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. 2021 Dec;144(6):553-562.
doi: 10.1111/acps.13369. Epub 2021 Sep 22.

Psychiatric Admissions, Referrals, and Suicidal Behavior Before and During the COVID-19 Pandemic in Denmark: A Time-Trend Study

Troels Boldt Rømer  1 , Rune Haubo Bojesen Christensen  1 , Stig Nikolaj Blomberg  2 , Fredrik Folke  2 , Helle Collatz Christensen  2   3 , Michael Eriksen Benros  1   4
Affiliations

Psychiatric Admissions, Referrals, and Suicidal Behavior Before and During the COVID-19 Pandemic in Denmark: A Time-Trend Study

Troels Boldt Rømer et al. Acta Psychiatr Scand. 2021 Dec.

Abstract

Objective: To assess the patterns in psychiatric admissions, referrals, and suicidal behavior before and during the COVID-19 pandemic.

Methods: This study utilized health records from hospitals and Emergency Medical Services (EMS) covering 46% of the Danish population (n = 2,693,924). In a time-trend study, we compared the number of psychiatric in-patients, referrals to mental health services and suicidal behavior in years prior to the COVID-19 pandemic to levels during the first lockdown (March 11 - May 17, 2020), inter-lockdown period (May 18 - December 15, 2020), and second lockdown (December 16, 2020 - February 28, 2021).

Results: During the pandemic, the rate of psychiatric in-patients declined compared to pre-pandemic levels (RR = 0.95, 95% CI = 0.94 - 0.96, p < 0.01), with the largest decrease of 19% observed three weeks into the first lockdown. Referrals to mental health services were not significantly different (RR = 1.01, 95% CI = 0.92 - 1.10, p = 0.91) during the pandemic; neither was suicidal behavior among hospital contacts (RR = 1.04, 95% CI = 0.94 - 1.14, p = 0.48) nor EMS contacts (RR = 1.08, 95% CI = 1.00 - 1.18, p = 0.06). Similar trends were observed across nearly all age groups, sexes, and types of mental disorders examined. In the age group <18, an increase in the rate of psychiatric in-patients (RR = 1.11, 95% CI = 1.07 - 1.15, p < 0.01) was observed during the pandemic; however, this did not exceed the pre-pandemic, upwards trend in psychiatric hospitalizations in the age group <18 (p = 0.78).

Conclusion: The COVID-19 pandemic has been associated with a decrease in psychiatric hospitalizations, while no significant change was observed in referrals to mental health services and suicidal behavior. Psychiatric hospitalizations among children and adolescents increased during the pandemic; however, this appears to be a continuation of a pre-pandemic trend.

Keywords: COVID-19; hospitalizations; psychiatry; referral and consultation; suicide.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Trends in the number of in‐patients at psychiatric clinics and referrals to mental health services during COVID‐19. Black dots represent weekly numbers. Smoother curves are added using natural cubic splines. Grey areas represent 95% confidence intervals. (A) In‐patients at psychiatric clinics (B) Referrals to mental health services
FIGURE 2
FIGURE 2
Trends in suicidal behavior during COVID‐19. Black dots represent weekly numbers. Smoother curves are added using natural cubic splines. Grey areas represent 95% confidence intervals. (A) Hospital‐registered suicidal behavior 1 year before and after first lockdown. (B) Suicidal behavior registered in Emergency Medical Service transports
FIGURE 3
FIGURE 3
Trends in psychiatric hospitalizations, referrals and suicidal behavior in the age group <18 during COVID‐19. Black dots represent weekly numbers (monthly counts in D). Smoother curves are added using natural cubic splines. Grey areas represent 95% confidence intervals. (A) In‐patients at psychiatric clinics in the age group <18. (B) Referrals to mental health services in the age group <18. (C) Hospital‐registered suicidal behavior in the age group <18. (D) Suicidal behavior in EMS transports in the age group <18
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