Effect of COVID-19 pandemic on utilisation of community-based mental health care in North-East of Italy: A psychiatric case register study

Abstract

Aims WHO declared that mental health care should be considered one essential health service to be maintained during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to describe the effect of lockdown and restrictions due to the COVID-19 pandemic in Italy on mental health services’ utilisation, by considering psychiatric diagnoses and type of mental health contacts. Methods The study was conducted in the Verona catchment area, located in the Veneto region (northeastern Italy). For each patient, mental health contacts were grouped into: (1) outpatient care, (2) social and supportive interventions, (3) rehabilitation interventions, (4) multi-professional assessments, (5) day care. A ‘difference in differences’ approach was used: difference in the number of contacts between 2019 and 2020 on the weeks of lockdown and intermediate restrictions was compared with the same difference in weeks of no or reduced restrictions, and such difference was interpreted as the effect of restrictions. Both a global regression on all contacts and separate regressions for each type of service were performed and Incidence Rate Ratios (IRRs) were calculated. Results In 2020, a significant reduction in the number of patients who had mental health contacts was found, both overall and for most of the patients’ characteristics considered (except for people aged 18–24 years for foreign-born population and for those with a diagnosis of schizophrenia. Moreover, in 2020 mental health contacts had a reduction of 57 096 (−33.9%) with respect to 2019; such difference remained significant across the various type of contacts considered, with rehabilitation interventions and day care showing the greatest reduction. Negative Binomial regressions displayed a statistically significant effect of lockdown, but not of intermediate restrictions, in terms of reduction in the number of contacts. The lockdown period was responsible of a 32.7% reduction (IRR 0.673; p-value <0.001) in the overall number of contacts. All type of mental health contacts showed a reduction ascribable to the lockdown, except social and supportive interventions. Conclusions Despite the access to community mental health care during the pandemic was overall reduced, the mental health system in the Verona catchment area was able to maintain support for more vulnerable and severely ill patients, by providing continuity of care and day-by-day support through social and supportive interventions.

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

“…The number of psychiatric day care facilities used was also significantly smaller in the months during the period of emergency declarations and priority preventative measures than in other months in FY 2020-2021. Previous studies outside Japan have reported that the number of services for outpatients with mental illness and rehabilitation needs, including psychiatric day care, has decreased since 2020 owing to the COVID-19 pandemic-related lockdown [18,19]. Our results were consistent with this, suggesting that the number had decreased due to effects such as staying at home and the operational scale of facilities; this trend continued in FY 2021.…”

Relationship between Environmental Conditions and Utilisation of Community-Based Mental Health Care: A Comparative Study before and during the COVID-19 Pandemic in Italy

“…It is possible that having a green space near the living apartment but not being able to access it due to COVID-19 restrictions could be an additional mental health stressor [ 58 , 59 ]. This evidence should also consider the fact that, on one side, the availability of the services was reduced during the pandemic as many facilities, in particular rehabilitation services and daycare, were closed to reduce contagion, and, on the other side, people were hesitant to visit the services in person during the pandemic [ 41 ].…”

“…All types of contacts (with psychiatrists, psychologists, nurses, psychiatric rehabilitation therapists, occupational therapists, and social workers) provided by mental health services were included. A comprehensive description of the study setting and clinical data sources can be found in a recently published article [ 41 ]. Our current study narrows its scope to the Verona municipality, diverging from the catchment area discussed in the previous publication and integrating environmental variables, an aspect previously omitted.…”

“…This is also the case in Italy, one of the first nations among Western countries to be affected by the COVID-19 outbreak [ 39 ]. Despite this increase, both emergency psychiatric consultations and community mental health contacts were significantly reduced during the pandemic [ 27 ], at −23.3% and −33.9%, respectively [ 40 , 41 ]. The pandemic also brought the need for fast and flexible adaptations in health organisations to balance the increased demand with reduced interactions among patients and between patients and professionals.…”

A Population-based Cohort to Investigate the Impact of Covid-19 on Socioeconomic Inequalities in Mental Health Care in Italy (Comeh): Cohort Profile

“…Moreover, there was a reduction in the number of patients attending mental health outpatient services (10,(12)(13)(14). In Italy, this was partly consequent to the reduced opening hours or temporary closure of outpatient community mental health centers (15).…”