Changes in emergency psychiatric consultations in time of COVID-19: a retrospective observational study in the Verona Academic Hospital over the two pandemic years 2020–2021

Introduction: Mental health warrants exist in most countries and are issued when patients have severe mental illness, refuse treatment, and present a serious risk to themselves or others. We describe the epidemiology of mental health warrant requests received, and warrants issued by a Public Health Unit in a Portuguese region, as well as subsequent hospital admissions before and during the COVID-19 pandemic.Methods: We used routine administrative data of mental health warrant request entries from a Public Health Unit serving a population of 219 739 individuals and compared the average of monthly requests, issued warrants, and hospital admissions during two separate periods (January 2013 to January 2021 and February 2021 to October 2022) as well as the proportion of warrants issued, hospital admissions among requests, and other patient characteristics. We identified factors associated with hospital admissions among the requests using logistic regression.Results: Monthly average warrant requests, issued warrants and hospital admissions increased after February 2021 (x̄ 2.87 vs 7.09 p < 0.001; x̄ 2.67 vs 6.42 p < 0.001; x̄ 1.55 vs 3.58 p < 0.001). We found no differences by period in the proportion of requests with issued warrants (92.8% vs 90.6% p = 0.42) nor the proportion of requests with subsequent hospital admissions (54.0% vs 49.0% p = 0.33). In the second period, there were differences in the proportion of patients with a previously diagnosed mental health disorder (95.3% vs 90.4% p = 0.049). There were significant differences in the distribution of the origin of requests. Being unemployed (OR:2.5 CI:1.2 - 5.2), not having completed high school (OR:2.01 CI:1.12 - 3.77) and having university education (OR:3.67 CI:1.27 - 10.57) degree were associated with hospital admission.Conclusion: Severe mental illness with criteria for mental health warrants may require more resources and different approaches due to a possible increase during and after the COVID-19 pandemic. Community based mental healthcare, incentivized follow-up by primary care and ambulatory treatment may be considered. Further research should evaluate both the national and international trends and associated factors.

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A Population-based Cohort to Investigate the Impact of Covid-19 on Socioeconomic Inequalities in Mental Health Care in Italy (Comeh): Cohort Profile

Petrelli,

Aragona,

Ciampichini

et al. 2024

Preprint

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Background The CoMeH cohort was established to assess the impact of the COVID-19 pandemic on the use of mental health services in Italy in the short and long term, with a particular focus on socioeconomic and/or citizenship inequalities. Methods All residents subjects for at least 2 years, aged ≥ 10 years, and assisted by an NHS general practitioner (GP) of the area of residence, in three vast catchment areas (N = 5,167,043). Primary outcomes of interest are the following indicators of mental health care services’ use: first access to any mental health care service, total number of accesses to mental health care services, the consumption of psychiatric drugs, the number of psychiatric or psychological outpatient visits, the number of residential or day care days spent in psychiatric facilities, the number of emergency and/or inpatient admissions to hospitals. Results Incident users were 3.2% of the population for Bergamo LHA, 3.5% for Rome2 LHA, and 4.4% for the Tuscany Region. The overall crude incidence rate of access to mental health care was 3.3% in the pre-COVID-19 period and 2.6% during the pandemic. Prescriptions for a mental disorder (57.2%) and ED admissions (25.1%) were the main reasons for enrollment. Compared to the general population, people with mental health conditions were older and more often female. The distribution of the incident users by deprivation index overlapped that of the population. Immigrants were younger, socioeconomically more deprived, and more often entered the study for an ED admission. Discussion We will focus on the impact of the pandemic through the evaluation of accesses to hospitalization, emergency, outpatient visits, residential and day care services, and drug prescriptions. We will also evaluate socioeconomic inequalities through the use of census-based deprivation index and migration status. Finally, we will also analyze the impact of COVID-19 infection and outcome on the study cohort.

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Changes in emergency psychiatric consultations in time of COVID-19: a retrospective observational study in the Verona Academic Hospital over the two pandemic years 2020–2021

Cited by 3 publications

References 31 publications

Psychiatric consultations at an Academic Medical Center during alpha strain of the COVID-19 pandemic: A comparison of COVID-19 positive and COVID-19 negative patients

Psychiatric consultations at an Academic Medical Center during alpha strain of the COVID-19 pandemic: A comparison of COVID-19 positive and COVID-19 negative patients

Requests, Issuing, and Hospital Admissions Regarding Mental Health Warrants Before and During the COVID-19 Pandemic in a Region in Portugal

A Population-based Cohort to Investigate the Impact of Covid-19 on Socioeconomic Inequalities in Mental Health Care in Italy (Comeh): Cohort Profile

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