Emergency Psychiatric Consultations During and After the COVID-19 Lockdown in Italy. A Multicentre Study

Abstract

Aims: The aim was to analyse the psychiatric consultations in nine Italian hospital emergency departments, by comparing the lockdown and post-lockdown periods of 2020 with the equivalent periods of 2019.Methods: Characteristics of psychiatric consultations, patients, and drug prescriptions were analyzed. Joinpoint models were used to identify changes in the weekly trend of consultations.Results: A 37.5% decrease in the number of consultations was seen during the lockdown period and 17.9% after the lockdown. The number of individual patients seen decreased by 34.9% during the lockdown and 11.2% after the lockdown. A significant change in the number of consultations from week 11 to week 18 occurred, followed by a gradual increase. There was a higher percentage of patients with previous psychiatric hospitalizations during the lockdown period (61.1 vs. 56.3%) and a lower percentage after the lockdown (59.7 vs. 64.7%). During the lockdown there was a large increase in psychiatric consultations for substance use disorders, whereas more consultations for manic episodes occurred after the lockdown. A 3.4% decrease was observed in consultations for suicidal ideation and planning during the lockdown, followed by an upward rebound after the lockdown, along with an increase in consultations for suicide attempts. During lockdown antipsychotic and benzodiazepine prescriptions increased by 5.2 and 4.1%, respectively. After the lockdown, the number of compulsory hospitalizations was higher than in 2019.Conclusions: We observed a decrease of psychiatric consultations during and after the lockdown. There was an increase in consultations for manic episodes and suicidality after the lockdown. The focus of psychiatric services must remain high particularly in this latter period.

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

“…It is also possible that during the COVID-19 outbreak physicians were less prone to prescribe ADs to these patients by preferring other alternatives such as benzodiazepines. This hypothesis is supported by findings from Balestri and colleagues that documented an increased use of benzodiazepines in the psychiatric setting during the first lockdown [37].…”

“…Additionally, data on incidence of drug use might also suggest a potential rebound/mid-long term effect of lockdown. In fact, it is possible to speculate that the emergency situation might have contribute to development of mental problems in individuals without pre-existing mental health problems who were resilient during the early phase of lockdown [37,41]. In this regard, stressors such as fear of contagion, long quarantine, isolation and movement restriction, lack of information, financial loss, inadequate supplies and stigma, and loss of relatives due to COVID-19 might have contributed to the deterioration in psychological outcomes with consequent onset of anxiety, depression and related symptoms [42][43][44].…”

Mid-term psychiatric consequences of the COVID-19 pandemic: a 4 months observational study on emergency room admissions for psychiatric evaluation after the (first) lockdown period in Italy

“…Admission to the emergency room (ER) is considered an index of severe psychiatric distress, since it represents a cry for help brought on by the patient's discomfort. Recent reports found a decrease in psychiatric ER visits [ 6 – 11 ] during the lockdown, despite an increase in suicide ideation/behavior [ 12 – 15 ], that is predicted to worsen in the near future [ 16 ].…”

Access to Mental Health Care during the First Wave of the COVID-19 Pandemic in Italy: Results from the COMET Multicentric Study

“…A few studies have assessed the use of mental health resources, especially during the first wave of the pandemic. Most evidence relies on qualitative reports from populations of service users or from data coming from limited settings, i.e., emergency departments [ 45 , 46 , 47 , 48 ]. An in-depth description of the use of mental health services during the COVID-19 pandemic is necessary in order to delineate new pathways to care and to develop supportive interventions for the general population [ 11 , 49 ].…”