explore the effects of COVID-19 pandemic lockdown on the utilization of mental health services in three periods - prior, during, and after the lockdown - compared to the matched weeks in the previous years 2018 and 2019. Materials and Method In this retrospective cohort, quantitative, single-center study, data were collected from electronic medical records, including all patients with referrals\consultations to the psychiatric section prior, during, and after COVID-19 lockdown. Results In total, 2,454 patients were either referred to psychiatric outpatient clinics or needed consultation as inpatients during the study periods. Only 2,326 patients were included in our study. The total number of inpatient consultations was 1,410, with a statistically significant increase during the lockdown (p-value<0.001) and post-lockdown (p<0.016) in comparison to previous years. A significant reduction in outpatient referrals was observed during the lockdown (p=0.005) and post-lockdown period. Psychiatric disorders were identified in most patients (N=1,599), representing 65%, 54%, and 74% of patients in pre-lockdown, lockdown, and post-lockdown periods compared to 71%, 71%, and 76%, respectively, in the previous years. A total of 821 patients manifested symptoms of depression, constituting the largest proportion among all reasons for referral\consultations. The number of patients referred for substance/alcohol use disorders during the lockdown increased compared to patients in the same period in 2019. Suicidal behavior was identified in 70 patients across all study periods, with the lowest number observed in 2020. Conclusion Our findings indicate that during the COVID-19 lockdown, a significant increase in inpatient psychiatric services utilization was observed. Outpatient psychiatric service utilizations were significantly reduced. Implementation of evidence-based policy and protocol to guide mental health challenges in future health emergencies is needed.
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28
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Bersia M, Koumantakis E, Berchialla P, Charrier L, Ricotti A, Grimaldi P, Dalmasso P, Comoretto RI. Suicide spectrum among young people during the COVID-19 pandemic: A systematic review and meta-analysis. EClinicalMedicine 2022; 54:101705. [PMID: 36338787 PMCID: PMC9621691 DOI: 10.1016/j.eclinm.2022.101705] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background There are concerns that suicidal behaviors are arising among adolescents. The COVID-19 pandemic could have worsened the picture, however, studies on this topic reported contrasting results. This work aimed to summarise findings from the worldwide emerging literature on the rates of suicidality among young people during the COVID-19 pandemic. Methods A systematic review and meta-analysis were performed, searching five electronic databases for studies published from January 1, 2020 until July 27, 2022. Studies reporting rates for each of the three considered outcomes (suicide, suicidal behaviors, and suicidal ideation) among young people under 19 years old during the COVID-19 pandemic were included. Random-effects meta-analyses were conducted, and the intra-study risk of bias was assessed. When pre-COVID-19 data were available, incidence rate ratio (IRR) and prevalence ratio (PR) estimates were calculated between the two periods. All the analyses were performed according to the setting explored: general population, emergency department (ED), and psychiatric services. The review protocol was registered on PROSPERO (CRD42022308014). Findings Forty-seven observational studies were selected for more than 65 million subjects. The results of the meta-analysis showed a pooled annual incidence rate of suicides of 4.9 cases/100,000 during 2020, accounting for a non-statistically significant increase of 10% compared to 2019 (IRR 1.10, 95% CI: 0.94-1.29). The suicidal behaviors pooled prevalence during the COVID-19 pandemic was higher in the psychiatric setting (25%; 95% CI: 17-36%) than in the general population (3%; 1-13%) and ED (1%; 0-9%). The pooled rate of suicidal ideation was 17% in the general population (11-25%), 36% in psychiatric setting (20-56%) and 2% in ED (0-12%). The heterogeneity level was over 97% for both outcomes in all settings considered. The comparison between before and during COVID-19 periods highlighted a non-statistically significant upward trend in suicidal behaviors among the general population and in ED setting. The only significant increase was found for suicidal ideation in psychiatric setting among studies conducted in 2021 (PR 1.15; 95% CI: 1.04-1.27), not observed exploring 2020 alone. Interpretation During the pandemic, suicide spectrum issues seemed to follow the known pattern described in previous studies, with higher rates of suicidal ideation than of suicidal behaviors and suicide events. Governments and other stakeholders should be mindful that youth may have unique risks at the outset of large disasters like the COVID-19 pandemic and proactive steps are necessary to address the needs of youth to mitigate those risks. Funding The present study was funded by the University of Torino (CHAL_RILO_21_01).
