Decline in Hospital Visits by Patients with Schizophrenia Early in the COVID-19 Outbreak in Korea

Trends in Psychiatric Day Care Practices in Japan: An Analysis Using the National Database of Health Insurance Claims Open Data

BACKGROUND

Psychiatric day care is a key framework for outpatient rehabilitation in Japanese psychiatric treatment. It targets a wide range of diseases and performs various roles. The current status and utilization of psychiatric day care in Japan have changed owing to an increase in the availability of other social resources and the coronavirus disease 2019 (COVID-19) pandemic. However, no reports have quantitatively analyzed the trends or current situation of psychiatric day care in Japan. Therefore, this study aimed to analyze the status of the operation of psychiatric day care in Japan and its trends by sex, region, and age group.

METHODS

Based on the publicly available data from the Japanese National Database of Health Insurance Claims and Specific Health Checkups (NDB Open Data), we investigated changes in the numbers related to psychiatric day care nationwide from fiscal year (FY) 2017-2021. Furthermore, we calculated the numbers of psychiatric day care facilities use per 1,000 people by prefecture, sex, and age group in 2021. A Mann-Whitney U test was conducted to compare the total number of psychiatric day care facilities used in months during periods of emergency declarations and priority preventative measures with those used in months when there were no such periods. Pearson's correlation coefficient test was conducted to examine the correlation between the numbers of psychiatric beds per 100,000 people and the annual numbers of psychiatric day care facilities use per 1,000 people in each prefecture. A Mann-Whitney U test was conducted to compare the number per 1,000 people per year of prefectures with or without capital- and government-designated cities and compare the annual total number (FY 2017-2021) by sex.

RESULTS

Overall, the number of psychiatric day care facilities use tended to decrease. The monthly data showed a significant decrease in the total number of psychiatric day care facilities' usage during periods of emergency declarations and priority preventative measures (p=0.02). The numbers of "psychiatric short care" use increased in 2021 and those of psychiatric day-night care (>3 years / >3 days per week) use showed an increasing trend from 2020. The overall number of psychiatric day care facilities' usage per 1,000 people by prefecture was significantly lower in prefectures having cities with populations of 700,000 or more (p<0.01). A significant positive correlation was found between the number of psychiatric day care facilities use per 1,000 people by prefecture and the number of psychiatric beds per 100,000 people by prefecture (r=0.61, p<0.01). The usage of psychiatric day care facilities was significantly lower for women (p<0.01). In terms of age group, the use of psychiatric day care facilities was significantly lower for younger age groups (under 65 years of age) (p<0.01).

CONCLUSIONS

Trends in the numbers reflected differences in user attributes and regional differences. It is necessary to establish a management system tailored to individual attributes and in regions where support is difficult to reach.

COVID-19 coping experiences of individuals with schizophrenia: A grounded theory approach in Korea

Humankind has responded to the profound medical, economic, social, and cultural consequences of coronavirus disease 2019 (COVID-19) by employing various strategies. However, although individuals with mental disorders, including schizophrenia, have suffered more challenges from the infectious disease spread, they have received inadequate attention and care. Hence, this study aimed to explore the experiences of individuals with schizophrenia coping with COVID-19; one-to-one interviews were conducted with 17 individuals diagnosed with schizophrenia in Korea. The data were analysed using grounded theory methodology. The results showed that individuals with schizophrenia became distanced from the routine care they received before COVID-19, faced a dual threat from their mental illness and the emerging infectious disease, and experienced inequity and paradoxical situations. Nevertheless, they strived to live their daily lives by utilizing non-face-to-face access, seeking support from mental health professionals, and devising self-help measures. Moreover, reflecting on their lives throughout the pandemic after returning to their regular daily lives provided an opportunity for healing and growth. This study's results can provide evidence for treating individuals with schizophrenia and other mental disorders during subsequent infectious disease spread. Practical policies and interventions tailored to their vulnerabilities are required.

Infection Anxiety and Coping Strategies Among Individuals With Schizophrenia During the COVID-19 Pandemic: Mediating Effects of Protection Motivation

The current study determined the mediating effects of protection motivation factors (PMFs) on the relationship between infection anxiety and coping strategies among individuals with schizophrenia during the coronavirus disease 2019 (COVID-19) pandemic. Data were collected using a questionnaire administered to 139 individuals with schizophrenia between September and October 2021. Data were analyzed using descriptive statistics, Pearson correlation coefficients, and multiple regression analyses based on the Baron and Kenny criteria. Problem-based coping (PBC) was positively correlated with perceived vulnerability (r = 0.385, p < 0.001) and self-efficacy (r = 0.321, p < 0.001) among the PMFs and with infection anxiety (r = 0.517, p < 0.001); perceived self-efficacy (β = 0.23 p = 0.002) had a partial mediating effect (Z = 1.99, p = 0.047) on the relationship between infection anxiety and PBC, confirming the importance of perceived self-efficacy among individuals with schizophrenia in developing positive coping strategies during the COVID-19 pandemic. Therefore, developing measures that promote perceived self-efficacy and build accurate situational awareness are essential to strengthen such patients' coping strategies during a pandemic. [Journal of Psychosocial Nursing and Mental Health Services, 61(11), 43-51.].

