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

Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric department: An interrupted time-series analysis

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.

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

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

Patients with affective disorders profit most from telemedical treatment: Evidence from a naturalistic patient cohort during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic telemedicine became essential in maintaining diagnostic procedures and treatment in psychiatry. However, it is still an open question if telemedicine is a feasible treatment option for all groups of psychiatric patients alike. This prospective monocentric observational trial was conducted to assess the general applicability of telemedical treatment in a naturalistic psychiatric outpatient cohort and to identify groups of disorders and clusters of psychopathology that respond particularly well to telemedical treatment considering sociodemographic characteristics and patients' perspectives.

METHODS

Patients were recruited April 2020-April 2021 and asked to fill out the WHO-5 and the SCL-90R at baseline, after 4-6 and 8-12 weeks and a feedback-survey. Additionally, medical records, psychopathology, psychosocial functioning, and socio-demographic data were analyzed. Primary outcomes were well-being, psychopathology and functioning during treatment. Secondly, diagnostic groups and psychopathology linked to a superior treatment-response were determined with respect to patients' subjective experiences.

RESULTS

Out of 1.385 patients, 254-mostly with hyperkinetic (35.3%) and depressive disorders (24.6%)-took part. Well-being and SCL-90R total scores improved substantially (both p < 0.001). CGI and GAF scores were worse in depressed subjects (both p < 0.05). Improvement was mainly seen in depressed patients; chronic disorders experienced a decline in well-being. Sociodemographic characteristics could not explain this difference. Particularly female (r = 0.413) patients found telepsychiatry equivalent to conventional treatment. The more virtual sessions participants attended the more likely they were to find telepsychiatry equal to conventional treatment (r = 0.231).

CONCLUSION

Telemedicine is an effective treatment for patients with depression under naturalistic conditions. Telemedical consultations are a simple and reliable way of monitoring symptom severity and directing treatment choices during the treatment of depressive disorders. Patients with depression benefited more from telemedical treatment compared to participants with chronic non-episodic psychiatric disorders. Future research needs to concentrate on improving telemedical treatment options suited for the latter conditions. Psychiatric telemedicine yielded overall high degrees of satisfaction among users.