Psychiatric Emergencies and Suicide Attempts Before and During COVID-19 Lockdown in Spain

Abstract

Abstract. Background: The COVID-19 pandemic had a significant impact on the mental health of the population. The lockdown period in Spain – from March 14 to June 21, 2020 – was particularly stressful. This study aims to examine the differences in visits to the emergency department for psychiatric reasons before and during the lockdown period in a hospital in the province of Lleida (Catalonia, Spain), which has a catchment area of 431,183 inhabitants. We hope that this study can contribute to the understanding of this difficult period in our recent history and help us to be prepared in case of new social emergencies that may affect the mental health of the general population. Aims: This study aims to examine the differences in ER visits due to psychiatric reasons before and during the COVID-19 lockdown period in a province hospital in Spain. Methods: We compared the n = 1,599 visits to the emergency room and their characteristics before (June 13 to March 13, 2020) and during (March 14 to June 21, 2020) the lockdown period in the province of Lerida, Spain. Data were obtained from the electronic health records. Information collected included sociodemographic variables, reason for consultation, previous diagnosis, and characteristics of suicidal ideation and attempts – including history of previous suicidal behavior, method, days spent in the ER, suicide reattempts at 6-month follow-up. Results: Before lockdown, there were an average of 11.2 psychiatric emergencies per day compared with 9.2 psychiatric emergencies per day during lockdown. Regarding suicidal behavior, before lockdown, there were an average of 0.9 suicide attempts before lockdown compared with 0.7 attempts per day during lockdown. Limitations: Since the data came from the electronic health records, we have relied on the clinical diagnosis made by different psychiatrists. Also, we did not record psychiatric comorbidities, but instead only registered one main Axis I diagnosis and one main Axis II diagnosis. Conclusions: We observed a decrease in the number of visits to the ER in general, as well as a lower frequency of patients with suicidal behavior during the first and only lockdown period in Spain, which occurred during the initial months of the pandemic. This is consistent with previous studies showing a reduction of suicidal behavior during periods of social emergency. However, this decrease could be only temporary, and several authors predict an increase of suicidal behavior in the aftermath of the COVID-19 crisis. Ensuring access to mental healthcare during periods of crisis is crucial for the population.

Relationship Between Severity and Length of Exposure to COVID-19 Parameters and Resulting Government Responses and the Suicide Crisis Syndrome (SCS)

“…These findings add to the extant literature in that they address how variation in the severity of exposure to pandemic-related stressors across individuals and countries can impact suicide risk. Likewise, these results may shed light on previous findings of a decrease in suicide deaths 7,8 or suicide-related emergency room visits 9 in the early stage of the pandemic. Our findings point to an effect of time, such that chronicity of exposure to pandemic stressors appears to increase the severity of SCS symptoms.…”

“…Likewise, in a Spanish study of emergency room (ER) visits pre and post lockdown, there was a decrease in both the number of visits to the ER and in patients presenting with suicidal behavior in the initial 3 months of the pandemic. 9 The authors speculated, however, that suicide risk might change over time as the pandemic persisted. Likewise, a whole population-based study from Wales showed a decrease in suicide rates during the pandemic along with an increased rate of deaths of unknown cause.…”

“…3,5 However, the research has not been consistent, with some studies showing either no change relative to pre-pandemic levels 6,7 or even a decrease. [7][8][9] Three possible reasons for these discrepant findings include (1) use of inadequately sensitive markers of suicidal risk 10 ; (2) variation in the severity of the impact of the pandemic across individuals and countries 5,6,8 ; and (3) the possible time-sensitive nature of the mental health impact. 5,7,9,11 Thus, to reach a fuller understanding of the impact of the global pandemic on suicide risk, it is critical to address all 3 factors.…”

Trajectories of children and adolescents attending a psychiatric emergency unit during the COVID-19 confinements: 2020-2022 longitudinal study

“…The data for this study have been obtained through a longitudinal review of electronic health records (EHR) regarding all patients under 18 years of age who were assessed in the emergency room (ER) for acute psychiatric requests during the two COVID con nements in Spain ( rst state of emergency from March 15, 2020, to June 20, 2020; second state of emergency from October 25, 2020, to May 9, 2021 24 ). During this time, a state of alarm was decreed, schools were closed, and citizens were ordered to stay at home except for justi ed reasons, such as unavoidable work, purchase of food, or attendance at health centers for urgent reasons 25 . The rst contact with the psychiatric emergency department during the two COVID con nements was de ned as the index episode (i.e., the rst assessment in the psychiatric emergency room during one of the two states of emergency).…”

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

“…The need of additional beds compatible with mechanical ventilation (2) reduced bed capacity in mental health inpatient services (3). Di culties in accessing emergency departments (EDs) due to the high number of COVID-19 patients may have decreased the overall number of psychiatric visits (4)(5)(6)(7)(8)(9)(10)(11).…”