Dramatic reduction of psychiatric emergency consultations during lockdown linked to COVID-19 in Paris and suburbs

Referral of Patients to Psychiatric Emergency Departments by Police: A Systematic Review and Meta-Analysis

OBJECTIVE

A significant number of patients in psychiatric emergency departments (PEDs) are brought in by police. The authors sought to identify the weighted global rate of police referrals to PEDs, to compare the characteristics of police-referred patients with those of patients not referred by police, and to assess possible effects of the COVID-19 pandemic on referral rates.

METHODS

A systematic review was conducted by searching medical databases according to PRISMA guidelines. Multivariate and pairwise meta-regression analyses were performed.

RESULTS

Overall, 1,374 articles were screened, and 34 samples comprising 542,143 patients (61,647 of whom were referred by police) from 28 articles were included. On average, 13.7% of PED admissions were referred by police, a rate that was higher in the United States (22.8%). Compared with patients not referred by police, police-referred patients were significantly more likely to show aggressive behavior (relative risk [RR]=4.73), to be homeless (RR=1.84), and to have a diagnosis of a substance use (RR=1.33) or psychotic (RR=1.45) disorder but were less likely to have depressive (RR=0.31) or adjustment (RR=0.58) disorders. Police-referred patients were also more likely to be admitted to inpatient care (RR=1.35) and involuntarily (RR=4.38). The pandemic had no apparent effect on police-referral rates to PEDs.

CONCLUSIONS

A substantial proportion of psychiatric patients is referred to PEDs by police. Police-referred patients had characteristics that were similar to those of incarcerated individuals with mental disorders. Early treatment may prevent later incarceration of police-referred PED patients. Interventions to reduce homelessness among psychiatric patients might help reduce police referrals to PEDs.

Exposure to COVID-19 Pandemic-Related Stressors and Their Association With Distress, Psychological Growth and Drug Use in People With HIV in Nouvelle Aquitaine, France (ANRS CO3 AQUIVIH-NA Cohort-QuAliV-QuAliCOV Study)

We investigated people living with HIV (PLWH)'s exposure to COVID-19 pandemic stressors and their association with distress, psychological growth, and substance use. PLWH in the ANRS CO3 AQUIVIH-NA cohort's QuAliV study (Nouvelle Aquitaine, France) completed an adapted CAIR Lab Pandemic Impact Questionnaire (C-PIQ) and reported substance use between 9/2021 to 3/2022. We described cumulative stressor exposure (score 0-16) and explored variation by PLWH characteristics (demographic, HIV-related, risk factors, psychosocial). Associations with distress (score 0-23), psychological growth (score 0-20), and substance use were assessed using regression models. Participants reported exposure to a median of 2 (IQR: 1-4) stressors. Stressor exposure was higher in working-age (<60) and psychosocially vulnerable PLWH. Exposure to an additional stressor correlated with a 0.7-point increase in distress scores (95% C.I. 0.5-1.0, p<0.001), a 0.04-point increase (95% C.I. 0.01-0.07, p=0.002) in psychological growth scores in working-age PLWH. In older PLWH, additional stressor correlated with a 0.8-point (95% C.I. 0.4-1.2, p<0.001) increase in distress and a 0.1-point increase (95% C.I. 0.06-0.2, p=0.001) in growth scores. Each additional stressor was associated with 1.2 (95% C.I. 1.0-1.4, p=0.02) higher adjusted odds of cannabis use in working-age PLWH, and 1.2 (95% C.I. 1.0-1.4, p=0.004) higher adjusted odds of drug use. Exposure to stressors was linked to increased distress, cannabis and drug use but also growth. Providers should not only be aware of risk (of severe COVID-19) but also be mindful of the social and psychological challenges PLWH face as these may affect their retention in care, especially during challenging times.

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.

Trends in psychiatric emergency visits: insights from France's largest psychiatric emergency department

INTRODUCTION

Psychiatric emergency departments (EDs) in France have been under pressure from several factors, exacerbated by the COVID-19 pandemic. The pandemic led to an increase in psychiatric disorders, particularly anxiety and depression, with younger people and women being most affected. The aim of this study was to provide a comprehensive description of the trends in the number of visits to the largest psychiatric emergency department in France, with a particular focus on the period preceding and following the advent of COVID-19 pandemic.

METHODS

This retrospective study analyzed data from 69,764 visits to the Centre Psychiatrique d'Orientation et d'Accueil (CPOA) in Paris from 2016 to 2023. Patient data, including demographics, reasons for visit, and diagnoses, were collected and analyzed to identify trends over this period.

RESULTS

The study observed a 28.5% increase in ED visits from 2016 to 2023. The increase was primarily driven by mood and anxiety disorders, which showed increases of 38.6% and 75.4%, respectively. The average age of patients decreased, reflecting a younger population increasingly affected by psychiatric problems. Interestingly, despite the increase in ED visits, hospital admissions decreased by 11.9%, with a notable decrease in involuntary commitment.

DISCUSSION

The findings highlight a paradox where increased psychiatric ED visits are not accompanied by an increase in hospital admissions. This suggests a shift toward outpatient care due to systemic factors, including reduced hospital bed availability and challenges in accessing timely outpatient services. This study underscores the need to strengthen outpatient mental health services to effectively manage the growing demand. Further research, especially multicenter studies, is recommended to validate these findings and inform policy changes.

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.

How Has the COVID-19 Pandemic Impacted Addiction Services? A Study of the Different Periods of the Pandemic and Patient Treatment Follow-up Over 1 Year

Background

Various studies have provided evidence of the impact of COVID-19 and the measures adopted by governments on drug use and its treatment. After 4 years, a more precise assessment of the evolution of patients and addiction treatment services can be made. The objective of this study is to compare different periods during the COVID-19 pandemic to identify changes in patient profiles and the care activity of addiction treatment centres.

Methods

A retrospective observational study was conducted using data from March 14, 2019 to June 22, 2022, from addiction centres of Andalusia (Spain). Information related to the treatment of each patient was collected during 1 year after the initiation of treatment (until June 22, 2023). Electronic health records of 29 740 outpatients were analysed and divided into 4 periods (pre-pandemic, lockdown, return to normal and post-lockdown).

Results

Differences were found across the analysed periods. Admissions declined during the lockdown period but subsequently increased, without reaching pre-pandemic levels. Admission to treatment due to opioid dependence increased during the lockdown. In contrast, the percentage of patients with dual pathology decreased. An increase in the dropout rate of patients from treatment was observed compared to the pre-pandemic period.

Conclusions

The results revealed a similar patient profile across the different analysed periods. The most notable changes are observed in healthcare activity, which appears to have decreased. Therefore, a greater investment is likely required for the reformulation of addiction centres and increased funding to provide adequate assistance to these patients.

Risk of admission to hospital for self-harm after admission to hospital for COVID-19: French nationwide longitudinal study

BACKGROUND

Assessing the risk of subsequent self-harm after hospitalisation for COVID-19 is critical for mental health care planning during and after the pandemic.

AIMS

This study aims to compare the risk of admission to hospital for self-harm within 12 months following a COVID-19 hospitalisation during the first half of 2020, with the risk following hospitalisations for other reasons.

METHOD

Using the French administrative healthcare database, logistic regression models were employed to analyse data from patients admitted to hospitals in metropolitan France between January and June 2020. The analysis included adjustments for sociodemographic factors, psychiatric history and the level of care received during the initial hospital stay.

RESULTS

Of the 96 313 patients hospitalised for COVID-19, 336 (0.35%) were subsequently admitted for self-harm within 12 months, compared to 20 135 (0.72%) of 2 797 775 patients admitted for other reasons. This difference remained significant after adjusting for sociodemographic factors (adjusted odds ratio (aOR) = 0.66, 95% CI: 0.59-0.73), psychiatric disorder history (aOR = 0.65, 95% CI: 0.58-0.73) and the level of care received during the initial hospital stay (aOR = 0.70, 95% CI: 0.63-0.78). History of psychiatric disorders and intensive care were strongly correlated with increased risk, while older age was inversely associated with self-harm admissions.

CONCLUSIONS

Hospitalisation for COVID-19 during the early pandemic was linked to a lower risk of subsequent self-harm than hospitalisation for other reasons. Clinicians should consider psychiatric history and intensive care factors in evaluating the risk of future suicide.

