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Multicenter Study
. 2021 Aug 30:110:110304.
doi: 10.1016/j.pnpbp.2021.110304. Epub 2021 Mar 16.

Consequences of the COVID-19 pandemic on admissions to general hospital psychiatric wards in Italy: Reduced psychiatric hospitalizations and increased suicidality

Tommaso Boldrini  1 , Paolo Girardi  2 , Massimo Clerici  3 , Andreas Conca  4 , Chiara Creati  5 , Giuseppe Di Cicilia  5 , Giuseppe Ducci  6 , Federico Durbano  7 , Carlo Maci  8 , Antonio Maone  6 , Giuseppe Nicolò  9 , Osmano Oasi  10 , Mauro Percudani  11 , Gian Marco Polselli  6 , Maurizio Pompili  12 , Alessandro Rossi  13 , Silvia Salcuni  1 , Federica Tarallo  9 , Antonio Vita  14 , Vittorio Lingiardi  5 ; Italian Network for Research on Mental Health during COVID-19 Pandemic
Affiliations
Multicenter Study

Consequences of the COVID-19 pandemic on admissions to general hospital psychiatric wards in Italy: Reduced psychiatric hospitalizations and increased suicidality

Tommaso Boldrini et al. Prog Neuropsychopharmacol Biol Psychiatry. .

Abstract

Aims: The present investigation aimed at evaluating differences in psychiatric hospitalizations in Italy during and after the lockdown due to the novel coronavirus disease 2019 (COVID-19), compared to the same periods in 2018 and 2019.

Methods: We obtained and analyzed anonymized data on psychiatric admissions (n = 4550) from 12 general hospital psychiatric wards (GHPWs) in different Italian regions (catchment area = 3.71 millions of inhabitants). Using a mixed-effects Poisson regression model, we compared admission characteristics across three periods: (a) March 1-June 30, 2018 and 2019; (b) March 1-April 30, 2020 (i.e., lockdown); and (c) May 1-June 30, 2020 (i.e., post-lockdown).

Results: During the COVID-19 lockdown, there was a 41% reduction (IRR = 0.59; p < 0.001, CI: 0.45-0.79) in psychiatric admissions in the enrolled GHPWs with respect to the 2018 and 2019 control period. Conversely, admission rates in the post-lockdown period were similar to those observed in the control period. Notably, a consistent and significant reduction in psychiatric hospitalizations of older patients (aged >65 years) was observed in the lockdown (40%; IRR = 0.60; 95% CI: 0.44-0.82) and post-lockdown (28%; IRR = 0.72; 95% CI: 0.54-0.96) periods. Long-stay admissions (>14 days) increased (63%; IRR = 1.63; 95% CI: 1.32-2.02) during the lockdown and decreased by 39% thereafter (IRR = 0.61; 95% CI: 0.49-0.75). A significant 35% increase in patients reporting suicidal ideation was observed in the post-lockdown period, compared to the rate observed in the 2018 and 2019 control period (IRR = 1.35; 95% CI: 1.01-1.79).

Conclusion: The COVID-19 lockdown was associated with changes in the number of psychiatric admissions, particularly for older patients and long-stay hospitalizations. Increased admission of patients reporting suicidal ideation in the post-lockdown period merits special attention. Further studies are required to gain insight into the observed phenomena.

Keywords: COVID-19; Emergency psychiatric department; General hospital psychiatric ward; Hospital admission; Psychiatric hospitalization; Suicidality.

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Conflict of interest statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. All Authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Predicted relative frequency of admission, by period (i.e., March 1–June 30, 2018 and 2019; lockdown [March 1–April 30, 2020]; post-lockdown [May 1–June 30, 2020]) and age class (i.e., <25, 24–45, 45–65, >65 years old).
Fig. 2
Fig. 2
Predicted relative frequency of admission, by period (i.e., March 1–June 30, 2018 and 2019; lockdown [March 1–April 30, 2020]; post-lockdown [May 1–June 30, 2020]) and length of stay (i.e., <7, 7–14, >14 days).
Fig. 3
Fig. 3
Predicted relative frequency of admission, by period (i.e., March 1–June 30, 2018 and 2019; lockdown [March 1–April 30, 2020]; post-lockdown [May 1–June 30, 2020]) and primary diagnosis class (i.e., mood disorders, personality disorders, schizophrenia spectrum disorders, suicide attempt, other diagnoses). N.B. The “suicidal attempt” class was determined by medical records, rather than ICD-9-CM diagnoses.
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