Forty Percent Reduction in Referrals to Psychiatric Services during the COVID-19 Pandemic

Lexical stability of psychiatric clinical notes from electronic health records over a decade

OBJECTIVE

Natural language processing (NLP) methods hold promise for improving clinical prediction by utilising information otherwise hidden in the clinical notes of electronic health records. However, clinical practice - as well as the systems and databases in which clinical notes are recorded and stored - change over time. As a consequence, the content of clinical notes may also change over time, which could degrade the performance of prediction models. Despite its importance, the stability of clinical notes over time has rarely been tested.

METHODS

The lexical stability of clinical notes from the Psychiatric Services of the Central Denmark Region in the period from January 1, 2011, to November 22, 2021 (a total of 14,811,551 clinical notes describing 129,570 patients) was assessed by quantifying sentence length, readability, syntactic complexity and clinical content. Changepoint detection models were used to estimate potential changes in these metrics.

RESULTS

We find lexical stability of the clinical notes over time, with minor deviations during the COVID-19 pandemic. Out of 2988 data points, 17 possible changepoints (corresponding to 0.6%) were detected. The majority of these were related to the discontinuation of a specific note type.

CONCLUSION

We find lexical and syntactic stability of clinical notes from psychiatric services over time, which bodes well for the use of NLP for predictive modelling in clinical psychiatry.

Access to rehabilitation professionals by individuals with stroke one month after hospital discharge from a stroke unit in Brazil is insufficient regardless of the pandemic

OBJECTIVE

To compare access to rehabilitation professionals by individuals with stroke one month after hospital discharge from a stroke unit in Brazil, before and during the COVID-19 pandemic.

MATERIALS AND METHODS

This longitudinal and prospective study included individuals aged 20 years or older without previous disabilities admitted into a stroke unit due to a first stroke. Individuals were divided into two groups: before (G1) and during (G2) the COVID-19 pandemic. Groups were matched for age, sex, education level, socioeconomic status, and stroke severity. One month after hospital discharge, individuals were contacted via telephone to collect data regarding their access to rehabilitation services based on the number of referred rehabilitation professionals. Then, between-group comparisons were conducted (α = 5%).

RESULTS

The access to rehabilitation professionals was similar between groups. Rehabilitation professionals accessed included medical doctors, occupational therapists, physical therapists, and speech therapists. The first consultation after hospital discharge was mainly provided by public services. Despite the pandemic, telehealth was not frequent in any period evaluated. In both groups, the number of accessed professionals (G1 = 110 and G2 = 90) was significantly lower than the number of referrals (G1 = 212 and G2 = 194; p < 0.001).

CONCLUSIONS

Access to rehabilitation professionals was similar between groups. However, the number of accessed rehabilitation professionals was lower than that of referred ones during both periods. This finding indicates a compromised comprehensiveness of care for individuals with stroke, regardless of the pandemic.

Comparison of Psychiatric Service Utilization Prior, During, and After COVID-19 Lockdown: A Retrospective Cohort Study

Background COVID-19 pandemic represents a significant risk factor for developing, relapsing, or exacerbating pre-existing mental health conditions. This negative impact on mental health results in increasing demand for psychiatric services. This study aimed to explore the effects of COVID-19 pandemic lockdown on the utilization of mental health services in three periods - prior, during, and after the lockdown - compared to the matched weeks in the previous years 2018 and 2019. Materials and Method In this retrospective cohort, quantitative, single-center study, data were collected from electronic medical records, including all patients with referrals\consultations to the psychiatric section prior, during, and after COVID-19 lockdown. Results In total, 2,454 patients were either referred to psychiatric outpatient clinics or needed consultation as inpatients during the study periods. Only 2,326 patients were included in our study. The total number of inpatient consultations was 1,410, with a statistically significant increase during the lockdown (p-value<0.001) and post-lockdown (p<0.016) in comparison to previous years. A significant reduction in outpatient referrals was observed during the lockdown (p=0.005) and post-lockdown period. Psychiatric disorders were identified in most patients (N=1,599), representing 65%, 54%, and 74% of patients in pre-lockdown, lockdown, and post-lockdown periods compared to 71%, 71%, and 76%, respectively, in the previous years. A total of 821 patients manifested symptoms of depression, constituting the largest proportion among all reasons for referral\consultations. The number of patients referred for substance/alcohol use disorders during the lockdown increased compared to patients in the same period in 2019. Suicidal behavior was identified in 70 patients across all study periods, with the lowest number observed in 2020. Conclusion Our findings indicate that during the COVID-19 lockdown, a significant increase in inpatient psychiatric services utilization was observed. Outpatient psychiatric service utilizations were significantly reduced. Implementation of evidence-based policy and protocol to guide mental health challenges in future health emergencies is needed.