Impact of COVID-19 restrictive measures during lockdown period on eating disorders: An umbrella review

The COVID-19 pandemic has sparked or amplified many mental health problems. The aim of this study was to compile evidence from existing systematic reviews to provide an overall assessment of the impact of social restrictions during the COVID-19 pandemic on people affected by eating disorders (EDs). PubMed and Scopus were searched up to August 16, 2023. Systematic reviews and meta-analyses were selected using the PRISMA 2020 statement. The quality assessment of the included studies was conducted using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Eleven studies were included in this umbrella review. Six main categories emerged from the studies described in the review: dietary changes and psychopathological effects showed an overall worsening of symptomatology; in studies concerning the impact of isolation and restrictive measures, it was found that social distancing was associated with feelings of loneliness, anxiety, and depression; limited access to direct care was found and therapeutic changes were made; the influence of mass media negatively impacted people with ED; several studies reported positive findings regarding symptomatology; finally, studies regarding 'impact on vulnerable populations showed that vulnerable people are more at risk of reporting body image distortion and eating disorders. The COVID-19 pandemic has negatively impacted most of the population with ED leading to a worsening of specific symptomatology. In addition, this worsening of the condition may be caused by limited access to care and treatment, changes in routine, or to the negative influence of the media.

COVID-19 pandemic and emergency department visits for psychosis: Visit volume, restraint use, medication use, psychiatric hospitalization, and length of stay

BACKGROUND

Individuals with a schizophrenia spectrum disorder were at heightened risk for interruptions in psychiatric care during the coronavirus-19 (COVID 19) pandemic. There is limited work exploring the pandemic's impact on emergency department (ED) visit volume, use of restraint and parenteral medications, inpatient psychiatric (IP) hospitalization, and ED length of stay (LOS) among this population.

METHODS

We retrospectively examined 2134 ED visits with a billing code for psychosis between March 1, 2019-February 28, 2021. We used Poisson regression analysis to compare ED visit volume between the pandemic and pre-pandemic periods. Restraint use, parenteral antipsychotic or benzodiazepine use, IP hospitalization, and ED LOS were compared between the two periods using chi-square tests and independent samples t-tests.

RESULTS

Overall volume of psychosis-related ED visits during the pandemic did not differ significantly from the prior year. Rates of restraint use (16.2 % vs 11.6 %, p < .01), parenteral antipsychotic (22.6 % vs 14.9, p < .001), and parenteral benzodiazepine (22.3 % vs 16.3 %, p < .001) use were significantly higher during the pandemic. Fewer patients had an IP hospital disposition during the pandemic than the year prior (57.8 % vs. 61.9 %, p < .05). ED LOS was longer during the pandemic compared to pre-pandemic (28.37 h vs 20.26 h, p < .001).

CONCLUSIONS

Although the volume of psychosis-related ED visits remained constant, restraint and parenteral medication use rates were significantly higher during the pandemic. ED LOS increased but fewer ED visits resulted in IP hospitalization. These findings underscore the importance of planning for increased acuity of psychosis ED presentations during public health emergencies.

Evolution of the profiles of new psychotropic drug users before and during the COVID-19 crisis: an original longitudinal approach through multichannel sequence analysis using the French health-care database

The COVID-19 pandemic has had a substantial impact on mental health. An increase in the use of anxiolytic, hypnotic, and antidepressant drugs has been highlighted in France, but with no information at the individual level (trajectories) or concerning patient characteristics. The objective of this study was to describe the profile of new psychotropic drug users since the beginning of the pandemic. We formed two historical cohorts using the Pays-de-la-Loire regional component of the National Health Data System (SNDS): a "COVID-19 crisis cohort" (2020-2021) and a "control cohort" (2018-2019). We analyzed reimbursements for psychotropic medications (anxiolytics, antidepressants, hypnotics, mood stabilizers, and antipsychotics) using a multichannel sequence analysis and performed clustering analysis of sequences. The proportion of new consumers of psychotropic drugs was higher in the COVID-19 crisis cohort (18.0%) than that in the control cohort (16.0%). In the COVID-19 cohort, three clusters of psychotropic drug users were identified, whereas four clusters were identified in the control cohort. A time lag in treatment initiation was observed in the COVID-19 crisis cohort (September) compared with the control cohort (July). This study is one of the first to analyze the profile of psychotropic treatment users during the COVID-19 crisis. Our analysis sheds light on changes in patterns of psychotropic drug use during the COVID-19 pandemic, possibly associated with changes in prescribing conditions and mental health conditions during the crisis. This study also provides an example of the application of an innovative longitudinal analysis methodology in the field of pharmacoepidemiology.

Development of depression assessment tools using humanoid robots -Can tele-operated robots talk with depressive persons like humans?

BACKGROUND

Depression is a common mental disorder and causes significant social loss. Early intervention for depression is important. Nonetheless, depressed patients tend to conceal their symptoms from others based on shame and stigma, thus hesitate to visit psychiatrists especially during early phase. We hypothesize that application of humanoid robots would be a novel solution. Depressed patients may feel more comfortable talking with such robots than humans.

METHODS

We recruited 13 patients with major depressive disorder (MDD) and 27 healthy volunteers as controls. Participants took both tele-operated humanoid robot and human interviews to evaluate severity of depression using the Hamilton Depression Rating Scale (HDRS). In addition, participants completed a self-administered questionnaire asking about their impressions of the robot interview.

RESULTS

Confidence interval and t-test analysis have revealed that the HDRS scores are equally reliable between robot and human interviews. No significant differences were observed between the two interviews regarding "nervousness about the interview" and "hesitancy to talk about depressed moods and suicidal ideation." Compared to human interviews, robot interviews yielded significantly lower scores on shame-related factors especially among patients with MDD.

LIMITATION

Small sample size, and the evaluator is male only.

CONCLUSIONS

This is the first report to show the reliability of tele-operated humanoid robot interviews for assessment of depression. Robot interviews are potentially equally reliable as human interviews. Robot interviews are suggested to be more appropriate in assessing shame-related suppressed emotions and hidden thoughts of depressed patients in clinical practice, which may reduce the stigma associated with depression.

[Impact of the 2020 lockdown on prehospital psychiatric emergencies in a large city]

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low.

OBJECTIVE

The aim of this paper is to investigate the impact of the first lockdown during the COVID-19 pandemic in 2020 on emergency ambulance services for psychiatric patients in a large German city.

MATERIAL AND METHODS

A retrospective analysis was conducted on all prehospital psychiatric emergencies in a large German city during the first pandemic-related lockdown from 22 March 2020 to 4 May 2020, with the same period in 2019 serving as a reference.

RESULTS

During the first lockdown there was a significant increase in the number of emergency missions with respect to psychiatric cases. A substantial rise in substance-associated deployments was observed. Moreover, there was an increase in the proportion of psychiatric patients who did not meet emergency criteria. Suicidal tendencies and agitation status played a minor role during the lockdown.

CONCLUSION

The lockdown had a notable impact on the frequency and profile of emergency physician calls in the metropolitan area studied. The substantial increase in substance-associated callouts can be interpreted as both a deterioration in access to the healthcare system and an expression of the increased stress faced by the general population and vulnerable groups in particular.

Prevalence of COVID-19 and Psychotropic Drug Treatment in Psychiatric In-patients in Germany in 2020: Results from a Nationwide Pilot Survey

INTRODUCTION

In patients with a pre-existing mental disorder, an increased risk for a first manifestation of a psychiatric disorder in COVID-19 patients, a more severe course of COVID-19 and an increased mortality have been described. Conversely, observations of lower COVID-19 incidences in psychiatric in-patients suggested protective effects of psychiatric treatment and/or psychotropic drugs against COVID-19.

METHODS

A retrospective multi-center study was conducted in 24 German psychiatric university hospitals. Between April and December 2020 (the first and partly second wave of COVID-19), the effects of COVID-19 were assessed on psychiatric in-patient care, the incidence and course of a SARS-CoV-2 infection, and treatment with psychotropic drugs.

RESULTS

Patients (n=36,322) were admitted to the hospitals. Mandatory SARS-CoV-2 tests before/during admission were reported by 23 hospitals (95.8%), while 18 (75%) conducted regular testing during the hospital stay. Two hundred thirty-two (0.6%) patients were tested SARS-CoV-2-positive. Thirty-seven (16%) patients were receiving medical treatment for COVID-19 at the psychiatric hospital, ten (4.3%) were transferred to an intermediate/intensive care unit, and three (1.3%) died. The most common prescription for SARS-CoV-2-positive patients was for second-generation antipsychotics (n=79, 28.2%) and antidepressants (SSRIs (n=38, 13.5%), mirtazapine (n=36, 12.9%) and SNRIs (n=29, 10.4%)).