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Affiliation(s)
- Michela Bersia
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Torino, Italy
| | - Emanuele Koumantakis
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Torino, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 43, 10043, Orbassano, Italy
| | - Lorena Charrier
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Torino, Italy
| | - Andrea Ricotti
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Torino, Italy
| | - Piercesare Grimaldi
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Torino, Italy
| | - Paola Dalmasso
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Torino, Italy
| | - Rosanna I. Comoretto
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Torino, Italy
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He J, Ning P, Schwebel DC, Yang Y, Li L, Cheng P, Rao Z, Hu G. Injury mortality and morbidity changes due to the COVID-19 pandemic in the United States. Front Public Health 2022; 10:1001567. [PMID: 36408028 PMCID: PMC9666887 DOI: 10.3389/fpubh.2022.1001567] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction The COVID-19 pandemic significantly changed society. We aimed to examine the systematic impact of the COVID-19 on injury burden in the United States. Methods We extracted mortality and morbidity data from CDC WONDER and WISQARS. We estimated age-standardized injury mortality rate ratio and morbidity rate ratio (MtRR and MbRR) with 95% confidence interval (95% CI) for all injuries, all unintentional injuries, homicide/assault by all methods, suicide/self-harm by all methods, as well as other 11 specific unintentional or intentional injury categories. Injury rate ratios were compared for 2020 vs. 2019 to those of 2019 vs. 2018 to demonstrate the influence of the COVID-19 pandemic on fatal and nonfatal injury burden. The ratio of MtRRs (RMtRR) and the ratio of MbRRs (RMbRR) with 95% CI between 2020 vs. 2019 and 2019 vs. 2018 were calculated separately. Results The COVID-19 pandemic was associated with an increase in injury mortality (RMtRR = 1.12, 95% CI: 1.11, 1.13) but injury morbidity decreased (RMbRR = 0.88, 95% CI: 0.88, 0.89) when the changes of these rates from 2019 to 2020 were compared to those from 2018 to 2019. Mortality disparities between the two time periods were primarily driven by greater mortality during the COVID-influenced 2020 vs. 2019 from road traffic crashes (particularly motorcyclist mortality), drug poisoning, and homicide by firearm. Similar patterns were not present from 2019 vs. 2018. There were morbidity reductions from road traffic crashes (particularly occupant and pedestrian morbidity from motor vehicle crashes), unintentional falls, and self-harm by suffocation from 2019 to 2020 compared to the previous period. Change patterns in sexes and age groups were generally similar, but exceptions were observed for some injury types. Conclusions The COVID-19 pandemic significantly changed specific injury burden in the United States. Some discrepancies also existed across sex and age groups, meriting attention of injury researchers and policymakers to tailor injury prevention strategies to particular populations and the environmental contexts citizens face.
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Affiliation(s)
- Jieyi He
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - David C. Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yang Yang
- Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States
| | - Li Li
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Peixia Cheng
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhenzhen Rao
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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30
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Changes in psychiatric services dynamics during the COVID-19 pandemic: Recognizing the need for resources shift. Psychiatry Res 2022; 317:114778. [PMID: 36029568 PMCID: PMC9364920 DOI: 10.1016/j.psychres.2022.114778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/20/2022]
Abstract
With the significant impact of COVID-19 pandemic on the health, and the functioning of health care system, it has become increasingly important to understand changes in the ways health services were utilized and the factors influencing it. Drop in psychiatric admissions was seen during the pandemic, but also an increase in acute hospitalizations and emergency visits. Our aim was to analyze changes in out- and in-patient services utilization in the largest Croatian psychiatric institution during the first year of the pandemic, observed through the lens of the stringency index, and compare it to the pre-pandemic year. Along with an overall drop in hospitalizations, but a unit-specific rise in hospitalization, we have observed a non-significant overall drop in regular outpatient visits, and a significant drop coinciding with strictest epidemiological measures. There was also a significant increase in emergency visits coinciding with epidemiological measures that failed to return to pre-pandemic values, pointing to an expected significant and prolonged burden on emergency services. Simultaneous analysis of changing dynamics of mental health care service utilization during the pandemic helps us identify specific points of increased burden, and help us plan for early and flexible resources shift in order to adequately respond to evolving challenges.
