Psychiatric hospitalization during the two SARS-CoV-2 pandemic waves: New warnings for acute psychotic episodes and suicidal behaviors

Psychiatric hospitalizations in the Unified Health System: an observational study on hospitalization rates from 2012 to 2023

BACKGROUND

Psychiatric care in Brazil is based on the National Mental Health Policy and is aligned with the guidelines of the Brazilian Unified Health System. It is based on the preeminence of care in the extra-hospital context over the hospital context. Hospital admissions should occur solely when extra-hospital resources prove insufficient for the proper management of the mental health condition.

METHOD

It refers to a time series investigation of a descriptive, ecological, and observational nature. We used publicly available hospital admissions data from the Brazilian Unified Health System's Department of Informatics. The study looked at information on diseases in ICD-10 group V that affected both men and women aged 0 to 80 or older, from 2012 to 2023. The information was analyzed using the statistical software SPSS 20.0, as well as Jointpoint, through permutation tests, with the aim of evaluating the temporal trend of hospitalization and mortality rates. The joinpoint regression model used a log-linear method to set up a series of connected lines on a logarithmic scale and the Monte Carlo permutation method to figure out the direction or statistical significance. A significance level of 5% was established for the execution of all statistical tests.

RESULTS

Overall, a trend of reduction in psychiatric hospitalization rates was observed. However, these trends exhibited fluctuations when analyzed in isolation with respect to the type of disorder, gender, and age group. In contrast to the general trend, the number of hospitalizations for affective disorders and disorders linked to stress and somatization went up. This was especially true between 2021 and 2023, when the number of hospitalizations for other disorders went down more significantly. The predominance of hospitalizations in the male gender was significant. However, the trends of decrease were less pronounced in the male group, especially regarding hospitalizations associated with alcohol and other substance use, which draws attention to the hospitalization rates of the female sex. As it relates to dementias, the national picture shows that hospitalizations are going down, and most of the patients are women and older adults or people who are very old. However, an analysis of the state scenario showed that hospitalizations went up for adults, more than for the elderly combined, with more men than women.

CONCLUSION

the results achieved in this research confirm the findings, both nationally and internationally. Studies have shown that investments made through the National Mental Health Policy and the effects of Covid-19 led to a drop in the number of people admitted to psychiatric hospitals. This was because of the restructuring of the care model, which meant that hospitalizations had to be prioritized to meet the needs of Covid-19, which hurt people with mental disorders.

The Importance of Treatment Modality in Veterans with Opioid Use Disorder: Implications for Virtual Care

This study examined treatment utilization across in-person and virtual treatment modalities in veterans who were on medications for opioid use disorder (MOUD; N = 139). Treatment records for veterans in addiction treatment on MOUD were examined for 3-months prior to telehealth conversions ("Pre-Telehealth," 12/02/2019-03/14/2020), 3-months during the initial telehealth transition ("Telehealth," 03/15/2020-06/30/2020) and 3-months during post-telehealth transition ("Re-Entry," 07/01/2020-10/01/2020). Analyses examined the relationship between treatment modality and demographic features, psychiatric comorbidities, treatment engagement, and illness severity as measured by psychiatric emergency room (PER) utilization. Results demonstrated that modality was not associated with PER utilization. Past-year PER visits, alcohol use disorder (AUD), and psychotic disorders were associated with PER utilization during Telehealth, while AUD was associated with Re-Entry PER utilization. Given the likelihood of virtual treatment in the future, frequent in-person visits may not be necessary for MOUD; however, individuals with comorbid AUD and psychotic disorders may need additional support to prevent emergency care.

Post-pandemic persistence of adverse health behaviors in patients with psychotic disorders: A follow-up study

OBJECTIVE

The ramifications of the COVID-19 pandemic on patients with psychotic disorders have been previously documented by the authors of this study. The aim of study is to investigate whether the effects of the pandemic continued among the same cohort of patients with psychotic disorders who participated in the initial study.

METHODS

232 of the 255 participants in the initial study participated in this follow-up study. The assessment covered sociodemographic data, changes in physical and mental health since the pandemic, new diagnoses of physical illnesses, smoking, medication adherence, suicidal behavior.

RESULTS

The body weight of the patients before, during, and after the pandemic was 77.6 ± 13.1,81.3 ± 14.1,and 83.1 ± 14.3, respectively and there was increase in BW in the post-pandemic compared to before the pandemc and the during the pandemic (Z: - 8.658, p < 0.001, r: -0.57; Z: -6.852, p < 0.001, r: -0.45 respectively). The mean number of cigarettes smoked daily by the patient's before the pandemic, during the pandemic, and after the pandemic was 11.1 ± 14.2,14.9 ± 16.2,and 12.9 ± 14.9, respectively. There was a decrease in the number of cigarettes smoked daily in the post-pandemic compared to the during the pandemic (Z: -4753, p < 0.001, r: -0.45). Both suicidal ideations and attempts were significantly higher during the pandemic compared to after the pandemic (p < 0.001,p < 0.001). Medication adherence in the post-pandemic period was not different compared to the pandemic levels (Z: -0.621, p:0.535).

