The effect of the COVID-19 lockdown on mental health care use in South Africa: an interrupted time-series analysis

Abstract

Aims The coronavirus disease 2019 (COVID-19) pandemic and ensuing restrictions have negatively affected the mental health and well-being of the general population, and there is increasing evidence suggesting that lockdowns have led to a disruption of health services. In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic, entailing the suspension of all non-essential activities and a complete ban of tobacco and alcohol sales. We studied the effect of the lockdown on mental health care utilisation rates in private-sector care in South Africa. Methods We conducted an interrupted time-series analysis using insurance claims from 1 January 2017 to 1 June 2020 of beneficiaries 18 years or older from a large private sector medical insurance scheme. We calculated weekly outpatient consultation and hospital admission rates for organic mental disorders, substance use disorders, serious mental disorders, depression, anxiety, other mental disorders, any mental disorder and alcohol withdrawal syndrome. We calculated adjusted odds ratios (OR) for the effect of the lockdown on weekly outpatient consultation and hospital admission rates and the weekly change in rates during the lockdown until 1 June 2020. Results 710 367 persons were followed up for a median of 153 weeks. Hospital admission rates (OR 0.38; 95% confidence interval (CI) 0.33–0.44) and outpatient consultation rates (OR 0.74; 95% CI 0.63–0.87) for any mental disorder decreased substantially after the introduction of the lockdown and did not recover to pre-lockdown levels by 1 June 2020. Health care utilisation rates for alcohol withdrawal syndrome doubled after the introduction of the lockdown, but the statistical uncertainty around the estimates was large (OR 2.24; 95% CI 0.69–7.24). Conclusions Mental health care utilisation rates for inpatient and outpatient services decreased substantially after the introduction of the lockdown. Hospital admissions and outpatient consultations for alcohol withdrawal syndrome increased after the introduction of the lockdown, but statistical uncertainty precludes strong conclusions about a potential unintended effect of the alcohol sales ban. Governments should integrate strategies for ensuring access and continuity of essential mental health services during lockdowns in pandemic preparedness planning.

Provision of community mental health care before and during the COVID-19 pandemic: A time series analysis in Peru

“…On the other hand, both the initial reduction and the subsequent increase in the trend of users attended, as well as appointments and activities performed in CMHCs reported in this study coincided with studies conducted in others mental health systems, where the same analysis (uninterrupted time series analysis) was used to estimate changes in user care in different health centers. One study in South Africa found that the levels of hospital admissions and outpatient consultations were reduced from the COVID-19 blocking measures, and during the pandemic there was a gradual recovery process in the number of hospital admissions (Wettstein et al, 2022). In other study performed in South-East England, the trend was similar to the previous study, outpatient and community care in mental health services decreased since the application of COVID-19 confinement, followed by a gradual recovery of care (Penington et al, 2022).…”

Patient and stakeholder perspectives on impacts of the COVID-19 pandemic on HIV and mental health care delivery in South Africa

“…This speaks to the need for greater access to and awareness of mental health and substance use services in South Africa for PWH. Though lockdowns may also have made it more challenging to access care, 12 there generally remains limited access to mental health and substance use care in the South African health system. 37 These findings speak to the ongoing need to develop and test task-shared interventions and implementation strategies to integrate mental health and substance use services into the broader health system in this context.…”

“… 9 Medical mistrust following the onset of the pandemic has also been documented among PWH in South Africa, 10 possibly contributing to these care interruptions. Pandemic-related increases in poor mental health and substance use and on use of mental health services in South Africa 11 , 12 may also be affecting HIV care engagement. However, there is only one study we are aware of that qualitatively explored how the pandemic affected HIV services and care engagement from the perspectives of PWH in South Africa.…”

Effect of the Friendship Bench intervention on antiretroviral therapy outcomes and mental health symptoms in rural Zimbabwe: A cluster randomized trial

“…27,28 In many settings, access to mental health services decreased during the COVID pandemic. 29,30 The Friendship Bench (FB) intervention is a lay health worker-led psychological intervention developed to close the treatment gap for common mental disorders (CMD) such as anxiety and depression in Zimbabwe. 31 The intervention reduced CMD symptoms in a cluster-randomized controlled trial in urban Zimbabwe, 31 where the prevalence of depression or anxiety is high.…”