Impact of the early phase of the COVID-19 pandemic on the use of mental health services in South Korea: a nationwide, health insurance data-based study

Transitions in mental health care utilisation at GHU Paris between 2019 and 2024: A post-pandemic perspective

OBJECTIVE

This study aimed to analyse the long-term evolution of mental health services use following the COVID-19 pandemic.

DESIGN

This was a retrospective study, conducted from 2019 to 2024, using the Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences (GHU Paris) databases.

METHODS

We considered the number of patients consulting at GHU Paris clinics, number of patients presenting at the emergency department (ED), and number of hospital admissions per week, by sex and age group. We performed a piecewise linear regression, using a threshold approach to identify time patterns between 2019 and 2024: pre-pandemic period (T1), short-term (T2) and long-term post-pandemic period (T3). Temporal changes in mental healthcare service use were then analysed.

RESULTS

No significant overall changes were observed in the number of outpatients after the COVID-19 pandemic, except for a slight increase among patients aged 15-24 years. The number of hospital admissions remained lower in 2024 compared with 2019, with a decreasing trend in T3 for all subgroups. In contrast, the number of ED visits increased over time, with higher use of emergency services by women and young people in 2024 compared with 2019. The overall long-term trend (T3) continued to show an increasing pattern. Additionally, a reduction in schizophrenia presentations was observed, while there was an overall increase in patients with substance use or neurotic disorders.

CONCLUSIONS

Our results described transitions in mental health service use at GHU Paris between 2019 and 2024, highlighting reduced hospital admissions, increased psychiatric emergencies, and changes in the reasons for seeking care.

Factors Associated with Leaving Ambulatory Psychiatric Treatment in a Large, Academic Health System During the COVID-19 Pandemic

Detailed evaluation of changes in patient retention in psychiatric care as a result of the onset of the COVID-19 pandemic have not been studied. Here, we present a retrospective analysis of aggregate data from a large academic health system (n = 16,701 patients) to examine if there were differences in patients leaving psychiatric care from the pre-COVID-19 period to the first 12 months of the COVID-19 pandemic. Demographic, clinical, and behavioral factors were studied using logistic regressions to determine significant associations in leaving psychiatric care during COVID-19 and in the 12 months immediately prior to the pandemic. Factors identified with a higher odds of leaving psychiatric care during COVID-19 that were not associated with leaving care prior to COVID-19 included demographic (male sex, uninsured (self-pay) status), behavioral (inactive patient health portal), and diagnostic (anxiety and trauma stressor disorders, pervasive and specific developmental disorders, and disorders of childhood) factors. These results highlight that the reasons patients left care during the period immediately after the COVID-19 pandemic may have been multifactorial in nature, although certain patterns seem to have appeared. Further study is needed to elucidate why these specific factors may have driven patients to leave psychiatric treatment during the COVID-19 pandemic.

Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysis

OBJECTIVES

To quantify access to health services during the COVID-19 pandemic and measure the change in use between the prepandemic and the pandemic periods in a population with assessment of psychological distress or diagnosis of mental disorders.

DATA SOURCES

We developed and piloted a search syntax and adapted it to enter the following databases from 1 January 2020 to 31 March 2023: PubMed/MEDLINE, PsycINFO, Web of Science, Epistemonikos and the WHO International Clinical Trials Registry Platform. We reran the searches from the end of the original search to 3 December 2024.

DESIGN

We systematically screened titles, abstracts and full texts of retrieved records.

ELIGIBILITY CRITERIA

We included observational studies on any populations and regions, covering health services such as doctor visits, hospital admissions, diagnostic examinations, pharmaceutical therapies and mental health (MH) services. Only studies using validated scales to assess psychological distress or mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders were included.

DATA EXTRACTION AND SYNTHESIS

We extracted data using a purposefully designed form and evaluated the studies' quality with the Newcastle-Ottawa Scale. We measured the incidence rate (IR) of access to health services and the IR ratio (IRR) between the prepandemic and the pandemic periods. We calculated contacts days and catchment areas in the different periods. We used the random effects DerSimonian-Laird inverse-variance model and calculated heterogeneity with statistics I² and τ². We computed pooled IR and pooled IRR and tested the hypothesis of no variation (IRR=1).