DISCUSSION

Contrary to previous studies, our results showed a low number of infections and mortality in SARS-CoV-2-positive psychiatric patients. Several preventive measures seem effective to protect this vulnerable group. Our observations are compatible with the hypothesis of a protective effect of psychotropic drugs against COVID-19 as the overall mortality and need for specific medical treatment was low.

Impacts of PM2.5 before and after COVID-19 outbreak on emergency mental disorders: A population-based quasi-experimental and case-crossover study

The ongoing COVID-19 pandemic is a great challenge to mental health, but fine particulate matter (PM2.5), an increasingly reported risk factor for mental disorders, has been greatly alleviated during the pandemic in many countries. It remains unknown whether COVID-19 outbreak can affect the association between PM2.5 exposure and the risk of mental disorders. This study aimed to investigate the associations of total and cause-specific mental disorders with PM2.5 exposure before and after the COVID-19 outbreak in China. Data on daily emergency department visits (EDVs) and hospitalizations of mental disorders from 2016 to 2021 were obtained from Anhui Mental Health Center for Hefei city. An interrupted time series analysis was used to quantify the impact of COVID-19 outbreak on EDVs and hospitalizations of mental disorders. A time-stratified case-crossover analysis was employed to evaluate the association of mental disorders with PM2.5 exposure before and after the COVID-19 outbreak, especially in the three months following the COVID-19 outbreak. After COVID-19 outbreak, there was an immediate and significant decrease in total mental disorders, including a reduction of 15% (95% CI: 3%-26%) in EDVs and 44% (95% CI: 36%-51%) in hospitalizations. PM2.5 exposure was associated with increased risk of EDVs and hospitalizations for total and cause-specific mental disorders (schizophrenia, schizotypal and delusional disorders; neurotic, stress-related, and somatoform disorders) before COVID-19 outbreak, but this PM2.5-related risk elevation significantly decreased after COVID-19 outbreak, with greater risk reduction at the first month after the outbreak. However, young people (0-45 years) were still vulnerable to PM2.5 exposure after the COVID-19 outbreak. This study first reveals that the risk of PM2.5-related emergency mental disorders decreased after the COVID-19 outbreak in China. The low concentration of PM2.5 might benefit mental health and greater efforts are required to mitigate air pollution in the post-COVID-19 era.

Impact of COVID-19 on emergency service usage in Turkey: interrupted time series analysis

The aim of this study is to reveal the impact of the COVID-19 pandemic, which constitutes an extraordinary situation, on the habits of emergency health service use. The data of the study consist of emergency service applications of a public hospital in Turkey between the years 2018-2021. The number of applications to the emergency service was examined periodically. The interrupted time series analysis method was used to reveal the impact of the COVID-19 outbreak on emergency service admissions. When the main findings are analyzed in quarterly periods (3 months = 1 quarter); there has been a sharp decrease in emergency service applications since March 2019, when the first case was seen in Turkey. When an evaluation is made between consecutive quarters, it is seen that there are fluctuations up to 80% in the number of applications. When the statistical analysis findings are examined; while the effect of COVID-19 on the number of applications was found to be significant for the first four periods, it was found to be insignificant for the following periods. With the conducted study, it was revealed that COVID-19 has a significant impact on the use of emergency health services. Although there was a statistically significant decrease in the number of applications, especially in the months following the first case, there was an increase in the number of applications over time. Considering the necessity of using emergency health services when necessary, it can be thought that some of the decrease in the number of applications during the COVID-19 period will be related to the use of unnecessary emergency health services.

Psychological state and predictors of psychiatric morbidity in COVID-19 patients six weeks after discharge

To be able to detect possible psychological distress and long-term deterioration caused by COVID-19, following the patient, who has recovered, is crucial. Therefore, this study (i); aims to examine the ongoing fear-loss of control, the rate of anxiety, depression, and post-traumatic stress disorder levels following the 6th week after discharge; (ii) to examine the effect of post-traumatic stress disorder on anxiety, and depression and (iii) within the same context to reveal the developmental markers of psychiatric morbidity and the risk group. The study includes 180 patients who were hospitalized with COVID-19 diagnosis. Sociodemographic Data Form, the Hospital Anxiety Depression Scale and the Impact of Event Scale-Revised were used in the current study. High rates of symptoms of anxiety, depression, and PTSD were reported by the inpatients, as more than one-third scored above the anxiety and depression cut-off scores of borderline abnormal and abnormal. Also, 37.22 % of the participants reported the likely presence of PTSD symptoms. Anxiety and depression were significantly positively related to the symptoms of PTSD. The results suggest that there is psychiatric morbidity in anxiety, depression, and post-traumatic stress disorder and that especially posttraumatic stress poses a risk for other psychopathologies.

One year of psychiatric presentations to a hospital emergency department during COVID-19

OBJECTIVES

To examine the impact of the first full year of the COVID-19 pandemic and its associated restrictions on the volume and nature of psychiatric presentations to an emergency department (ED) in a large academic hospital.

METHODS

Anonymised clinical data on psychiatric presentations to the ED were collected for the 52-week period from the start of the COVID-19 pandemic and compared with corresponding 1 year periods in 2019 and 2018.

RESULTS

There was a significant increase in psychiatric presentations overall to the ED during the first year of the COVID-19 pandemic compared to previous years, in contrast to a reduction in total presentations for all other specialties. There was a marked increase in psychiatric presentations of those below 18 years, and in the 30-39 years and 40-49 years age groups, but a decrease in the 18-29 years group. There was a significant increase in anxiety disorder presentations but a decrease in alcohol related presentations. There was no significant change observed in the rates of presentations for self-harm or suicidal ideation.

CONCLUSIONS

Psychiatric presentations to the ED have increased during the first year of the COVID-19 pandemic in contrast to a decrease in presentations for other medical specialties, with this increase being driven by out-of-hours presentations. The fourfold increase in presentations of young people below the age of 18 years to the ED with mental health difficulties is an important finding and suggests a disproportionate burden of psychological strain placed on this group during the pandemic.

Impacts of COVID-19 Pandemic on Three IVF Clinics of Jakarta, Indonesia: A Retrospective Qualitative and Quantitative Study

BACKGROUND

Corona virus disease-19 (COVID-19) pandemic also led to a reduction or even the suspension of elective health services. These decisions affected in vitro fertilization (IVF) programs worldwide. Therefore, it is essential to map the readiness of IVF clinics in providing safety in this situation and in the future.

MATERIALS AND METHODS

This is a retrospective qualitative and quantitative research done in 2021 that involved three IVF clinics of Jakarta, Indonesia. Those three clinics were government-owned, private-owned, and educational and training center. The qualitative data of each clinic's readiness towards COVID-19 was obtained from interviews with the clinics staff. The quantitative data were collected from the clinics patients' number and demographic data from 2019-2021 as well as from COVID-19 databases. Both data sets were analysed descriptively and only for the quantitative analysis Stata version 16 was used.

RESULTS

There were changes in the domiciles and number of patients attending the three clinics. The ratio of patients from Jakarta increased while patients from outside Java Island decreased. There was a drop in annual patient numbers in 2020. However, from June 2020 to December 2021, the number of monthly IVF cycles increased significantly by 3.5 cycles per month (P=0.001). There was no association between IVF patients' attendance numbers and COVID-19 cases (P=0.785). One of the clinics had a negative pressure operating theatre, which made them more confident in treating patients with COVID-19 positive and made them even had higher IVF cycles started than the pre-pandemic period.

CONCLUSION

Those three clinics are prepared in facing COVID-19, as they complied with government regulations. As the COVID-19 pandemic progressed, the number of patients gradually returned to normal.

