Emergency Psychiatric Consultations During and After the COVID-19 Lockdown in Italy. A Multicentre Study.

Matteo Balestrieri,Giulio Castelpietra,Miki Bonizzoni,Giulia Piccinini,Federico Grasso,Claudio Mencacci,Emi Bondi,Maria Giuseppa Elmo,Alberto Vitalucci,Vincenzo Villari,Giancarlo Cerveri,Clara Locatelli,Marco Vaggi,Livia Pischiutta,Giuseppe Ducci,Filippo Dragogna,Davide Amendola,Paola Rucci,Lucio Ghio,Alessandra Nicotra,Marco Toscano,Leonardo Monaco,Chiara Colli

doi:10.3389/fpsyt.2021.697058

Abstract

Aims: The aim was to analyse the psychiatric consultations in nine Italian hospital emergency departments, by comparing the lockdown and post-lockdown periods of 2020 with the equivalent periods of 2019.Methods: Characteristics of psychiatric consultations, patients, and drug prescriptions were analyzed. Joinpoint models were used to identify changes in the weekly trend of consultations.Results: A 37.5% decrease in the number of consultations was seen during the lockdown period and 17.9% after the lockdown. The number of individual patients seen decreased by 34.9% during the lockdown and 11.2% after the lockdown. A significant change in the number of consultations from week 11 to week 18 occurred, followed by a gradual increase. There was a higher percentage of patients with previous psychiatric hospitalizations during the lockdown period (61.1 vs. 56.3%) and a lower percentage after the lockdown (59.7 vs. 64.7%). During the lockdown there was a large increase in psychiatric consultations for substance use disorders, whereas more consultations for manic episodes occurred after the lockdown. A 3.4% decrease was observed in consultations for suicidal ideation and planning during the lockdown, followed by an upward rebound after the lockdown, along with an increase in consultations for suicide attempts. During lockdown antipsychotic and benzodiazepine prescriptions increased by 5.2 and 4.1%, respectively. After the lockdown, the number of compulsory hospitalizations was higher than in 2019.Conclusions: We observed a decrease of psychiatric consultations during and after the lockdown. There was an increase in consultations for manic episodes and suicidality after the lockdown. The focus of psychiatric services must remain high particularly in this latter period.

Highlights

To date, much work has focused on medium-term mental health consequences of COVID-19 pandemic [1]
Information on hospital emergency departments (HEDs) psychiatric consultations of patients was retrospectively collected between March 9, 2020 and June 30, 2020 and during the same period of the previous year from patient records in 9 Italian centres, 4 of which were in Lombardy Region, that was the first hit by COVID-19 pandemic (59.6% of cases nationwide on March 9, 2020)
We modelled the weekly counts of HED psychiatric consultations as a function of the week using a Poisson model of variation

Summary

Introduction

Much work has focused on medium-term mental health consequences of COVID-19 pandemic [1]. Some preliminary reports on mental health management in the acute phase of the pandemic have found a decrease in requests for psychiatric consultations in hospital emergency departments (HEDs) [4,5,6,7,8,9,10,11]. Which was the European country with the highest initial impact of the pandemic [12], has a community-based organization of mental health care. A nation-wide network of Mental Health Departments provides outpatient care primarily through Community Mental Health Centres (CMHCs), and operates semi-residential and residential facilities. Public mental health care is typically provided free of charge to the entire population and is by far the most widely used form of mental health care in the country [14]

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Results

Conclusion