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

doi:10.1016/j.pnpbp.2021.110304

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 Boldrini¹, Paolo Girardi², Massimo Clerici³, Andreas Conca⁴, Chiara Creati⁵, Giuseppe Di Cicilia⁵, Giuseppe Ducci⁶, Federico Durbano⁷, Carlo Maci⁸, Antonio Maone⁶, Giuseppe Nicolò⁹, Osmano Oasi¹⁰, Mauro Percudani¹¹, Gian Marco Polselli⁶, Maurizio Pompili¹², Alessandro Rossi¹³, Silvia Salcuni¹, Federica Tarallo⁹, Antonio Vita¹⁴, Vittorio Lingiardi⁵; Italian Network for Research on Mental Health during COVID-19 Pandemic

Affiliations

¹ Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy.
² Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy. Electronic address: paolo.girardi@unipd.it.
³ Department of Mental Health and Addiction, ASST of Monza; Psychiatric Clinic, University of Milan Bicocca, Italy.
⁴ General Hospital of Bolzano, Department of Psychiatry, Bolzano, Italy.
⁵ Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
⁶ Mental Health Department, ASL Roma 1, S.Spirito Hospital, Rome, Italy.
⁷ Department of Mental Health and Addiction, ASST of Melegnano and Martesana, Italy.
⁸ Psychiatric Unit, Sandro Pertini Hospital, ASL Roma2, Rome, Italy.
⁹ Department of Mental Health and Addiction, ASL Roma5, Rome, Italy.
¹⁰ Department of Psychology, Catholic University of Milan, Milan, Italy.
¹¹ Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy.
¹² Department of Neuroscience, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
¹³ Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Mental Health Department ASL 1 Abruzzo, Psychiatric Unit, L'Aquila, Italy.
¹⁴ Department of Mental Health and Addiction, ASST of Brescia, Psychiatric Clinic, University of Brescia, Italy.

PMID: 33737215
PMCID: PMC8569419
DOI: 10.1016/j.pnpbp.2021.110304

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. 2021.

. 2021 Aug 30:110:110304.

doi: 10.1016/j.pnpbp.2021.110304. Epub 2021 Mar 16.

Authors

Affiliations

¹ Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy.
² Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy. Electronic address: paolo.girardi@unipd.it.
³ Department of Mental Health and Addiction, ASST of Monza; Psychiatric Clinic, University of Milan Bicocca, Italy.
⁴ General Hospital of Bolzano, Department of Psychiatry, Bolzano, Italy.
⁵ Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
⁶ Mental Health Department, ASL Roma 1, S.Spirito Hospital, Rome, Italy.
⁷ Department of Mental Health and Addiction, ASST of Melegnano and Martesana, Italy.
⁸ Psychiatric Unit, Sandro Pertini Hospital, ASL Roma2, Rome, Italy.
⁹ Department of Mental Health and Addiction, ASL Roma5, Rome, Italy.
¹⁰ Department of Psychology, Catholic University of Milan, Milan, Italy.
¹¹ Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy.
¹² Department of Neuroscience, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
¹³ Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Mental Health Department ASL 1 Abruzzo, Psychiatric Unit, L'Aquila, Italy.
¹⁴ Department of Mental Health and Addiction, ASST of Brescia, Psychiatric Clinic, University of Brescia, Italy.

PMID: 33737215
PMCID: PMC8569419
DOI: 10.1016/j.pnpbp.2021.110304

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**
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**
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**
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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References

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1. Boldrini T., Schiano Lomoriello A., Del Corno F., Lingiardi V., Salcuni S. Psychotherapy during COVID-19: how the clinical practice of Italian psychotherapists changed during the pandemic. Front. Psychol. 2020;11:2716. doi: 10.3389/fpsyg.2020.591170. - DOI - PMC - PubMed
1. Brody B.D., Parish S.J., Kanellopoulos D., Russ M.J. Short communication a COVID-19 testing and triage algorithm for psychiatric units: one hospital ’ s response to the New York region ’ s pandemic. Psychiatry Res. 2020;291:113244. doi: 10.1016/j.psychres.2020.113244. - DOI - PMC - PubMed
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[1] Bojdani E., Rajagopalan A., Chen A., Gearin P., Olcott W., Shankar V., Cloutier A., Solomon H., Naqvi N.Z., Batty N., Festin F.E.D., Tahera D., Chang G., DeLisi L.E. COVID-19 pandemic: impact on psychiatric care in the United States. Psychiatry Res. 2020;289 doi: 10.1016/j.psychres.2020.113069. - DOI - PMC - PubMed