Stability of diagnostic coding of psychiatric outpatient visits across the transition from the second to the third version of the Danish National Patient Registry

OBJECTIVE

In Denmark, data on hospital contacts are reported to the Danish National Patient Registry (DNPR). The ICD-10 main diagnoses from the DNPR are often used as proxies for mental disorders in psychiatric research. With the transition from the second version of the DNPR (DNPR2) to the third (DNPR3) in February-March 2019, the way main diagnoses are coded in relation to outpatient treatment changed substantially. Specifically, in the DNPR2, each outpatient treatment course was labelled with only one main diagnosis. In the DNPR3, however, each visit during an outpatient treatment course is labelled with a main diagnosis. We assessed whether this change led to a break in the diagnostic time-series represented by the DNPR, which would pose a threat to the research relying on this source.

METHODS

All main diagnoses from outpatients attending the Psychiatric Services of the Central Denmark Region from 2013 to 2021 (n = 100,501 unique patients) were included in the analyses. The stability of the DNPR diagnostic time-series at the ICD-10 subchapter level was examined by comparing means across the transition from the DNPR2 to the DNPR3.

RESULTS

While the proportion of psychiatric outpatients with diagnoses from some ICD-10 subchapters changed statistically significantly from the DNPR2 to the DNPR3, the changes were small in absolute terms (e.g., +0.6% for F2-psychotic disorders and +0.6% for F3-mood disorders).

CONCLUSION

The change from the DNPR2 to the DNPR3 is unlikely to pose a substantial threat to the validity of most psychiatric research at the diagnostic subchapter level.

Symptom severity and well-being of patients with mental illness during the COVID-19 pandemic: a two-wave survey

PURPOSE OF THE ARTICLE

To examine changes in symptom severity and well-being during the coronavirus disease 2019 (COVID-19) pandemic among individuals with pre-existing mental illness.

MATERIALS AND METHODS

In February 2021, we conducted a follow-up questionnaire-based survey among adults with mental illness, who responded to a similar survey on mental health in June 2020. The participants completed the 18-item Brief Symptom Inventory (BSI-18), the five-item World Health Organization Well-Being Index (WHO-5), and 14 questions evaluating worsening or improvement in mental health using the pre-pandemic period as reference. The survey data were merged with sociodemographic and clinical data from the medical records of all invitees to the first survey, enabling analysis of attrition and weighting of the results.

RESULTS

A total of 613 of 992 (62%) invitees participated in the follow-up wave of the survey. The weighted mean WHO-5 and BSI-18 scores were 38 and 27, respectively, and did not differ statistically significantly from the first wave. Multivariate logistic regression showed that having a vocational education (skilled worker/craftsman) was positively associated with reporting deterioration in psychological well-being (OR: 2.95, 95%CI: 1.14-7.81), while being unemployed was negatively associated with reporting deterioration in psychological well-being (OR: 0.20, 95%CI: 0.07-0.56) from the first to the second survey wave. The most common reason for self-reported deterioration in mental health was loneliness (70%).

CONCLUSIONS

Approximately one year into the COVID-19 pandemic, the level of symptoms remained high, whereas the level of psychological well-being remained low among patients with mental illness.

Mental health of patients with mental illness during the COVID-19 pandemic lockdown: a questionnaire-based survey weighted for attrition

BACKGROUND

Individuals with pre-existing mental illness may be particularly vulnerable to the negative impact that the coronavirus disease 2019 (COVID-19) pandemic seems to have on mental health. Accordingly, the objective of the present study was to assess whether patients with mental illness experienced deterioration in mental health during the COVID-19 lockdown of Denmark in the Spring of 2020.