The Impact of COVID-19 on Psychiatric Health in the Korean Population

Coronavirus disease 2019 (COVID-19) has multiple negative impacts on the psychiatric health of both those previously infected and not infected with severe acute respiratory syndrome coronavirus 2. Moreover, the negative impacts of COVID-19 are closely associated with geographical region, culture, medical system, and ethnic background. We summarized the evidence of the impact of COVID-19 on the psychiatric health of the Korean population. This narrative review included thirteen research articles, which investigated the impact of COVID-19 on the psychiatric health of Koreans. COVID-19 survivors were reported to have a 2.4 times greater risk of developing psychiatric disorders compared to members of a control group, and anxiety and stress-related disorders were the most common newly diagnosed psychiatric illnesses. Studies also reported that COVID-19 survivors had a 3.33-fold higher prevalence of insomnia, a 2.72-fold higher prevalence of mild cognitive impairment, and a 3.09-fold higher prevalence of dementia compared to the control group. In addition, more than four studies have highlighted that the medical staff members, including nurses and medical students, exhibit a greater negative psychiatric impact of COVID-19. However, none of the articles investigated the biological pathophysiology or mechanism linking COVID-19 and the risk of diverse psychiatric disorders. Moreover, none of the studies were actual prospective studies. Thus, longitudinal studies are needed to more clearly elucidate the effect of COVID-19 on the psychiatric health of the Korean population. Lastly, studies focusing on preventing and treating COVID-19-associated psychiatric problems are needed to provide a benefit in real clinical settings.

Effect of COVID-19 pandemic on serious mental illness-related outpatient department utilization in Ningbo, China: an interrupted time series analysis

Background

Globally, the coronavirus disease 2019 (COVID-19) pandemic has negatively affected mental health services, but there is no clear evidence of this in China. Therefore, we examined the effect of the COVID-19 pandemic on the use of serious mental illness (SMI)-related outpatient services in Ningbo, China.

Methods

We analyzed the trends in monthly SMI-related outpatient department utilization from January 2018 to June 2022 using interrupted time series (ITS) regression analysis, and we defined the onset of the COVID-19 pandemic as January 2020. We also performed ITS regression analyses for sex and age subgroups.

Results

A significant difference in the monthly number of outpatient visit slopes before and after the onset of the pandemic was shown in the SMI analysis [-175.6, 95% confidence interval (CI) (-338.3 to -12.9), p < 0.05]. All sex and age categories, except the 20-30 years age category, showed statistically significant changes in their slopes after the onset of the pandemic. Significant differences in the number of outpatient visit slopes before and after the onset of the pandemic were seen for schizophrenia and bipolar disorders [-153.3, 95% CI (-294.1 to -12.5) and -16.8 (-31.0 to -2.6), respectively]. Moreover, a negative relationship was observed between the monthly number of outpatient visits and the number of incidents and accidents due to SMI (r = -0.38, p < 0.05).

Conclusion

The COVID-19 pandemic has had a negative effect on SMI-related outpatient visits in Ningbo, especially by patients with schizophrenia. A strategy should be developed and implemented to maintain access to SMI services during the COVID-19 pandemic.

Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic

Objective

This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic.

Methods

Mental health-related hospitalization rates among patients enrolled in a large academic hospital's outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar's test.

Results

In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777).

Conclusion

Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.

Lessons from the coronavirus disease 2019 pandemic in schizophrenia: a review

PURPOSE OF REVIEW

Multiple countries have reported increased COVID-19 mortality in patients with schizophrenia. The purpose of this review was to synthetize the consequences of the pandemic on patients with schizophrenia including vaccination data.

RECENT FINDINGS

We have synthetized data on the increased risk of infection and increased mortality, the impact of the pandemic and lockdowns on psychiatric care, vaccination policies, unwillingness to vaccine in patients and the rates of vaccination.

SUMMARY

Schizophrenia has been confirmed at increased risk of both COVID-19 infection and developing a severe/lethal form of the infection. Patients with schizophrenia should, therefore, be prioritized for vaccination whenever possible and should be prioritized for psychiatric and somatic care access. Psychotic symptomatology may be a barrier to vaccination in some patients, and heterogenous vaccination rates were identified in national databases. The COVID-19 pandemic has been also a unique opportunity to develop telehealth. A mixed face-to-face and distance model should be encouraged, whenever possible, to improve the experience of patients, relatives and healthcare professionals. No major change of long-acting antipsychotics has been reported in most countries, and there was no consistent evidence for clozapine prescription to increase the risk of COVID-19 infection or severe outcomes.