CONCLUSION

The study confirmed the continuation of adverse outcomes noted previously, such as increased body weight, increased daily cigarette consumption, and diminished medication adherence.

Mental health in Europe during the COVID-19 pandemic: a systematic review

The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.

Psychiatric ward admissions during the COVID-19 pandemic in Canton of Ticino (Swiss Confederation) and the province of Como (Italy): a comparison between two different systems of care and outbreak response strategies

The aim of the study was to estimate the effect of the COVID- 19 pandemic and response policies on the psychiatric ward admissions in the hospitals referring to the ASST Lariana (province of Como, Italy) and the Hospital of Mendrisio (Canton of Ticino, Switzerland), two similar territories that belong to countries that dealt differently with the pandemic. We compared the two territories for type of admission (voluntary vs. compulsory), the Stringency Index (SI) and the country’s number of admission in Intensive Care Units (ICU). We found a significant reduction in the psychiatric ward admission in the lockdown period in both territories, even in periods with milder lockdown measures. The admission rate’s reduction in the ASST Lariana was significantly associated with the ICU admissions (p<0.001). In the Hospital of Mendrisio, admissions included a weekly seasonality, were significantly correlated with SI (p=0.001) and period (pre-pandemic and pandemic; p<0.001) and we observed also a significant reduction of compulsory admission that is influenced both by the stringency index (p<0.001) and period (p<0.001). The differences between the two territories seem influenced by the different mental health systems.

Profile changes in admissions to a psychiatric hospitalisation unit over 15 years (2006-2021), considering the impact of the pandemic caused by SARS-CoV-2

The objective of this current work was to explore whether modification of the diagnostic criteria upon the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the impact of the COVID-19 pandemic had influenced the diagnostic and sociodemographic profiles of mental health admissions. For that purpose, we designed an observational, longitudinal, and retrospective study of the data recorded in the discharge reports of the Brief Hospitalization Unit at Castellon (Spain), between January 2006 and December 2021. The sample consisted of 7,037 participants, with a mean age of 42.1 years. The mean age of admissions, number of women, and presentation of affective disorders, addictions, and dementias all increased significantly during the DSM-5 period. Beyond diagnoses, the reduction in readmissions before the pandemic could be attributed to the use of long-acting injectable antipsychotics. In contrast, the pandemic did not change the percentage of readmissions or the volume of admissions. Also, during the pandemic period, the significant results obtained indicate that the average stay was reduced, affective disorders decreased, and addictions increased. Therefore, clinicians should consider these diagnostic and sociodemographic fluctuations when adapting clinical care, taking into account gender perspective, ageing of patients and increasing of dual and affective disorders.

The role of psychological autopsy in investigating a case of atypical suicide in schizophrenia: a case report with a brief review of literature

Background

Self-harm typically is without lethal intent. Death can occur rarely, with suicide taking on an atypical form that raises the suspicion of hetero-aggression. Our study aimed to identify the link between self-harm and suicide intent and also to outline the positive diagnosis of an atypical suicide case which has raised the suspicion of hetero-aggression. For this purpose, the psychological autopsy method should be used regularly in suicide investigation because it not only allows a positive diagnosis of suicide but can also provide a detailed picture of mental degradation and associated suicide risk factors.

Case presentation

The case of a 26-year-old man from a rural area, found dead in the basement, at home, naked, barricaded inside, is described.

Methods

The on-site investigation and a complete forensic autopsy were performed. In addition, we apply the psychological autopsy method which gathered enough information to outline the positive diagnosis of suicide. We also made a brief literature review on the suicide risk factors and the behavioral changes that occurred during the COVID-19 pandemic in schizophrenic patients.

Results

The forensic autopsy revealed that he presented a complex craniofacial trauma as the cause of death (with scalp lacerations, frontal fracture, subarachnoid hemorrhage, and frontal cerebral contusions) associated with torso trauma (with self-inflicted stabbed wounds) with bruises and abrasions on the limbs. The injuries that caused death were self-inflicted and ensued repeatedly hitting his head against blunt objects. Using the psychological autopsy method, we found out that he presented multiple psychiatric hospitalizations for schizophrenia for almost 10 years, recently with reduced compliance to treatment. We also documented two previous suicide attempts and a gradual deterioration of his mental health.

Conclusions

We highlighted the role of the psychological autopsy (in addition to the judicial investigation and the forensic autopsy) for the diagnosis of committed suicide, for making a rigorous differential diagnosis between accident, hetero-aggression, and suicide, and also in pin-pointing the suicide risk factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41935-022-00291-5.