How COVID-19 Phases Have Impacted Psychiatric Risk: A Retrospective Study in an Emergency Care Unit for Adolescents

Abstract

Dramatic events during the COVID-19 pandemic have acutely impacted the psychosocial environment worldwide, with negative implications for mental health, particularly for more vulnerable children and adolescents with severe psychiatric illnesses. Some data suggest that the pandemic waves may have produced different psychopathological consequences, further worsening in the second phase of the pandemic, compared to those in the first lockdown, soon after March 2020. To test the hypothesis of a further worsening of psychiatric consequences of COVID-19 in the second lockdown compared to the first lockdown, we focused our analysis on a consecutive sample of youth referred to a psychiatric emergency unit for acute mental disorders in the time period between March 2019–March 2021. The sample, consisting of 241 subjects (123 males and 118 females, ranging in age from 11 to 17 years), was divided into three groups: Pre-Lockdown Group (PLG, 115 patients); First Lockdown Group (FLG, 65 patients); and Second Lockdown Group (SLG, 61 patients). Patients in the SLG presented more frequently with non-suicidal self-injuries (NSSIs), suicidal ideation, and suicidal behavior, while no significant differences in self-harm were found between PLG and FLG. Eating disorders were more frequent in both the FLG and SLG, compared to the PLG, while sleep problems were higher only in the SLG. Furthermore, patients in the SLG presented with more frequent psychological maltreatments and neglect, as well as with psychiatric disorders in the parents. Adverse traumatic experiences and internalizing disorders were significantly associated with an increased risk of suicidality. Intellectual disability was less represented from the PLG to SLG, and similarly, the rate of ADHD was lower in the SLG. No differences were found for the other psychiatric diagnoses. This information may be helpful for a better understanding and management of adolescents with severe emotional and behavioral disorders after the exposure to long-lasting collective traumas.

Psychiatric Hospitalization for Psychopathological Disorders and Self-Injurious Behaviors in Italian Children and Adolescents during COVID-19

“…Concerning self-injurious behaviors among the admitted patients during the quarantine periods, an increased frequency of non-suicidal self-injurious behaviors was observed compared to the reference periods (i.e., 58.6% during the quarantine periods vs. 43.2% during the reference periods). This finding aligns with the results of previous studies of adolescents during COVID-19 [16,[31][32][33]. As proposed by Plener [30], non-suicidal self-injurious behaviors are often applied as an emotion regulation strategy to temporarily decrease or eliminate negative emotions.…”

The Risk-Taking and Self-Harm Inventory for Adolescents: Validation of the Italian Version (RTSHIA-I)

“…One example is the COVID-19 pandemic, which has affected the psychosocial environment of vulnerable children and adolescents by causing loss of lives, isolation, contact restrictions, and disruption of daily rhythms, particularly eating and sleeping routines. In this regard, Mucci and colleagues [ 30 ] and Beghi and colleagues [ 31 ] found that non-suicidal self-injury significantly increased among Italians during the lockdown periods in 2020 and 2021.…”

“…The prevalence of self-harm and risky behavior is increasing and becoming more evident, as seen in Ougrin and colleagues’ investigation [ 41 ] of self-harm in adolescents in 10 countries, including Italy. They found that the proportion of teens turning to inpatient emergency departments increased by 50% in 2019 and 57% in 2020, with an increase in those having difficulty with emotion regulation between 58% and 66% likely due to the COVID-19 pandemic in the past two years [ 30 ]. These data highlight the importance of investigating these behaviors with culturally appropriate measures [ 42 , 43 ], which are useful in each specific social context, taking into account social and moral norms.…”

Urgent Psychiatric Consultations for Suicidal Ideation and Behaviors in Italian Adolescents during Different COVID-19 Pandemic Phases

“…Economic uncertainty among families with a lower socio-economic status, alteration of sleep habits with inversion of the circadian rhythms, decreased physical activity, unhealthy eating habits, and possible difficulties in family relationships including exposure to intrafamilial violence/traumas are all possible reasons for the adverse health outcomes relating to the pandemic lockdown [24]. Several other studies reported an increase in ED psychiatric consultations from suicide attempts after the spring season of 2020, and adolescents have been reported as the most vulnerable group [21,[25][26][27][28]. The present study showing an increase in CP consultations for suicidal ideation and attempts confirms the results of a previous Italian study, providing information on the persistence of this increase during the year after gradual resumption of normal activities for both adults and juveniles.…”