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How COVID-19 shaped mental health: from infection to pandemic effects. Nat Med 2022; 28:2027-2037. [PMID: 36192553 PMCID: PMC9711928 DOI: 10.1038/s41591-022-02028-2] [Citation(s) in RCA: 134] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has threatened global mental health, both indirectly via disruptive societal changes and directly via neuropsychiatric sequelae after SARS-CoV-2 infection. Despite a small increase in self-reported mental health problems, this has (so far) not translated into objectively measurable increased rates of mental disorders, self-harm or suicide rates at the population level. This could suggest effective resilience and adaptation, but there is substantial heterogeneity among subgroups, and time-lag effects may also exist. With regard to COVID-19 itself, both acute and post-acute neuropsychiatric sequelae have become apparent, with high prevalence of fatigue, cognitive impairments and anxiety and depressive symptoms, even months after infection. To understand how COVID-19 continues to shape mental health in the longer term, fine-grained, well-controlled longitudinal data at the (neuro)biological, individual and societal levels remain essential. For future pandemics, policymakers and clinicians should prioritize mental health from the outset to identify and protect those at risk and promote long-term resilience.
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Kippe YD, Adam M, Finck A, Moran JK, Schouler-Ocak M, Bermpohl F, Gutwinski S, Goldschmidt T. Suicidality in psychiatric emergency department situations during the first and the second wave of COVID-19 pandemic. Eur Arch Psychiatry Clin Neurosci 2022; 273:311-323. [PMID: 36071277 PMCID: PMC9451117 DOI: 10.1007/s00406-022-01486-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022]
Abstract
Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020-5/24/2020 "first-wave") and second (9/15/2020-3/1/2021 "second-wave") wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.
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Affiliation(s)
- Yann David Kippe
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Maia Adam
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Anna Finck
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - James Kenneth Moran
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Meryam Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Felix Bermpohl
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Stefan Gutwinski
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Thomas Goldschmidt
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany.
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Bernstorff M, Hansen L, Perfalk E, Danielsen AA, Østergaard SD. Stability of diagnostic coding of psychiatric outpatient visits across the transition from the second to the third version of the Danish National Patient Registry. Acta Psychiatr Scand 2022; 146:272-283. [PMID: 35730386 PMCID: PMC9543445 DOI: 10.1111/acps.13463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In Denmark, data on hospital contacts are reported to the Danish National Patient Registry (DNPR). The ICD-10 main diagnoses from the DNPR are often used as proxies for mental disorders in psychiatric research. With the transition from the second version of the DNPR (DNPR2) to the third (DNPR3) in February-March 2019, the way main diagnoses are coded in relation to outpatient treatment changed substantially. Specifically, in the DNPR2, each outpatient treatment course was labelled with only one main diagnosis. In the DNPR3, however, each visit during an outpatient treatment course is labelled with a main diagnosis. We assessed whether this change led to a break in the diagnostic time-series represented by the DNPR, which would pose a threat to the research relying on this source. METHODS All main diagnoses from outpatients attending the Psychiatric Services of the Central Denmark Region from 2013 to 2021 (n = 100,501 unique patients) were included in the analyses. The stability of the DNPR diagnostic time-series at the ICD-10 subchapter level was examined by comparing means across the transition from the DNPR2 to the DNPR3. RESULTS While the proportion of psychiatric outpatients with diagnoses from some ICD-10 subchapters changed statistically significantly from the DNPR2 to the DNPR3, the changes were small in absolute terms (e.g., +0.6% for F2-psychotic disorders and +0.6% for F3-mood disorders). CONCLUSION The change from the DNPR2 to the DNPR3 is unlikely to pose a substantial threat to the validity of most psychiatric research at the diagnostic subchapter level.