Psychotropic drugs consumption during 2020 COVID-19 pandemic and lockdowns: Evidence of a surprising resilience of the drugs delivery system in France

The COVID-19 pandemic imposed two lockdowns of eight and six weeks in France. While access to care was reduced during lockdown periods, these stressful situations with the pandemic and lockdown periods may have a negative impact on mental health, especially in vulnerable subgroups. Monitoring of psychotropic drugs consumption in France is a comprehensive and reliable tool for indirectly analyzing the mental health of French people. This historical cohort study (n = 767 147) investigated the short-term and long-term evolution of the weekly trend of psychotropic drugs users in 2020 by performing a Seasonal Trend decomposition time series analysis. Rate of progression of consumers per week increased from 186 in the last week of 2019 to 261 per week in the last week of 2020 (+40.3%). Our results did not show a significant break in psychotropic drugs consumption trends during the year 2020 and its two lockdowns. The increase in trend regarding psychotropic drugs consumptions was greatest in young people (<15 years) and patients not being socially deprived. Despite the increase in consumers with restrictive health measures, the French drugs delivery system has been able to adapt with the support of government and pharmacy network. This point should be kept in mind as the necessary reforms to the health care system are undertaken. The COVID-19 pandemic has a negative impact on mental health and two lockdowns occurred in France with reduced access to care. In this context, monitoring of psychotropic drugs consumption is a comprehensive and reliable tool for analyzing the mental health of French people. We hypothesized that the psychotropic drugs consumption has increased during the 2020 COVID-19 pandemic, testifying to French people mental health deterioration, with psychotropic drugs consumption breaks during lockdowns, especially during the first "grand national lockdown", due to the closure or difficulties for accessing to health care structures. By carrying out a historical cohort study among Pays de la Loire residents (n = 767 147), we investigated evolution of the weekly trend of psychotropic drugs users in 2020 compared to 2019 by performing a Seasonal Trend decomposition time series analysis. Between 2019 to 2020, we found a + 40.3% rate of progression of consumers per week. During the year 2020, changes in trend regarding psychotropic drugs consumptions was observed in various sub-groups, e.g. greater in the youngest (< 15 years), which may indicate a vulnerable group strongly impacted by COVID-19 negative consequences, and patients not being socially deprived, which may indicate a group with probably an easier access to care. Lockdown periods were not associated with a significant change in psychotropic drug use, suggesting a form of resilience in the French health care system to maintain its capacity to deliver psychotropic treatments. We mainly discussed that despite the increase in consumers and the policies of restricting access to care during lockdown periods, the French drugs delivery system has been able to adapt thanks to supportive policy actions (extension of the prescriptions validity without the need for a renewal by a physician during periods of lockdowns), an efficient pharmacy network with a collaborative practice of health actors that need to be developed and/or conserved to face potential future health crises.

The risk of hospitalization for psychotic disorders following hospitalization for COVID-19: a French nationwide longitudinal study

COVID-19, like other infectious diseases, may be a risk factor for psychotic disorders. We aimed to compare the proportions of hospitalizations for psychotic disorders in the 12 months following discharge from hospital for either COVID-19 or for another reason in the adult general population in France during the first wave of the pandemic. We conducted a retrospective longitudinal nationwide study using the national French administrative healthcare database. Psychotic disorders were first studied as a whole, and then chronic and acute disorders separately. The role of several adjustment factors, including sociodemographics, a history of psychotic disorder, the duration of the initial hospitalization, and the level of care received during that hospitalization, were also analyzed. Between 1 January 2020 and 30 June 2020, a total of 14,622 patients were hospitalized for psychotic disorders in the 12 months following discharge from hospital for either COVID-19 or another reason. Initial hospitalization for COVID-19 (vs. another reason) was associated with a lower rate of subsequent hospitalization for psychotic disorders (0.31% vs. 0.51%, odds ratio (OR) = 0.60, 95% confidence interval (CI) [0.53-0.67]). This was true for both chronic and acute disorders, even after adjusting for the various study variables. Importantly, a history of psychotic disorder was a major determinant of hospitalization for psychotic disorders (adjusted OR = 126.56, 95% CI [121.85-131.46]). Our results suggest that, in comparison to individuals initially hospitalized for another reason, individuals initially hospitalized for COVID-19 present a lower risk of hospitalization for first episodes of psychotic symptoms/disorders or for psychotic relapse in the 12 months following discharge. This finding contradicts the hypothesis that there is a higher risk of psychotic disorders after a severe COVID-19.

Mental Health in the Post-Lockdown Scenario: A Scientometric Investigation of the Main Thematic Trends of Research

Since the outbreak of COVID-19, researchers and clinicians have published scientific articles on the SARS-CoV-2 virus and its medical, organizational, financial, and psychological implications. However, many effects have been observed in the post-lockdown scenario. In this study, we adopted a scientometric-bibliometric approach to drawing the state of the art regarding the emotional and psychological effects of the pandemic after the lockdown. In Scopus, we found 791 papers that were subsequently analyzed using CiteSpace. The document co-citation analysis (DCA) computation generated a network of eight major clusters, each representing a central area of investigation. Specifically, one major cluster-cluster no. 1-focuses on the long-term effects of the COVID-19 pandemic and individuals' ability to develop adaptive coping mechanisms and resilience. The results allow us to frame the fields covered by researchers more precisely and the areas that still need more investigation.

Impact of the lockdown by the COVID-19 pandemic on suicidal trend in the Colombian Coffee Region

Suicide is considered a Public Health issue. In 2019 the Colombian suicide rate was 5.8 per-100.000 inhabitant. Likewise, the Colombian Coffee Region has doubled the national average on these rates. On the other hand, the Pandemic COVID 19 socio-economic consequences are aggravating the risk factors that we've known about suicide.

Objective

To evaluate the suicidal trend in the population of the Colombian Coffee Region during the COVID-19 pandemic and compare it with a non-pandemic period.

Methods

The data were taken from the National Institute of Legal Medicine and Forensic Science for the suicidal events during the 2016-2020 period in the Colombian Coffee Region, and the Montecarlo Regression was applied using the JoinPoint Regression Program.

Results

We found 1022 cases, most of them were men. The mean age was 34 years. The most used method was hanging in both sexes. Half of them had at least a high school degree. Half of the suicides were committed by single people. One-third of the cases had a previous mental illness. There are significant differences in the suicidal trend between the lockdown period and the non-lockdown period with a P value < 0.05.

Conclusions

We found most suicidal cases between older men and an inversely proportional relationship between education and suicidal rate. Is interesting that the most applied method for suicide for both sexes was hanging. The suicidal trend was increasing until 2020, although in the lockdown we found a decrease. In the post-lockdown period for men was a posterior increase and for women the trend has a continued decrease.

Trends and Prevalence of Hospital Admissions Related to Deliberate Self-Poisoning and Used Substances in Romanian Adolescents between 2016 and 2022

Rates of self-poisoning are increasing substantially all around the world, with self-poisoning being the most common form of self-harm leading to hospitalization in children and adolescents. This study aims to investigate the trends in the number of deliberate self-poisoning admissions in Romanian adolescents during the period of 2016-2022, as well as the most frequently used substances and the impact of the COVID-19 pandemic on hospital admissions due to self-poisoning and substance use in relation to these episodes. The sample included 178 patients admitted to the Clinic of Pediatric Psychiatry in Cluj-Napoca from 2016 to 2022 due to an episode of self-poisoning. Data were collected on patients' sociodemographic characteristics, psychosocial characteristics, and medical histories. We report a slight overall increase in the self-poisoning admission rate during the studied period. There was a decrease during the initial period of the pandemic, with significantly increasing rates in the second year of the pandemic. The mean prevalence rate of hospital admissions due to self-poisoning episodes during the study period was 3.14% (95% CI 2.72, 3.63). Adolescent girls were identified as the most vulnerable group, with the female-to-male ratio increasing dramatically. In terms of substance use, benzodiazepines; over-the-counter analgesics, including paracetamol; and antidepressants were the most frequently used substances. We emphasize the importance of careful consideration in prescribing psychotropic drugs, as well as the need for regulation of over-the-counter drug dispensation.

Locked down or locked out? Trends in psychiatric emergency services utilization during the COVID-19 pandemic

OBJECTIVE

To estimate changes in Boston Emergency Services Team (BEST) psychiatric emergency services (PES) encounter volume (total and by care team) and inpatient disposition during the first 8 months of the COVID-19 pandemic.

METHODS

Data on 30,657 PES encounters was extracted from the four-county, BEST reporting system. The study period consisted of the first 34 weeks of 2019 and 2020. This period corresponded to the first five stages of Massachusetts's COVID-19 public health restrictions: pre-lockdown, lockdown, Phase I, II and III reopenings. Descriptive and regression analyses were performed to estimate changes in encounter volume by care team and disposition.

RESULTS

Compared to the same period in 2019, covariate-adjusted, weekly PES encounters decreased by 39% (β = -0.40, 95% Confidence Interval (CI) = [-0.51, -0.28], p < 0.00) during the lockdown. PES volume remained significantly lower during Phase I reopening compared to the previous year but returned to 2019 levels during Phase II. The covariate-adjusted proportion of weekly encounters that led to inpatient admission significantly increased by 16% (CI = [0.11, 0.21], p < 0.00) for mobile crisis teams (MCTs) and significantly declined by 13% (CI = [-0.19, -0.07], p < 0.00) for BEST-designated emergency departments during the lockdown period compared to the prior year.

CONCLUSIONS

The overall drop in PES utilization and the rise in inpatient admissions for MCT encounters suggests that during the early phases of the pandemic, patients delayed psychiatric care until they had a psychiatric crisis. Public health messaging about the lockdowns and absent equivalent messaging about the availability of telehealth services may have made patients more reluctant to seek psychiatric care.