[2] Bojdani E., Rajagopalan A., Chen A., Gearin P., Olcott W., Shankar V., Cloutier A., Solomon H., Naqvi N.Z., Batty N., Festin F.E.D., Tahera D., Chang G., DeLisi L.E. COVID-19 pandemic: impact on psychiatric care in the United States. Psychiatry Res. 2020;289 doi: 10.1016/j.psychres.2020.113069. - DOI - PMC - PubMed

[3] Boldrini T., Schiano Lomoriello A., Del Corno F., Lingiardi V., Salcuni S. Psychotherapy during COVID-19: how the clinical practice of Italian psychotherapists changed during the pandemic. Front. Psychol. 2020;11:2716. doi: 10.3389/fpsyg.2020.591170. - DOI - PMC - PubMed

[4] Boldrini T., Schiano Lomoriello A., Del Corno F., Lingiardi V., Salcuni S. Psychotherapy during COVID-19: how the clinical practice of Italian psychotherapists changed during the pandemic. Front. Psychol. 2020;11:2716. doi: 10.3389/fpsyg.2020.591170. - DOI - PMC - PubMed

[5] Brody B.D., Parish S.J., Kanellopoulos D., Russ M.J. Short communication a COVID-19 testing and triage algorithm for psychiatric units: one hospital ’ s response to the New York region ’ s pandemic. Psychiatry Res. 2020;291:113244. doi: 10.1016/j.psychres.2020.113244. - DOI - PMC - PubMed

[6] Brody B.D., Parish S.J., Kanellopoulos D., Russ M.J. Short communication a COVID-19 testing and triage algorithm for psychiatric units: one hospital ’ s response to the New York region ’ s pandemic. Psychiatry Res. 2020;291:113244. doi: 10.1016/j.psychres.2020.113244. - DOI - PMC - PubMed

[7] Brooks S.K., Webster R.K., Smith L.E., Woodland L., Wessely S., Greenberg N., Rubin G.J. Rapid review the psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020:6736. doi: 10.1016/S0140-6736(20)30460-8. - DOI - PMC - PubMed

[8] Brooks S.K., Webster R.K., Smith L.E., Woodland L., Wessely S., Greenberg N., Rubin G.J. Rapid review the psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020:6736. doi: 10.1016/S0140-6736(20)30460-8. - DOI - PMC - PubMed

[9] Carpiniello B., Tusconi M., Zanalda E., Di Sciascio G., Di Giannantonio M., Zanalda E., Di Giannantonio M., Carpiniello B., Mencacci C., Balestrieri M., Bondi E., Varia S., Vita A., Di Sciascio G., De Rossi M., Amore M., Bellomo A., Calò P., Cerveri G., Corrivetti G., Ducci G., Fagiolini A., Forti B., Ghio L., Politi P., Rocca P., Roncone R., Villari V., Zoccali R., Psychiatry, T.E.C. of T.I.S. of Psychiatry during the Covid-19 pandemic: a survey on mental health departments in Italy. BMC Psychiatr. 2020;20:593. doi: 10.1186/s12888-020-02997-z. - DOI - PMC - PubMed

[10] Carpiniello B., Tusconi M., Zanalda E., Di Sciascio G., Di Giannantonio M., Zanalda E., Di Giannantonio M., Carpiniello B., Mencacci C., Balestrieri M., Bondi E., Varia S., Vita A., Di Sciascio G., De Rossi M., Amore M., Bellomo A., Calò P., Cerveri G., Corrivetti G., Ducci G., Fagiolini A., Forti B., Ghio L., Politi P., Rocca P., Roncone R., Villari V., Zoccali R., Psychiatry, T.E.C. of T.I.S. of Psychiatry during the Covid-19 pandemic: a survey on mental health departments in Italy. BMC Psychiatr. 2020;20:593. doi: 10.1186/s12888-020-02997-z. - DOI - PMC - PubMed

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

Affiliations

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

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Abstract

Conflict of interest statement

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