Psychometric Properties of the Korean Version of Functioning Assessment Short Test in Bipolar Disorder

Objective

The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. This brief instrument includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST).

Methods

A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted.

Results

The internal consistency (Cronbach's alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p < 0.001). The K-FAST exhibited significant correlations with GAF (r = -0.771), WHOQOL-BREF (r = -0.326), YMRS (r = 0.509) and BDRS (r = 0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed four factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI = 0.925; TLI = 0.912; RMSEA = 0.078).

Conclusion

The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.

Impact of the COVID-19 Pandemic on Utilization of Inpatient Mental Health Services in Shanghai, China

(1) Purpose: The ongoing COVID-19 pandemic has had an impact on mental health and the utilization of hospital-based inpatient mental health care worldwide. The aim of this study was to determine the impact of this pandemic on the utilization of this service in Shanghai by comparison with hospital-based health care records during the preceding 4 years. (2) Methods: The medical records were provided by the Shanghai Municipal Health Insurance Bureau. Diagnostic coding was based on International Classification of Diseases-10th revision (ICD-10), and inpatients with codes from F00 to F99 were examined. (3) Results: Inpatients were compared according to gender, age, pandemic stage, and type of mental disease. Utilization of psychiatric inpatient care in Shanghai during each of the four stages of the pandemic (1 January 2016 to 21 January 2020; 22 January 2020 to 9 February 2020; 10 February 2020 to 1 March 2020; 2 March 2020 to 31 July 2020) was analyzed. Before the lockdown, the utilization of psychiatric inpatient care had an overall upward trend; after the lockdown, the number of inpatients dropped sharply; as of 31 July 2020, it has not been restored. The utilization of this service for most types of mental disease declined rapidly during the pandemic; for vascular dementia (VAD, F01), it was relatively steady. The observed number of inpatient patients was about 51.07% lower than the predicted number in 2020. (4) Conclusions: The COVID-19 pandemic led to the implementation of prevention and control measures that reduced the utilization of psychiatric inpatient care in Shanghai. The use of inpatient services for categories F20–F29 had the greatest decline, and VAD (F01) had the smallest change during the pandemic. This service consequence of COVID-19 is apparent; to assure access to adequate service during a pandemic, health care professionals should pay close attention to changes in the utilization of different mental health services.

Systematic Review of Mind–Body Modalities to Manage the Mental Health of Healthcare Workers during the COVID-19 Era

Healthcare workers (HCWs) have suffered physical and psychological threats since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Mind-body modalities (MBMs) can reduce the long-term adverse health effects associated with COVID-specific chronic stress. This systematic review aims to investigate the role of MBMs in managing the mental health of HCWs during the COVID-19 pandemic. A comprehensive search was conducted using 6 electronic databases, resulting in 18 clinical studies from 2019 to September 2021. Meta-analysis showed that MBMs significantly improved the perceived stress of HCWs (standardized mean difference, −0.37; 95% confidence intervals, −0.53 to −0.21). In addition, some MBMs had significant positive effects on psychological trauma, burnout, insomnia, anxiety, depression, self-compassion, mindfulness, quality of life, resilience, and well-being, but not psychological trauma and self-efficacy of HCWs. This review provides data supporting the potential of some MBMs to improve the mental health of HCWs during COVID-19. However, owing to poor methodological quality and heterogeneity of interventions and outcomes of the included studies, further high-quality clinical trials are needed on this topic in the future.

Effects of COVID-19-related stress and fear on depression in schizophrenia patients and the general population

This study compared the coronavirus disease 2019 (COVID-19)-related stress, fear of infection, loneliness, and depression between patients with schizophrenia and the general population. A face-to-face survey was administered to 1340 patients with a schizophrenia spectrum disorder and online survey of the general population (n = 2000) was conducted. The information gathered included the level of COVID-19-related stress, fear of infection, the Patient Health Questionnaire-9 score, and the three-item UCLA Loneliness Scale score. Structural equation modeling revealed a significant effect of fear of COVID-19 infection on depression among the general population and on loneliness among patients with schizophrenia. Loneliness experienced during COVID-19 exacerbated depression in both groups. In the COVID-19-related stress-loneliness-depression pathway, the partial mediating effect of loneliness was significant in both groups. Conversely, in the COVID-19-related fear-loneliness-depression pathway, the full mediating effect of loneliness was only significant in patients with schizophrenia. In conclusion, the loneliness associated with COVID-19-related stress and fear of infection was an important factor influencing depression, and the impact was greater in patients with schizophrenia compared with the general population. Thus, different mental health intervention plans are needed for patients with schizophrenia during the COVID-19 pandemic. During the long-lasting COVID-19 pandemic, social support and provision of mental health services to prevent loneliness and consequent depression are required in patients with schizophrenia.