METHODS

We conducted a cross-sectional, questionnaire-based survey coupled with sociodemographic and clinical data from the medical records of all invitees. The latter enabled analysis of attrition and weighting of results. The online questionnaire included the 18-item Brief Symptom Inventory (BSI-18), the five-item World Health Organization Well-Being Index (WHO-5), and 14 questions evaluating worsening or improvement in symptoms during lockdown using the pre-pandemic period as reference.

RESULTS

A total of 992 randomly drawn patients with mental illness from the psychiatric services of the Central Denmark Region responded to the questionnaire (response rate = 21.6%). The weighted mean WHO-5 and BSI-18 scores were 38 and 28, respectively. A total of 52% of the respondents reported that their mental health had deteriorated during the lockdown, while 33% reported no change, and 16% reported improvement. The most commonly reported reasons for deterioration were loneliness, disruption of routines, concerns regarding the coronavirus, less contact with family/friends, boredom, and reduced access to psychiatric care.

CONCLUSION

More than half of the patients reported worsening of their mental health during the pandemic lockdown. There should be an increased emphasis on ensuring both social and clinical support for individuals with mental illness during pandemics.

Clinical characterization of brief psychotic disorders triggered by the COVID-19 pandemic: a multicenter observational study

This study aimed to characterize the clinical profile of patients with brief psychotic disorders (BPD) triggered by the psychosocial distress derived from the COVID-19 crisis. A multicenter study was conducted from March 14 to May 14, 2020 (the peak weeks of the pandemic in Europe). All consecutive patients presenting non-affective psychotic episodes with a duration of untreated psychosis of less than 1 month and whose onset was related to the COVID-19 crisis were recruited, but only those patients meeting Diagnostic Statistical Manual 5th edition (DSM-5) criteria for "BPD with marked stressors" (DSM-5 code: 298.8) during follow-up were finally included. Patients' sociodemographic and clinical characteristics were collected at baseline and summarized with descriptive statistics. During the study period, 57 individuals with short-lived psychotic episodes related to the emotional stress of the COVID-19 pandemic were identified, of whom 33 met DSM-5 criteria for "BPD with marked stressors". The mean age was 42.33 ± 14.04 years, the gender distribution was almost the same, and the majority were rated as having good premorbid adjustment. About a quarter of the patients exhibited suicidal symptoms and almost half presented first-rank schizophrenia symptoms. None of them were COVID-19 positive, but in more than half of the cases, the topic of their psychotic features was COVID-19-related. The coronavirus pandemic is triggering a significant number of BPD cases. Their risk of suicidal behavior, their high relapse rate, and their low temporal stability make it necessary to closely monitor these patients over time.

Impact of the coronavirus 2019 (COVID-19) pandemic on anxiety diagnosis in general practices in Germany

Little is known about the effects of the coronavirus disease-2019 (COVID-19) pandemic on the diagnosis of anxiety disorder. Therefore, the goal of this study was to compare the number of adults with a diagnosis of anxiety disorder and the number of adults newly diagnosed with anxiety disorder in Germany between January-June 2019 and January-June 2020, and to identify potential differences in terms of sociodemographic characteristics, prescriptions and comorbidities between these patients. The study included patients with at least one consultation in one of 1140 general practices in Germany in January-June 2019 and January-June 2020. Sociodemographic characteristics included age and sex, while there were three families of drugs and nine common comorbidities available for the analysis. An increase in the number of patients with anxiety disorder was observed in 2020 compared with 2019 (January: +4%, p = 0.643; February: +4%, p = 0.825; March: +34%, p < 0.001; April: +8%, p = 0.542; May: +2%, p = 0.382; June: +19%, p = 0.043; and March-June: + 19%, p < 0.001). There was also an increase in the number of patients newly diagnosed with anxiety disorder between March-June 2020 and March-June 2019 (11,502 versus 9506; +21%, p-value<0.001). Antidepressants, anxiolytics and herbal sedatives were less frequently prescribed in patients newly diagnosed with anxiety disorder in 2020 than in 2019 (30.4% versus 35.6%, p-value<0.001). Finally, COPD (9.4% versus 7.9%, p-value<0.001) and asthma (11.3% versus 9.7%, p-value<0.001) were more frequent in 2020 than in 2019. Taken these findings together, public health measures are urgently needed to mitigate the negative impact of the COVID-19 pandemic on anxiety disorder.