Trends in emergency department visits for suicide attempts before and during the COVID-19 pandemic in Korea: A nationwide study, 2016-2021

BACKGROUND

There is increasing concern that the effects of the COVID-19 pandemic will result in excess suicides by increasing known risk factors, such as suicide attempts. However, evidence on the long-term impacts of COVID-19 on suicide attempts is lacking. We aimed to assess the short- and long-term effects of the COVID-19 pandemic on patients with suicide attempts in emergency departments (EDs) and to evaluate age- and sex-specific differences.

METHOD

We conducted nationwide cross-sectional study among patients with suicide attempts in the ED from 2016 to 2021. The trend test were used to determine whether study subjects were affected by changes in ED visits for suicide attempts. We estimated the average annual percentage change (APC) stratified by sex and age groups.

RESULTS

The number of ED visits related to suicide attempts increased from 27,581 in 2016 to 37,719 in 2021. In particular, it decreased immediately after the COVID-19 pandemic but increased again in 2021. We identified that the average APC increased by 6.8 % overall, 1.6 % among males, and 10.8 % among females. Moreover, the APC of trend sharply increased in patients aged 10s and 20s. The in-hospital mortality was 3.6 % for females, compared to 9.5 % for males, which showed sex differences.

LIMITATIONS

Other information such as severity of injury, interpersonal relationships were not available. This study was limited to confirming causal relationship based on a descriptive study.

CONCLUSIONS

The incidence of suicide attempts in ED has increased in Korea. In particular, there was a sharp increase among women, adolescents and young adults. Patient-tailored treatment and preventive medical system for suicide attempts is important.

Utilisation of rehabilitation due to mental disorders during the SARS-CoV-2 pandemic: a difference-in-differences analysis

BACKGROUND

Our analyses examined the extent to which the use of rehabilitation for patients with mental disorders decreased due to the COVID-19 pandemic in Germany.

METHODS

We used monthly cross-sectional administrative data on rehabilitation utilisation due to mental disorders in 2019 and 2020 and estimated a difference-in-differences model to determine the reduction in rehabilitation utilisation attributable to the pandemic.

RESULTS

We included 151,775 rehabilitations in 2019 and 123,229 rehabilitations in 2020 in our analysis. The number of rehabilitations decreased from April to December by 14.2% due to the pandemic (March to December: 21.8%). The decline was more pronounced for women than for men and varied regionally. Temporal and regional differences in utilisation were moderately associated with the decrease in mobility in the pandemic year. In the first phase of the pandemic, i.e., March and April 2020, the decline was strongly associated with the regional incidence of SARS-CoV-2 infection.

CONCLUSION

Due to the pandemic, significantly fewer rehabilitations due to mental disorders occurred in Germany in 2020 than in 2019. The likely increasing need for rehabilitation for people with mental disorders should be addressed by making rehabilitation access and delivery more flexible.

Psychiatric Admissions in a Large Hospital in Madrid during COVID-19 Lockdown: Was There a Change in Patient Profile?

COVID-19 led to a reorganization of health care in Madrid. The objective of this study is to describe the sociodemographic and clinical profile of psychiatric patients admitted to Gregorio Marañón Hospital during lockdown.

Use of mental health services in the aftermath of COVID-19 waves: a retrospective study conducted in a French Psychiatric and Neurosciences University Hospital

OBJECTIVE

The COVID-19 pandemic and the restrictive measures taken to prevent its propagation had profound effects on mental health and well-being, especially in children and young adults (<25 years old). This study aimed to analyse the medium and long-term impact of the COVID-19 pandemic on the use of the mental health services, by age groups and gender.

DESIGN

We conducted a retrospective study using the medical and administrative information system databases of patients, between 2019 and 2021.

SETTING

This study was conducted in the Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences.

OUTCOME MEASURES

We reported three indicators: the number of new patients attending outpatient clinics, the number of emergency department (ED) visits and the number of hospital admissions.

METHODS

We considered the weekly number of each indicator, by age groups and by gender. We also collected the reasons of ED visits and hospital admissions. The 2020 and 2021 data were compared with the same period in 2019. The evolution of the indicators over the 3 years was analysed with interrupted time-series analysis.

RESULTS

All three indicators showed a dramatic decrease during the first lockdown period (March 2020) especially for the youngest. In 2021, the activity resumed but without reaching its prepandemic level. Moreover, mental healthcare seeking was significantly lower since the beginning of the pandemic compared with the prepandemic period for all age groups, except for young women (<25 years old). Among them, there was a higher level of mental health services use in 2021, compared with 2019: +20% of new patients at the outpatient clinics, +39% of ED visits and+17% of hospital admissions.

CONCLUSIONS

The COVID-19 pandemic has had severe consequences on populations' mental health, especially among young women, which seem to persist months after the end of restrictive measures.

Retrospective Study of Psychiatric Hospitalizations in a West Texas Mental Health Treatment Facility during the COVID-19 Pandemic

OBJECTIVES

The association between the coronavirus disease (COVID-19) pandemic and adverse mental health outcomes has been well documented; however, little is known about its impact in rural areas of the United States. This study aims to characterize and compare inpatient psychiatric admissions in West Texas before and during the initial months of the COVID-19 pandemic.

METHODS

A retrospective study was conducted using the electronic health records of 1392 inpatient psychiatric admissions from period A (March 13, 2019-July 3, 2019) to period B (March 13, 2020-July 3, 2020).

RESULTS

During period B, there was a significant increase in the length of stay (P < 0.01) compared with period A. The pandemic was associated with an increased history of psychiatric medication use (P < 0.01), substance use (P ≤ 0.01), and suicide risk at the time of admission (P < 0.01). Significant differences were found in employment status (P < 0.01), living situation (P < 0.01), and ethnicity (P = 0.03).

CONCLUSIONS

Rural communities in West Texas experienced a decrease in psychiatric hospitalizations during the beginning of the COVID-19 pandemic, followed by an increase as lockdown restrictions began to lift; this warrants further investigation into healthcare service utilization during the pandemic.

Trends in incident diagnoses and drug prescriptions for anxiety and depression during the COVID-19 pandemic: an 18-month follow-up study based on the UK Biobank

Serious concerns have been raised about the negative effects of the COVID-19 pandemic on population psychological well-being. However, limited data exist on the long-term effects of the pandemic on incident psychiatric morbidities among individuals with varying exposure to the pandemic. Leveraging prospective data from the community-based UK Biobank cohort, we included 308,400 participants free of diagnosis of anxiety or depression, as well as 213,757 participants free of anxiolytics or antidepressants prescriptions, to explore the trends in incident diagnoses and drug prescriptions for anxiety and depression from 16 March 2020 to 31 August 2021, compared to the pre-pandemic period (i.e., 1 January 2017 to 31 December 2019) and across populations with different exposure statuses (i.e., not tested for COVID-19, tested negative and tested positive). The age- and sex-standardized incidence ratios (SIRs) were calculated by month which indicated an increase in incident diagnoses of anxiety or depression among individuals who were tested for COVID-19 (tested negative: SIR 3.05 [95% confidence interval 2.88-3.22]; tested positive: 2.03 [1.76-2.34]), especially during the first six months of the pandemic (i.e., March-September 2020). Similar increases were also observed for incident prescriptions of anxiolytics or antidepressants (tested negative: 1.56 [1.47-1.67]; tested positive: 1.41 [1.22-1.62]). In contrast, individuals not tested for COVID-19 had consistently lower incidence rates of both diagnoses of anxiety or depression (0.70 [0.67-0.72]) and prescriptions of respective psychotropic medications (0.70 [0.68-0.72]) during the pandemic period. These data suggest a distinct rise in health care needs for anxiety and depression among individuals tested for COVID-19, regardless of the test result, in contrast to a reduction in health care consumption for these disorders among individuals not tested for and, presumably, not directly exposed to the disease.

Psychiatric presentations and admissions during the first wave of Covid-19 compared to 2019 in a psychiatric emergency department in Berlin, Germany: a retrospective chart review

BACKGROUND

Most studies agree that the Covid-19 pandemic and the subsequent lockdown had a negative impact on mental health. On the other hand, international studies have shown that psychiatric emergency departments (pED) experienced a decrease in presentations and admissions.

METHODS

Retrospective chart review of all pED presentations and admissions during the first wave of Covid-19 pandemic in Germany (Covid-19 period: 3/2/20 to 05/24/20) in a psychiatric hospital in Berlin compared to 1 year earlier (pre-Covid-19 period). Descriptive statistics and logistic regression were performed.

