Psychiatric emergencies during, after, and before the COVID-19 lockdown; what happened to our patients? A naturalistic observational study

Abstract

Background: Despite concerns on mental health problems related to COVID19 lockdown, recent reports revealed a reduction in psychiatric admissions in Emergency Departments (ED) during the lockdown period compared with the previous year in several countries. Most of the existing studies focused on the first lockdown not considering the different phases of the COVID-19 crisis. The present study aimed to analyze differences in ED admission for psychiatric consultation during three different phases of the COVID-19 pandemia in Italy. Methods: Information on ED admission for psychiatric consultations were retrospectively collected at the ED of the Santo Spirito Hospital in Rome (Italy), and compared between the three periods: the lockdown (March - June 2020) and the post-lockdown period (June 2020 - June 2021) compared to the pre-lockdown (January 2019 - March 2020). Multinomial logistic regression was used to assess the risk of accessing ED for psychiatric consultation before, during, after the lockdown. Results: 3,871 ED psychiatric consultations were collected. A significant reduction of psychiatric consultations in ED during the lockdown period and the post-lockdown (H: 762,45; p<0.001) was documented. Multinomial logistic regression analysis showed that compared to pre-lockdown during the lockdown and post-lockdown patients were more likely to be men (RRR: 1.52; 95% CI: 1.10 - 2.12) and more often diagnosed with non-severe mental illnesses (nSMI) (relative risk ratio [RRR]: 1.53, 95% CI: 1.10 - 2.15; and 1.72, 95% CI: 1.42 - 2.08); during the lockdown, patients were also more often diagnosed with alcohol/substance abuse (A&S) (RRR: 1.70; 95% CI: 1.10 - 2.65). Conclusions: Several changes in the clinical characteristics of psychiatric consultations during and after the lockdown emerged from the present study; nSMI and A&S abuse patients were more likely to present at the ED in the lockdown and post-lockdown periods while SMI patients appeared to be less likely. These may inform clinicians and future preventive strategies among community mental health services.