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Affiliation(s)
- Martin Bernstorff
- Department of Affective DisordersAarhus University Hospital – PsychiatryAarhusDenmark,Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Lasse Hansen
- Department of Affective DisordersAarhus University Hospital – PsychiatryAarhusDenmark,Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Erik Perfalk
- Department of Affective DisordersAarhus University Hospital – PsychiatryAarhusDenmark,Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Andreas Aalkjær Danielsen
- Department of Affective DisordersAarhus University Hospital – PsychiatryAarhusDenmark,Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Søren Dinesen Østergaard
- Department of Affective DisordersAarhus University Hospital – PsychiatryAarhusDenmark,Department of Clinical MedicineAarhus UniversityAarhusDenmark
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Dionisie V, Ciobanu AM, Moisa E, Manea MC, Puiu MG. 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. Healthcare (Basel) 2022; 10:healthcare10081570. [PMID: 36011227 PMCID: PMC9407826 DOI: 10.3390/healthcare10081570] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Vlad Dionisie
- Department of Psychiatry and Psychology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Adela Magdalena Ciobanu
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
- Discipline of Psychiatry, Neurosciences Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Emanuel Moisa
- Department of Anaesthesia and Intensive Care Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihnea Costin Manea
- Department of Psychiatry and Psychology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
- Correspondence: (M.C.M.); (M.G.P.)
| | - Maria Gabriela Puiu
- Department of Psychiatry and Psychology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
- Correspondence: (M.C.M.); (M.G.P.)
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Liu CH, Chen PC, Chen JH, Yeh CC. Changes in self-harm- and violence-related urgent psychiatric consultation in the emergency department during the different stages of the COVID-19 pandemic. BMC Psychiatry 2022; 22:384. [PMID: 35672738 PMCID: PMC9171742 DOI: 10.1186/s12888-022-04029-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 pandemic significantly affected emergency department (ED) visits and urgent psychiatric consultation (UPC) seeking behavior in EDs. Our study explored the changes in UPCs during and after the pandemic peak. METHODS This retrospective observational study evaluated UPCs in the ED of a referral medical center in Taiwan, where treated both physical and psychiatric complaints. We defined the COVID-19 pandemic peak period as calendar week 4-18, 2020. The corresponding baseline as calendar week 4-18, 2019, and the slack period as week 4-18, 2021. The total number of UPCs, patient demographic data such as sex and age of the patients seen, the referral system (whether police or emergency medical service [EMS] or other sources), and the chief complaint (self-harm or violence) were recorded. RESULTS Compared with the baseline period, a significant decline in UPCs was observed in the pandemic peak period, and a rebound was observed in the slack period, with the median [IQR] Q1, Q3 values of 22 [18, 26], 12 [10, 17]), and 16 [15, 23], respectively. We observed significantly few men (34.9% vs 45.2%) and less violence (10.2% vs 17.6%) in the peak period compared with in the baseline period, but no significant difference was found compared with the slack period. Throughout the pandemic, younger patients (41.8 ± 17.4 in 2019, 39.2 ± 18.5 [p = 0.121] in 2020, and 35.6 ± 17.2 [p < 0.001] in 2021), higher proportions of police/EMS referral (38.7% in 2019, 41.9% [p = 0.473] in 2020, and 51.9% [p = 0.001] in 2021) and self-harm-related complaints (57% in 2019, 62.4% [p = 0.233] in 2020, and 64.9% [p = 0.049] in 2021) was noted among UPC seekers during the pandemic. However, the proportion of violence-related UPCs (17.6% in 2019, 10.2% [p = 0.023] in 2020, and 12.3% [p = 0.072] in 2021) declined. CONCLUSIONS This study found that UPCs changed throughout the pandemic. This result raises the concern that mental health needs are masked during the pandemic.
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Affiliation(s)
- Chun-Hao Liu
- Department of Child Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan city, Taiwan.,College of Medicine, Chang Gung University, Taoyuan city, Taiwan
| | - Po-Cheng Chen
- College of Medicine, Chang Gung University, Taoyuan city, Taiwan.,Department of Rehabilitation Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung city, Taiwan
| | - Jian-Hong Chen
- College of Medicine, Chang Gung University, Taoyuan city, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung city, Taiwan.,National Taiwan Sport University, Taoyuan city, Taiwan
| | - Chung-Cheng Yeh
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Keelung, Keelung city, Taiwan.
