Youth Psychiatric Hospitalization in Israel during COVID-19: A Multi-Center Study

Abstract

During the COVID-19 pandemic there have been numerous reports of increases in psychiatric morbidity and a deterioration of status among existing patients. There is little information about how this increase has affected youth and rates of adolescent psychiatric hospitalization. Our study was aimed at examining trends in youth psychiatric hospitalization during the first year of the COVID-19 pandemic. Method: We used medical records to compare trends in hospitalization rates from 2019 to 2020, among psychiatric youth wards from five different centers in Israel. Results: The number of patients that were hospitalized in youth psychiatric wards decreased significantly from 2019 (Mean ± SD=52.2 ± 28.6 per month) to 2020 (M ± SD = 40.8 ± 22.0; unstandardized B = −11.4, 95% CI = −14.4 to −8.3, p < 0.0001). There was a significant decrease in the number of patients that were hospitalized due to internalizing disorders from 2019 (M ± SD = 22.3 ± 9.3 per month) to 2020 (M ± SD = 16.8 ± 7.7; B = −5.5, 95% CI = −8.0 to −3.0, p = 0.0002) and a marginally significant increase in the number of restraints per month (2019: M ± SD = 2.8 ± 6.8, 2020: M ± SD = 9.0 ± 14.5; Z = −1.96, Rosenthal’s r= 0.36, p = 0.07).Conclusions: There was a significant decline in psychiatric hospitalizations during the pandemic, specifically among patients suffering from internalizing disorders. The reasons for this decline, and the future impact these changes had on hospitalizations during the pandemic demand further research. Study limitations: This is a retrospective multicenter study from five medical centers in Israel, therefore generalizability of our findings is limited.

Has Anything Changed in the Frequency of Emergency Department Visits and the Profile of the Adolescent Seeking Emergency Mental Care during the COVID-19 Pandemic?

“…In this current study, we registered a significant increase of 45.8% in the cumulative incidence of ED visits for MHDs in adolescents during the COVID-19 period. This finding was similar to other studies [ 13 , 14 , 23 , 24 , 25 ]. Nevertheless, two other studies reported a decline in psychiatric ED referrals during the pandemic [ 18 , 26 ]; however, both were limited to a short-term period of analysis near the lockdown.…”

“…As mentioned above, another interesting aspect of the ED presentation during the COVID-19 period was the first contact ED visit for MHDs, i.e., the significant rate of previously healthy youths who were at a new onset of mental health problems in the emergency care setting. On this topic of “acute onset” of mental health problems in previously healthy individuals at the ED, some studies have reported up to half of the children and young people, who present to the ED, have no prior history or contact with the medical health care system; consequently, the ED has become the primary portal of access to the mental health system for young people not only before but also during the COVID-19 pandemic [ 13 , 14 , 18 , 23 , 24 , 25 , 26 ]. Nevertheless, the highest rate of ED presentations with an acute onset of MHDs during the COVID-19 period might be explained by the interaction between bio-psychological vulnerability and environmental stressors [ 31 , 32 , 33 ].…”

“…Research highlighting the effects of the COVID-19 pandemic on ED visits for MHDs of adolescents is beginning to surface [ 13 , 14 , 15 , 16 , 17 , 18 ]. However, studies appraising the longitudinal psychological burden of the COVID-19 pandemic on adolescents in an emergency setting are not much [ 13 , 14 ], and this is important if we aim to “photograph” the effective COVID-19-related changes in the trend of the phenomenon.…”

“…Research highlighting the effects of the COVID-19 pandemic on ED visits for MHDs of adolescents is beginning to surface [ 13 , 14 , 15 , 16 , 17 , 18 ]. However, studies appraising the longitudinal psychological burden of the COVID-19 pandemic on adolescents in an emergency setting are not much [ 13 , 14 ], and this is important if we aim to “photograph” the effective COVID-19-related changes in the trend of the phenomenon. In addition, most studies focus only on psychopathology in ED, describing the overall frequency of adolescent psychiatric ED visits, and the frequency and trends in specific reasons for ED utilization [ 13 , 16 , 17 , 18 , 19 ].…”

A 16-month longitudinal investigation of risk and protective factors for mental health outcomes throughout three national lockdowns and a mass vaccination campaign: Evidence from a weighted Israeli sample during COVID-19

“…The financial, social, and political crisis in Israel, coupled with concerns over physical health, has brought mental health to the forefront of public discussion ( Efrati, 2020 , Jeffay, 2022 ). The increasing demand for mental health services which was masked in 2020 by lockdowns and fear of contagion ( Dror et al, 2022a , Dvorak et al, 2021 , Pikkel Igal et al, 2021 , Schreiber et al, 2021 ), erupted during 2021 ( Bilu et al, 2022 , Dror et al, 2022b , Mevorach et al, 2023 ), exposing weaknesses in the country's public mental health system, which was unable to keep up with the sudden influx of patients. This has prompted mental health professionals to raise an alarm and call for immediate government intervention.…”