RESULTS

We observed no statistical significant changes in overall pED presentations and overall hospital admissions during the Covid-19 period compared to the pre-Covid-19 period (813 vs. 894, - 9.1%, p = 0.064 and (363 vs. 437, - 16.9%, p = 0.080 respectively). In the subgroup analysis, less patients with depressive disorders (p = 0.035) and with personality disorders (p = 0.002) presented to the pED, a larger number of presentations with schizophrenia was observed (p = 0.020). In the Covid-19 period, less patients with substance use disorder and paranoid schizophrenia were admitted to the hospital via the pED than in the pre-Covid-19 period (p = 0.035 and p = 0.006, respectively). Bed capacity was reduced in the Covid-19 period by - 32.8% (p <  0.001). Presentations in police custody were 13.7% (p = 0.029) higher during the Covid-19 compared to pre-Covid-19 period, with higher rates in female presentations (p = 0.008) and suicide attempts (p = 0.012) and less hospital admissions (p = 0.048). Logistic regression analyses revealed that positive predictors for pED presentation during Covid-19 period were police custody (p <  0.001), being redirected from another hospital (p <  0.001), suicide attempt (p = 0.038), suicidal thoughts (p = 0.004), presentation with paranoid schizophrenia (p = 0.001) and bipolar and manic disorders (p = 0.004), negative predictors were hospital admission (p <  0.001), depressive disorders (p = 0.021) and personality disorders (p <  0.001).

CONCLUSIONS

A larger number of presentations in police custody during the Covid-19 period may represent untreated medical needs. This was seen predominantly in female patients, suggesting this subgroup might have suffered particularly under lockdown measures. Patients with paranoid schizophrenia were the only subgroup, which increased in absolute numbers, also suggesting a particular lockdown effect. Reduced bed capacity due to infection curbing measures is suggestive to have played an important role in augmenting the threshold for hospital admissions.

The Impact of theCovid-19 Pandemic on the Admission of Psychiatric Patients in Emergency Department During the Early Pandemic Period

OBJECTIVE

The COVID-19 pandemic and its restrictions cause increasing mental health problems in both the general population and psychiatric patients. In this study, it was aimed to compare the number and characteristics of emergency psychiatric consultations in the earlypandemic period and in the same period of 2019, in order to understand how the COVID-19 pandemic affects psychiatric emergencies and the health care seeking behavior of people with psychiatric disorders.

METHOD

A retrospective cross-sectional study was designed in which patients who applied to Emergency Department of Bursa Uludağ University and were consulted to psychiatry between 11 March 2019 - 1 September 2019 and 11 March 2020 - 1 September 2020 were included. Sociodemographic characteristics of the patients, psychiatric diagnoses, hospitalizations, psychotropic drug use and treatment compliance, frequency of admission, indications for hospitalization/ referral and suicide attempts were compared.

RESULTS

It was observed that the ratio of psychiatric admissions to the emergency department to all emergency department admissions was significantly higher in the early-pandemic period than in the prepandemic period. In the early-pandemic period, emergency department admissions due to depression disorders were found to be significantly lower; schizophrenia and other psychotic disorders, and psychotropic drug side effects were found to be significantly higher than in the prepandemic period.

CONCLUSION

In this study, it was shown that the COVID-19 pandemic may have a negative impact on psychiatric patients. Prompt implementation of measures to deal with the psychiatric effects of the pandemic, using online health services, developing coping strategies and identifying early signs of psychiatric illness exacerbations can reduce the negative effects of this stressful period on vulnerable individuals.

The Impact of the COVID-19 Pandemic on Pediatric Mental Health Emergency

OBJECTIVE

The aim of this study was to compare pre/post-coronavirus disease 2019 pandemic changes in mental health-related visits to the pediatric emergency department.

MATERIALS AND METHODS

We conducted a retrospective analysis of all mental health-related pediatric emergency department visits to a tertiary general hospital between June and September 2019, 2020, and 2021. We described pre/post-coronavirus disease 2019 changes in the use of pediatric emergency departments, such as timing of visits, sex discrepancies, diagnostic distribution, discharge planning, and others.

RESULTS

Compared with the corresponding months before the pandemic (n = 187), mental health-related pediatric emergency department visits decreased by 20.8% in June-September 2020 (n = 148) and increased by 12.2% in 2021 (n = 210). The distributions of age, sex, timing of visits, reasons for presentations, hospitalization, and outpatient clinic appointment rates were not statistically significant between the years. Self-harm in females and aggression/violence in males were the most common reasons for presentation to pediatric emergency departments in each year. In the post-pandemic period, ambulance use and patients referred by other hospitals for psychiatric consultation increased, while the completion time of consultations decreased (P < .05). The frequency of attention-deficit hyperactivity disorder and depression decreased, but obsessive-compulsive disorder and anxiety disorders were more common in the post-pandemic period than in the corresponding months before the pandemic (P < .05).

CONCLUSION

Our results suggest that the coronavirus disease 2019 pandemic resulted in a significant change in mental health-related visits to the pediatric emergency department. Those in the groups with reduced visits may be at risk for delayed access to treatment for their mental and behavioral difficulties.

COVID-19 restrictions and visitations to an Israeli psychiatric emergency department: A four-lockdowns retrospective study

We examine the volume and characteristics of psychiatric ED visitations through a perspective of four COVID-19 lockdowns. All adult visitations to the ED of Shalvata Mental Healthcare center (Israel) during 2020-2021 were retrieved and statistically analysed and data from 2017 to 2019 was considered as control. Voluntary and involuntary ED visitations were considered, separately and combined. We find that the significant decrease in the volume of voluntary ED visitations during the 1st lockdown was quickly overturned, roughly returning to the pre-pandemic state following its conclusion. In parallel, the volume of involuntary ED visitations has dramatically increased, with the most striking levels observed during the second and third lockdowns. Elapsed time since the first occurrence of COVID-19 in Israel and the level of governmental restrictions is significantly associated with the increase in the volume of ED visits and admissions, the admission rate and the rate of involuntary visits. The prolonged consequences associated with the pandemic and the measures taken to control it suggest that it is unreasonable to expect a return to normal ED utilization in the near future. As such, alternatives to strict lockdowns should be favored when possible and urgent strengthening of psychiatric care is warranted.

[What Influence did the Lockdown 2020 have on the Use of a Central Emergency Room by Psychiatric Emergency Patients]

OBJECTIVE

The current coronavirus pandemic (Covid-19 disease) poses major challenges to healthcare systems worldwide. The aim of this work was to identify the impact on psychiatric emergency presentations in an ED during the implemented lockdown.

METHODS

A retrospective survey of all psychiatric emergency presentations in the ED during the lockdown was conducted. The same period in 2019 served as the reference year.

RESULTS

There was a decrease in psychiatric patients. Changes were observed in the age and diagnoses.

CONCLUSION

Some clear effects of the lockdown on psychiatric emergencies in an ED setting can be described. However, the changes were smaller than in other countries with other health care systems.

Was size of healthcare institution a factor affecting changes in healthcare utilisation during the COVID-19 pandemic in Korea? A retrospective study design analysing national healthcare big data

OBJECTIVES

Many small-sized healthcare institutions play a critical role in communities by preventing infectious diseases. This study examines how they have been impacted by the global COVID-19 pandemic compared with large hospitals.

DESIGN

This study adopted a retrospective study design looking back at the healthcare utilisation of medical facilities according to size after the COVID-19 pandemic. The dependent variable was change in the number of outpatient health insurance claims before and after onset of the COVID-19 pandemic. The independent variable was an observation time point of the year 2020 compared with 2019.

SETTING AND PARTICIPANTS

The study was conducted in Korea having a competitive medical provision environment under the national health insurance system. The units of analysis are hospitals and clinics: tertiary hospitals (42), general hospitals (293), small hospitals (1272) and medical clinics (27 049). This study analysed all the health insurance claim data from 1 January 2019 to 31 December 2020.

RESULTS

Compared with 2019, in 2020, there were significant decreases in the number of claims (-14.9%), particularly in small hospitals (-16.8%) and clinics (-16.3%), with smaller decreases in general hospitals (-8.9%) and tertiary hospitals (-5.3%). The reduction in healthcare utilisation increased as the size of institutions decreased. The magnitude of decrease was significantly greatest in small hospitals (absolute risk (AR): 0.8317, 0.7758 to 0.8915, p<0.0001; relative risk (RR): 0.8299, 0.7750 to 0.888, p<0.0001) followed by clinics (AR: 0.8369, 0.8262 to 0.8478, p<0.0001; RR: 0.8362, 0.8255 to 0.8470, p<0.0001) even after controlling institutional covariates.