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Antonazzo IC, Fornari C, Maumus-Robert S, Cei E, Paoletti O, Ferrara P, Conti S, Cortesi PA, Mantovani LG, Gini R, Mazzaglia G. Antidepressants Drug Use during COVID-19 Waves in the Tuscan General Population: An Interrupted Time-Series Analysis. J Pers Med 2022; 12:jpm12020178. [PMID: 35207666 PMCID: PMC8879880 DOI: 10.3390/jpm12020178] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Ippazio Cosimo Antonazzo
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (P.F.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (P.F.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
- Correspondence:
| | - Sandy Maumus-Robert
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, F-33000 Bordeaux, France;
| | - Eleonora Cei
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (P.F.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
| | - Olga Paoletti
- Regional Agency for Healthcare Services of Tuscany, Epidemiology, 50141 Florence, Italy; (O.P.); (R.G.)
| | - Pietro Ferrara
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (P.F.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
- Value-Based Healthcare Unit, IRCCS Multi Medica, 20099 Sesto San Giovanni, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (P.F.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (P.F.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
- Value-Based Healthcare Unit, IRCCS Multi Medica, 20099 Sesto San Giovanni, Italy
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (P.F.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
- Value-Based Healthcare Unit, IRCCS Multi Medica, 20099 Sesto San Giovanni, Italy
| | - Rosa Gini
- Regional Agency for Healthcare Services of Tuscany, Epidemiology, 50141 Florence, Italy; (O.P.); (R.G.)
| | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (P.F.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
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Wiegand HF, Bröcker AL, Fehr M, Lohmann N, Maicher B, Röthke N, Rueb M, Wessels P, de Greck M, Pfennig A, Unterecker S, Tüscher O, Walter H, Falkai P, Lieb K, Hölzel LP, Adorjan K. 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. Front Psychiatry 2022; 13:855040. [PMID: 35573380 PMCID: PMC9091906 DOI: 10.3389/fpsyt.2022.855040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/15/2022] [Indexed: 01/14/2023] Open
Abstract
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.
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Affiliation(s)
- Hauke Felix Wiegand
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Anna-Lena Bröcker
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mandy Fehr
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Niklas Lohmann
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Birgit Maicher
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Nikolaus Röthke
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mike Rueb
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Paula Wessels
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wurzburg, Wurzburg, Germany
| | - Moritz de Greck
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wurzburg, Wurzburg, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lars Peer Hölzel
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Oberberg Parkklinik Schlangenbad, Wiesbaden Schlangenbad, Wiesbaden, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
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Efstathiou V, Stefanou MI, Siafakas N, Makris M, Tsivgoulis G, Zoumpourlis V, Spandidos DA, Smyrnis N, Rizos E. Suicidality and COVID-19: Suicidal ideation, suicidal behaviors and completed suicides amidst the COVID-19 pandemic (Review). Exp Ther Med 2022; 23:107. [PMID: 34976149 PMCID: PMC8674972 DOI: 10.3892/etm.2021.11030] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 12/14/2022] Open
Abstract
Since the outbreak of the coronavirus 2019 (COVID-19) pandemic, there has been widespread concern that social isolation, financial stress, depression, limited or variable access to health care services and other pandemic-related stressors may contribute to an increase in suicidal behaviors. In patients who have recovered from COVID-19, an increased risk of developing suicidal behaviors may be noted, while post-COVID syndrome comprises another potential risk factor contributing to increased suicidal behaviors. Despite the initial alarming predictions for an increase in suicide rates due to the COVID-19 pandemic, the majority of published studies to date suggest that experienced difficulties and distress do not inevitably translate into an increased number of suicide-related deaths, at least not in the short-term. Nevertheless, the long-term mental health effects of the COVID-19 pandemic have yet to be unfolded and are likely to remain for a long period of time. Suicide prevention and measures aiming at promoting well-being and mitigating the effects of COVID-19 on mental health, particularly among vulnerable groups, should thus be a priority for healthcare professionals and policymakers amidst the evolving COVID-19 pandemic.
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Affiliation(s)
- Vasiliki Efstathiou
- Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Maria-Ioanna Stefanou
- Second Department of Neurology, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Nikolaos Siafakas
- Clinical Microbiology Laboratory, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Michael Makris
- Allergy Unit, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Vassilios Zoumpourlis
- Biomedical Applications Unit, Institute of Chemical Biology, National Hellenic Research Foundation (NHRF), Athens 11635, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion 71003, Greece
| | - Nikolaos Smyrnis
- Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece
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