RESULTS

We retrieved 10 014 records and examined the full text of 580 articles. We included 136 primary studies of which 44 were meta-analysed. The IR of access to services during the pandemic was 2.59 contact months per 10 000 inhabitants (IR=2.592; 95% CI: 1.301 to 5.164). We observed a reduction of 28.5% in the use of services with negligible differences by age group and type of services (IRR=0.715; 95% CI: 0.651 to 0.785). We observed significant differences in effect sizes across studies (τ2=5.44; p<0.001 and τ2=0.090; p<0.001).

CONCLUSION

By considering MH, our study provides consolidated evidence and quantifies the reduction in the use of health services during the COVID-19 pandemic.

PROSPERO REGISTRATION NUMBER

CRD42023403778.

Changes in the number and characteristics of tertiary hospital psychiatric admissions in south Croatia before and during the COVID-19 pandemic: a retrospective study

BACKGROUND

There is mixed evidence on the impact of the Coronavirus disease (COVID-19) pandemic on psychiatric hospital care for people with severe mental diseases, possibly due to regional differences. There is a significant gap in knowledge regarding the specific impact of the COVID-19 pandemic on mental health in Croatia, a country in South-Eastern Europe. Our study aimed to evaluate the number and characteristics of psychiatric hospitalizations in the year before and during the first year of the COVID-19 pandemic in a tertiary hospital in south Croatia.

METHODS

This was a retrospective study of adult psychiatric hospitalizations at the University Hospital of Split, Croatia. Sociodemographic and clinical data of inpatients during the first year of the COVID-19 outbreak (March 1, 2020 - March 1, 2021) and the year before the pandemic (March 1, 2019 - February 29, 2020) were compared. Incidence rate ratio (IRR) was used to compare the number of hospitalizations; while sociodemographic and hospitalization characteristics were compared between the two periods with the Mann-Whitney U test or chi-squared test, as appropriate.

RESULTS

A significant reduction in hospitalization rate was observed during the COVID-19 pandemic (IRR = 0.72, 95% confidence interval 0.67-0.78, P < 0.0001). Compared to the year before the pandemic, hospitalizations due to suicidality increased almost 3 times, while hospitalizations due to both autoagression and heteroagression increased almost 4 times (P = 0.000). The proportion of hospitalized patients diagnosed with schizophrenia, schizotypal, and delusional disorders was significantly higher during the pandemic (61% vs. 52%), while neurotic, stress-related, and somatoform disorders decreased significantly (5.9% vs. 10%, P = 0.001). Furthermore, inpatients during the COVID-19 year were younger (P = 0.004), more educated (P = 0.040), had a higher prevalence of personal history of psychiatric diseases (P = 0.024), and experienced longer hospital stays (P = 0.002).

CONCLUSIONS

The COVID-19 pandemic caused a significant reduction in the psychiatric hospitalization rate at a tertiary university hospital in Croatia, with an increase in patients presenting with suicidality, aggression, and severe mental illnesses such as schizophrenia, schizotypal, and delusional disorders. These findings could help healthcare systems better adapt to the needs of the most vulnerable patients and address challenges in maintaining continuity of psychiatric care during public health crises.

Changes in psychiatric disorder incidence patterns during the COVID-19 pandemic in Korea: a study using the nationwide universal health insurance data

BACKGROUND

Few studies have evaluated the incidence of various psychiatric disorders during the coronavirus disease (COVID-19) pandemic using hospital visit data for the entire population of a nation. We used Korea's universal compulsory health insurance data to conduct a descriptive analysis to evaluate changes in psychiatric disorder incidence during the COVID-19 pandemic.

METHODS

Hospital visit data related to psychiatric disorders were retrieved from the National Health Insurance Database. First-ever diagnosis for specific psychiatric disorders for each Korean was identified (from January 2015 to February 2023) and monthly age-standardized incidence rates were calculated. An interrupted time-series analysis was used to estimate counterfactual disease incidence rates and observed and counterfactual rates were compared using difference-in-difference framework.

RESULTS

Compared to pre-pandemic period, there was a decrease in the incidence [percentage changes in monthly rate (95% confidence intervals)] of organic mental disorders [-14.6% (-18.4, -10.9)] and psychoactive substance related disorders [-12.9% (-17.5, -8.3)] during the pandemic. However, anxiety disorders [8.8% (3.1, 14.6)], behavioral syndromes associated with physiological disturbances [8.1% (4.2, 11.9)], mental retardation [8.6% (3.0, 14.2)], psychological developmental disorders [19.6% (11.5, 27.7)], childhood- and adolescent-onset behavioral and emotional disorders [45.1% (28.4, 61.8)], and unspecified mental diseases [51.8% (39.8, 63.8)] increased.