CONCLUSION

The external impact of the pandemic increased incrementally as the size of healthcare institutions decreased. Healthcare policy-makers need to keep in mind the possibility that small hospitals and clinics may experience reduced healthcare utilisation in the infectious disease pandemic. This fact has political implications for how healthcare policy-makers should prepare for the next infectious disease pandemic.

Have the COVID-19 outbreak and related restrictions affected the right to mental health of people with severe mental health conditions?

The Coronavirus disease (COVID-19) outbreak, and the restrictions implemented by governments to limit its public health impact, may have determined a reduction of the right to mental health of people with severe mental health conditions, that is a limitation to adequate, human, and value-based mental healthcare, with rising inequalities in comparison with the general population. This systematic review was, therefore, conducted to collate evidence on the impact of the pandemic period on the mental health of individuals with pre-existing severe mental health conditions. Of 3,774 retrieved citations, we selected 21 studies meeting the inclusion criteria. The majority of the included studies assessed trends in psychological symptoms over the pandemic period, then arguing that symptoms worsened for a number of reasons, including the risk of contracting the virus, the disruption of mental health services, and the feelings of loneliness and isolation associated with the restriction measures. Even though studies provided somewhat contradictory results, the majority of evidence indicates that people with pre-existing mental health conditions were more likely to report greater self-isolation distress, anxiety, depression, COVID-19-related perceived stress, and were more likely to voluntarily self-isolate than those without a mental health condition. These findings appeared to suggest that a combination of factors related to the pandemic itself and to the prevention and mitigation strategies were responsible for a reduction of the right to mental health of people with mental health conditions, with increased inequalities in comparison with the general population.

Effects of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health: systematic review

BACKGROUND

A rise in mental illness is expected to follow the COVID-19 pandemic, which has also been projected to lead to a deep global economic recession, further adding to risk factors.

AIMS

The aim of this review was to assess the impact of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health.

METHOD

Searches were conducted in PubMed, Web of Science, PsycINFO and Sociological Abstracts. We included studies of all populations exposed to the COVID-19 pandemic, and other similar pandemics/epidemics and economic crises, compared with non-exposed time periods or regions. The outcome was mental health.

RESULTS

The 174 included studies assessed mental health impacts of the COVID-19 pandemic (87 studies), 2008 economic crisis (84 studies) and severe acute respiratory syndrome (SARS) epidemic (three studies). Outcomes were divided into affective disorders, suicides, mental healthcare utilisation and other mental health. COVID-19 pandemic studies were of lesser quality than those for the economic crisis or SARS epidemic. Most studies for all exposures showed increases in affective disorders and other mental health problems. For economic crisis exposure, increases in mental healthcare utilisation and suicides were also found, but these findings were mixed for COVID-19 pandemic exposure. This is probably because of quarantine measures affecting help-seeking and shorter follow-ups of studies of COVID-19 pandemic exposure.

CONCLUSIONS

Our findings highlight the importance of available, accessible and sustainable mental health services. Also, socioeconomically disadvantaged populations should be particular targets of policy interventions during the COVID-19 pandemic.

The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review

BACKGROUND

Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020.

AIMS

To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic.

METHOD

A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool.

RESULTS

Fifty-one studies were included: 57% (29/51) were rated as 'low' quality, 31% (16/51) as 'moderate' and 12% (6/51) as 'high-moderate'. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17-56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls.

CONCLUSIONS

Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.

Pandemics and Suicide Risk: Lessons From COVID and Its Predecessors

ABSTRACT

In its mortality and global reach, COVID-19 is among the worst pandemics to hit the globe since the 1918 influenza. During a pandemic, it is not uncommon for deaths from suicide to be downplayed as communities respond to the immediate mortality of the disease. In this analysis, we review pandemic history to uncover its impact on suicide rates, a frequent proxy for community mental health, and whether public health responses were effective. We incorporate lessons from more than 100 years of epidemics to assess whether the current public health response can benefit from the lessons of history.

The Reorganization of a Psychiatric Unit During COVID-19: A Reflection for Psychiatric Hospital Design

OBJECTIVE

The COVID-19 pandemic has impacted healthcare systems worldwide. Although this disease has primarily impacted general medicine intensive care units, other areas of healthcare including psychiatry were modified in response to corona measures to decrease the transmission of the disease. Reflecting on the modifications to the environment provides an opportunity to design psychiatric environments for future pandemics or other demands for healthcare.

BACKGROUND

The therapeutic environment of psychiatric wards was modified in Friesland, the Netherlands, in response to COVID-19. During this time, an interdisciplinary team met consistently to contribute to the preliminary design of a new psychiatric hospital.

METHODS

During the first 18 months of the pandemic, clinical reflections were made to describe the impact of COVID-19 on the psychiatric care environment. Architects have created a preliminary design of a new psychiatric hospital based on these reflections, monthly collaborative design discussions based on virtual mock-ups and evidence-based design based on theoretical concepts and research.

RESULTS AND CONCLUSIONS

This theoretical and reflective study describes how an inpatient psychiatric environment was restructured to manage infection during COVID-19. The therapeutic environment of the psychiatric ward and patient care changed drastically during COVID-19. The number of patients accessing care decreased, patient autonomy was restricted, and the function of designated behavioral support spaces changed to manage the risk of infection. However, these challenging times have provided an opportunity to reflect on theories and consider the design of new hospital environments that can be adapted in response to future pandemics or be restructured for different care functions.

Suicidality in psychiatric emergency department situations during the first and the second wave of COVID-19 pandemic

Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020-5/24/2020 "first-wave") and second (9/15/2020-3/1/2021 "second-wave") wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.

Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from 4 centres in Italy

Objectives: An observation of the Emergency Room (ER) admissions during the lockdown.Methods: We monitored admissions to the ER requiring psychiatric evaluation during the 2020 lockdown (March 9^th-May 3^rd, 2020) compared to the same period of 2019, in four sites of Northern Italy (ASST Lariana, AUSL Modena, ASU Friuli Centrale and AUSL Romagna). Number of admissions, baseline demographic and clinical variables were extracted from the clinical databases.Results: A 20.0% reduction of psychiatric referrals was observed across the sites (24.2% in ASST Lariana, 30.5% in AUSL Modena, 12.0% in ASU Friuli Centrale and 14.5% in AUSL Romagna). This reduction peaked at 41.5% in the first month of the lockdown. Being homeless as well as with a dual diagnosis (OR 1,67, CI: 1.02-2.74), while living in a residential facility and admission for a depressive episode Being homeless (OR 2.50, CI: 1.36-4.61) and having a dual diagnosis (OR 1,67, CI: 1.02-2.74) were significantly associated with an increase in ER admission, while living in a residential facility (OR 0.48, CI: 0.31-0.74), having a depressive episode (OR 0.36, CI: 0.18-0.73) and a diagnosis of anxiety disorder (OR 0.60, CI: 0.36-0.99) were significantly associated with a decrease.Conclusions: During lockdown, a decrease in psychiatric referrals was observed.

Risk factors of hikikomori among office workers during the COVID-19 pandemic: A prospective online survey

The global pandemic of COVID-19 has forced people to restrict their outings. In Japan, self-restraint behavior (SRB) has been requested by the government, and some of those decreasing their outings may shift to pathological social withdrawal; hikikomori. The purpose of this study was to examine the risk factors of hikikomori conducting an online prospective survey. An online survey was conducted in June 2020 and December 2020; (1) SRB-related indicators (degree of SRB, motivation for SRB, stigma and self-stigma toward COVID-19, anxiety and depressive feelings toward COVID-19) and (2) general mental health (hikikomori tendency, depressive symptoms, modern type depression (MTD) tendency, internet addiction) were collected. A cross-lagged effects model was performed to examine the association between these variables. Lack of emotional support and lack of socialization in June 2020 increased isolation in December 2020. Besides, MTD and hikikomori interacted with each other. Interestingly, although hikikomori tendency increased depressive tendencies, SRB itself did not have a significant path on any mental health-related variables. Poor interpersonal relationships, rather than SRB per se, are suggested to be a risk factor for increased isolation among office workers in the COVID-19 pandemic. Appropriate early interventions such as interpersonal or emotional support may prevent the transition to pathological hikikomori. The association between MTD and hikikomori seems to reveal the interesting possibility that MTD is a gateway to increased risk of hikikomori, and that hikikomori is a gateway to MTD as well. Future research is required to elucidate the relationship between hikikomori and MTD.