[Neuropsychiatric Aspects of COVID-19 - A Narrative Overview]

The SARS-CoV-2 virus (Severe Acute Respiratory Syndrome Coronavirus Type 2) and COVID-19 (Coronavirus Disease 2019) can affect numerous organ systems. In the present paper we offer an overview of the current state of knowledge about the psychiatric aspects of SARS-CoV-2 infection.Medline, Embase und LIVIVO were searched for relevant literature, the last query dating from March 2nd, 2021. Different stress factors in the context of the pandemic can lead to manifest mental illnesses. In addition, there is a risk of neuropsychological changes due to the biological effects of the virus itself.Our work describes the psychological symptoms of COVID-19 sufferers themselves and the psychological effects of the epidemic and the associated socio-economic and psychosocial stress factors on those who are not sick.The most common psychiatric complication among people with COVID-19 is delirium, while hospitalized patients seem to have an increased incidence of symptoms of anxiety, depression and PTSD. There are many case reports on psychotic disorders. In general, an existing psychiatric illness (especially dementia and psychotic disorders) also increases the risk of infection and of a more severe course of the disease. After recovery from COVID-19 infection, there is also a higher incidence of mental illnesses, in particular "Chronic Post-SARS Syndrome" with its manifestations such as fatigue, anxiety, depression and PTSD. In addition, the course of dementia seems to be negatively influenced by an infection with SARS-CoV-2.The second part deals with the effects of the epidemic as a stressor and the established socio-political measures on the mental health of people with and without previous mental illnesses. The literature currently available shows high symptom values for anxiety and depressive disorders as well as post-traumatic stress disorders, stress, suicidality, sleep disorders etc. Risk factors seem to include female gender, younger age and fewer resources, as well as previous psychiatric or physical illnesses. Extrinsic factors such as high infection rates, large numbers of deaths, long curfews/lockdowns, low trust in the government and ineffective measures against economic and social consequences increase the burden.

[Impact of the COVID-19 pandemic on the care situation in psychiatric hospitals in Germany]

Ziel

Um die strukturelle Leistungsfähigkeit psychiatrischer Kliniken in Deutschland während der COVID(„coronavirus disease“)-19-Pandemie beurteilen zu können, wurde im März 2020 eine Umfrage durchgeführt, in der die Corona-bedingten Veränderungen der Versorgungstrukturen während der ersten Welle der Pandemie erfasst wurden.

Methode

Zur Erfassung der Versorgungssituation wurden mittels Umfrage Daten in 38 von 388 angeschrieben Kliniken für Psychiatrie und Psychotherapie in Deutschland im Verlauf eines Monats erhoben. Dokumentiert wurden die Veränderungen und Anpassungen der Versorgungsstrukturen, die Art der angewendeten Therapiemaßnahmen und Versorgungsmöglichkeiten für Menschen mit psychischen Störungen und einer COVID-19-Infektion sowie die der Versorgung zugrunde liegende Rechtsgrundlage bei nichteinwilligungsfähigen Patient*innen.

Ergebnisse

Im Durchschnitt verringerte sich die stationäre Behandlungskapazität psychiatrischer Kliniken in Deutschland etwa um 40 % im Vergleich zu Zeiten vor der Pandemie. Auch die tagesklinischen und ambulanten Angebote der Kliniken waren nur noch in eingeschränkter Form vorgehalten oder wurden sogar komplett eingestellt. In den meisten befragten Einrichtungen (84 %) standen Spezialbereiche für COVID-19-infizierte Patient*innen zur Verfügung.

Schlussfolgerung

Psychiatrische Kliniken waren bereits in der ersten Welle der Pandemie in der Lage, schnell und adäquat auf die Krisensituation z. B. durch Einrichtung von COVID-Stationen zu reagieren. Durch die Reduzierung der Behandlungskapazitäten auf 60 % hat sich jedoch die Versorgungssituation für Menschen mit psychischen Erkrankungen deutlich verschlechtert. Deshalb sollten dringend weitere Anstrengungen unternommen werden, um die Versorgung im Bereich der psychischen Gesundheit langfristig an die Anforderungen der Pandemie anzupassen.