CONCLUSIONS

Psychological disease incidence patterns changed substantially during the pandemic in South Korea. Various pandemic-related stressors, such as disrupted lifestyles and hospital accessibility, may have influenced these changes. The causes and public health consequences of these changes require further evaluation.

National trends in counseling for stress and depression and COVID-19 pandemic-related factors among adults, 2009-2022: A nationwide study in South Korea: Stress, depression, and pandemic

To investigate the long-term trends in counseling for stress and depression using data from a nationwide survey in South Korea. We conducted a nationwide serial, large-scale, cross-sectional, survey-based study using data from 2,903,887 Korean adults from the Korea Community Health Survey, 2009-2022. Our study investigated the trends and risk factors for counseling for stress and depression during the pre-pandemic (2009-2019) and pandemic era (2020-2022). The prevalence of counseling for stress and depression increased across pre-pandemic (counseling for stress: β, 0.217 [95 % CI, 0.194 to 0.241]; counseling for depression: β, 0.136 [0.118 to 0.154]) and pandemic periods (β, 0.324 [0.287 to 0.360]; β, 0.210 [0.182 to 0.239], respectively). The prevalence of counseling for stress and depression showed steeper slopes for increasing trends after the outbreak. In addition, subgroups with female sex, urban residence, lower household income, lower self-rated health, shorter sleep time, and higher worries about contracting COVID-19 were the risk factors associated with the increased prevalence of counseling for stress and depression. Our study analyzed the trends in counseling for stress and depression among over two million South Korean adults in 2009-2022, revealing a significant escalation during the pandemic. These findings emphasize the need for mental health policies to support vulnerable groups during the pandemic.

Impact of the COVID-19 pandemic on adult mental health-related admissions at a large university health system in North Carolina - one year into the pandemic

OBJECTIVE

Pandemic-associated stress may have exacerbated preexisting mental health and substance use disorders (MH/SUD) and caused new MH/SUD diagnoses which would be expected to lead to an increase in visits to emergency departments and hospital admissions for these conditions. This study assessed whether the proportion of hospital and emergency department encounters for MH/SUD diagnoses increased during the first year of the COVID-19 pandemic in the United States.

METHODS

We conducted a longitudinal (interrupted time series) analysis of 994,724 eligible encounters identified by electronic query between January 1, 2016 and March 31, 2021. Of these, 55,574 encounters involved MH/SUD diagnosis. The pre-pandemic period was defined as January 1, 2016 to March 31, 2020, and the pandemic period was defined as April 1, 2020 to March 31, 2021. All statistical analyses were performed with R.

RESULTS

No significant trend in MH/SUD encounters at baseline (rate ratio 1.00, 95% CI 0.99-1.01, p = 0.75) was observed. However, the onset of the pandemic was temporally associated with a significant level increase in the proportion of MH/SUD encounters relative to overall encounters (rate ratio 1.14, 95% CI 1.06-1.21, p<0.001) with no change in the overall trend (rate ratio 0.99, 95% CI 0.90-1.10, p = 0.89).

CONCLUSIONS

The significant pandemic-associated increase in the proportion of MH/SUD encounters relative to overall encounters was driven largely by sustained numbers of MH/ SUD encounters despite a decrease in total encounters. Increased support for mental health care is needed for these vulnerable patients during pandemics.

The Impact of COVID-19 on Mental Healthcare Utilization in Switzerland Was Strongest Among Young Females-Retrospective Study in 2018-2020

Objectives: To provide a thorough assessment of the impact of the COVID-19 pandemic on the utilization of inpatient and outpatient mental healthcare in Switzerland. Methods: Retrospective cohort study using nationwide hospital data (n > 8 million) and claims data from a large Swiss health insurer (n > 1 million) in 2018-2020. Incidence proportions of different types of psychiatric inpatient admissions, psychiatric consultations, and psychotropic medication claims were analyzed using interrupted time series models for the general population and for the vulnerable subgroup of young people. Results: Inpatient psychiatric admissions in the general population decreased by 16.2% (95% confidence interval: -19.2% to -13.2%) during the first and by 3.9% (-6.7% to -0.2%) during the second pandemic shutdown, whereas outpatient mental healthcare utilization was not substantially affected. We observed distinct patterns for young people, most strikingly, an increase in mental healthcare utilization among females aged <20 years. Conclusion: Mental healthcare provision for the majority of the population was largely maintained, but special attention should be paid to young people. Our findings highlight the importance of monitoring mental healthcare utilization among different populations.