Impact of the COVID-19 Pandemic on Utilization of Inpatient Mental Health Services in Shanghai, China

(1) Purpose: The ongoing COVID-19 pandemic has had an impact on mental health and the utilization of hospital-based inpatient mental health care worldwide. The aim of this study was to determine the impact of this pandemic on the utilization of this service in Shanghai by comparison with hospital-based health care records during the preceding 4 years. (2) Methods: The medical records were provided by the Shanghai Municipal Health Insurance Bureau. Diagnostic coding was based on International Classification of Diseases-10th revision (ICD-10), and inpatients with codes from F00 to F99 were examined. (3) Results: Inpatients were compared according to gender, age, pandemic stage, and type of mental disease. Utilization of psychiatric inpatient care in Shanghai during each of the four stages of the pandemic (1 January 2016 to 21 January 2020; 22 January 2020 to 9 February 2020; 10 February 2020 to 1 March 2020; 2 March 2020 to 31 July 2020) was analyzed. Before the lockdown, the utilization of psychiatric inpatient care had an overall upward trend; after the lockdown, the number of inpatients dropped sharply; as of 31 July 2020, it has not been restored. The utilization of this service for most types of mental disease declined rapidly during the pandemic; for vascular dementia (VAD, F01), it was relatively steady. The observed number of inpatient patients was about 51.07% lower than the predicted number in 2020. (4) Conclusions: The COVID-19 pandemic led to the implementation of prevention and control measures that reduced the utilization of psychiatric inpatient care in Shanghai. The use of inpatient services for categories F20–F29 had the greatest decline, and VAD (F01) had the smallest change during the pandemic. This service consequence of COVID-19 is apparent; to assure access to adequate service during a pandemic, health care professionals should pay close attention to changes in the utilization of different mental health services.

The Role of Hope and Resilience in Protecting Against Suicidal thoughts and Behaviors During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic has impacted the mental health and wellbeing of populations across the world. This study aimed to examine: (1) which specific aspects of the COVID-19 pandemic were associated with the presence of suicidal thoughts and behaviors, and (2) the extent to which participants' hopelessness and resilience moderated the relationship between COVID-19 related stress and suicidal thoughts and behaviors.

METHOD

We administered an online survey to 12,989 adult (16+) participants across Wales from the 9th June to the 13th July 2020. Participants completed a series of questionnaires measuring the stressors they had experienced during the COVID-19 pandemic, their levels of hopelessness over the past two weeks, their levels of resilience, and whether they had experienced suicidal thoughts or behaviors since the onset of the COVID-19 pandemic.

RESULTS

Our findings revealed that: (1) food insecurity, domestic abuse, relationship problems, redundancy, social isolation and financial problems were the COVID-19 related stressors most strongly associated with suicidal thoughts and behaviors, and (2) that both hopelessness and resilience moderated the relationship between COVID-19 stress and suicidal thoughts, such that the relationship between COVID-19 stress and the presence of suicidal thoughts was much stronger for individuals with high hopelessness and low resilience.

CONCLUSIONS

These results highlight the aspects of the COVID-19 pandemic that are closely related to suicidal thoughts and behaviors and demonstrate the important role that hope for the future and resilience play in protecting individuals against the negative effects of the COVID-19 pandemic.HighlightsStressors caused by the pandemic are linked to increased suicidal thoughts.Hope protects individuals against the negative impact of the COVID-19 pandemic.Resilience also protects people from the negative impact of the COVID-19 pandemic.

Évolution du nombre de passages aux urgences pour intoxications aiguës lors des périodes de confinement de Covid-19 en Bourgogne-Franche-Comté

Objectif : Estimer l’évolution du nombre de passages aux urgences pour intoxications aiguës (IA) lors des périodes de confinement en 2020 par rapport à l’année précédente.

Matériels et méthode : Une étude rétrospective multicentrique de type transversale a été menée en utilisant les données des résumés de passages aux urgences. Deux périodes ont été étudiées en 2020 : période 1 = 1er confinement et période 2 = 2e confinement et ont été comparées aux mêmes périodes en 2019. Les diagnostics pour IA volontaires ou accidentelles toutes causes ont été définis à partir du code CIM-10. Le critère de jugement principal a été la variation du nombre de passages aux urgences pour IA entre les périodes de confinement en 2020 et les périodes de référence en 2019.

Résultats : Comparé à la même période en 2019, le nombre de passages aux urgences pour IA a baissé de 31 % (p = 0,001) pendant le premier confinement et de 18 % (p = 0,07) pendant le deuxième confinement. Le nombre de passages pour IA médicamenteuse a baissé de 3 % (p = 0,035) pendant le deuxième confinement en comparaison à 2019. Les caractéristiques des patients consultant pour IA étaient comparables dans chacune des périodes.

Conclusion : Dans cette étude, une diminution du nombre de passages aux urgences pour IA a été observée pendant les périodes de confinement en 2020 par rapport aux mêmes périodes l’année précédente.

The Impact of COVID-19 Pandemic on Psychiatric Emergencies in Two Different Settings: Emergency Room and Community Mental Health Service

Background

The SARS-CoV-2 pandemic caused a public health emergency with profound consequences on physical and mental health of individuals. Emergency Rooms (ER) and Community Mental Health Services (CMHS) played a key role in the management of psychiatric emergencies during the pandemic. The purpose of the study was to evaluate urgent psychiatric consultations (UPCs) in the ERs of the General Hospitals and in the CMHS of a Northern Italian town during the pandemic period.

Methods

This monocentric observational study collected UPCs carried out in ER from 01/03/2020 to 28/02/2021 (the so called "COVID-19 period") and the demographic and clinical characteristics of patients who required UPCs in the 12-months period, comparing these data with those collected from 01/03/2019 to 29/02/2020 (the so called "pre-COVID-19 period"). The same variables were collected for UPCs carried out in CMHS from 01/03/2020 to 31/01/2021 and compared with those collected from 01/03/2019 to 31/01/2020. The data, were statistically analyzed through STATA 12-2011.

Results

In ER, we reported a 24% reduction in UPCs during the COVID-19 period (n = 909) in comparison with the pre-COVID-19 period (n = 1,194). Differently, we observed an increase of 4% in UPCs carried out in CMHS during the COVID-19 period (n = 1,214) in comparison with the previous period (n = 1,162). We observed an increase of UPCs in ER required by people who lived in psychiatric facilities or with disability pension whereas more UPCs in CMHS were required by older people or those living in other institutions compared to the previous period. In the COVID-19 period, the most frequent reasons for UPCs in ER were aggressiveness, socio-environmental maladjustment and psychiatric symptoms in organic disorders whereas in CMHS we reported an increase of UPCs for control of psychopharmacology therapy and mixed state/mania.

Conclusion

In light of our findings, we conclude that the most vulnerable people required more frequent attention and care in both ER and CMHS during pandemic, which disrupted individuals' ability to adapt and induced many stressful reactive symptoms. In order to reduce the impact of the COVID-19 pandemic on mental health, psychological support interventions for the general population should be implemented, having particular regard for more psychologically fragile people.

The Acute Impact of the Early Stages of COVID-19 Pandemic in People with Pre-Existing Psychiatric Disorders: A Systematic Review

People with pre-pandemic health conditions are more vulnerable and more likely to suffer greater psychosocial impact due to the current COVID-19 pandemic and the lockdown measures. Thus, the objective of this work was to systematically review the impact of the early stages COVID-19 pandemic on people with pre-existing psychiatric disorders. The search was performed between 23 January and 2 September 2021 in PubMed, PsycINFO, and EMBASE. A total of 4167 published results were identified; however, only 49 were included in this review. Results show that there was considerable heterogeneity among studies, which resulted in a low consensus. However, it seems that the impact of the first stage of the COVID-19 pandemic on psychiatric disorders was two-fold: (1) an overall effect, in which people suffering from psychiatric disorders in general experienced more psychological distress and anxiety when compared to people who had no psychiatric diagnosis, and (2) a condition-specific effect, namely in people suffering from eating disorders and obsessive compulsive disorders. Moreover, the current work highlights that there were also some external factors that were related to worsening symptoms. For instance, unemployment or experiencing work and financial difficulties can be a trigger for greater distress during the pandemic for people with mood disorders, and being alone and in social isolation during the COVID-19 pandemic may actually increase substance use and relapse rates. Further studies are needed to prospectively investigate the long-term effects of the current COVID-19 pandemic on people with (pre)-existing psychiatric conditions and on the onset or deterioration of psychiatric-related symptoms in a larger number of participants, as well as exploring the long-term effects of the current pandemic on mental health.