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

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

OBJECTIVE

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Impact of COVID-19 on medical utilization for psychiatric conditions in Japan

BACKGROUND

During COVID-19, Japan experienced an increase in suicides, in contrast to many other countries. We sought to examine whether access to outpatient and inpatient care for psychiatric conditions was maintained in Japan during the pandemic.

METHODS

Difference-in-differences analysis with Poisson regression comparing psychiatric patient admissions during the pre-pandemic period (January 2015-December 2019) versus the pandemic period (January 2020-December 2020) was performed, using the data from 242 acute-care hospitals in Japan. The Japanese government's emergency declaration in April 2020 was considered an exogenous shock. Primary outcomes included the number of inpatient and outpatient admissions for schizophrenia, mood disorders, anxiety disorders, dementia, and alcohol-related disorders.

RESULTS

During the study period, 79,867 outpatient cases and 2600 hospitalizations were observed. The difference-in-differences analysis showed a decline in the number of outpatient and inpatient admissions except for anxiety disorders after April 2020: incidence-rate ratios (95% confidence intervals), 0·92 (0·83 - 1·02) and 0·71 (0·46 - 1·09) for outpatients and inpatients with schizophrenia, 0·92 (0·85 - 0·99) and 0·87 (0·50 - 1·49) for mood disorders, 1·02 (0·92 - 1·13) and 1·07 (0·69 - 1·65) for anxiety disorders, 0·88 (0·80 - 0·96) and 0·68 (0·38 - 1·22) for dementia, and 0·77 (0·54 - 1·11) and 0·63 (0·43 - 0·90) for alcohol-related disorders.

CONCLUSION

In Japan, psychiatric admissions decreased overall following the start of the COVID-19 pandemic, with the exception of anxiety disorder cases. The decrease in psychiatric care utilization contrasted with rising suicide rates in the nation, underscoring the need for enhanced psychiatric access during crises.

The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in Italy

Objective

Comprehensive evidence on the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on the use of mental health services is scarce. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the access to mental health services in Italy and to assess the socioeconomic and citizenship inequalities for the same outcome.

Methods

A population-based longitudinal open cohort of residents aged ≥ 10 years was established in three large centers covering about 6 million beneficiaries (nearly 10% of the entire population) of the Italian National Health Service (NHS) from 01 January 2018 to 31 December 2021. The primary outcome of interest was the first access to one of the following mental health care services (FAMHS): outpatient facilities, hospital discharges, psychiatric drug prescriptions, emergency room admissions, residential and day care facilities, co-pay exemptions. To evaluate the effect of the COVID-19 pandemic on FAMHS, the temporal trend of FAMHS rates was investigated through an interrupted time series (ITS) analysis of their monthly rates. Crude incidence rates per 100,000 person days with 95%CI were calculated comparing the two time periods (pre- and post-COVID-19) by sex, age group, deprivation index (as a proxy of socioeconomic status), and citizenship. Finally, adjusted rates and rates ratios with 95%CI were estimated via ITS analysis using a step-change model.

Results

ITS analysis for the trend of FAMHS rates showed a significant drop at the outbreak of the pandemic in crude rates and after adjusting for age, sex, deprivation level, and citizenship (RR=0.83 p<0.001). After the outbreak of COVID-19, the trend increased, with rates returning to pre-pandemic levels. Adjusted incidence rate ratios (IRRs) showed a higher probability of having a FAMHS for females, Italians, and for residents in the most deprived areas. A gradient of higher rates with the increase in age was observed. Greater COVID-19 impact was found on the most deprived areas of residence, with a reduction in IRRs from pre- to post-COVID-19 significantly stronger.

Conclusions

The COVID-19 pandemic increased socioeconomic inequalities in mental health in Italy. Population-based cohorts are the most powerful instrument to monitor inequalities in access to mental health services and to provide timely information to drive policy.

Emerging Health Care Leaders: Lessons From a Novel Leadership and Community-Building Program

Background

Although there are guidelines and ideas on how to improve public health education, translating innovative approaches into actual training programs remains challenging. In this article, we provide an overview of some initiatives that tried to put this into action in different parts of the world, and present the Emerging Health Care Leader (EHCL), a novel training program developed in Switzerland.

Policy Options and Recommendations

Looking at the experience of the EHCL, we propose policymakers and other interested stakeholders who wish to help reform public health education to support these initiatives not only through funding, but by valuing them through the integration of early career healthcare leaders in projects where their developing expertise can be practically applied.

Conclusion

By openly sharing the experiences, strengths, weaknesses, and lessons learned with the EHCL program, we aim to foster a transparent debate on how novel training programs in public health can be organised.