A Population-Based Cohort to Investigate the Impact of COVID-19 on Socioeconomic Inequalities in Mental Health Care in Italy (Comeh): Study Protocol (preprint)

Purpose 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.Conclusion 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.

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

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.

Magnitude and time-course of excess mortality during COVID-19 outbreak: population-based empirical evidence from highly impacted provinces in northern Italy (preprint)

BackgroundThe real impact of SARS-CoV-2 on overall mortality remains uncertain and surveillance reports attributed to COVID-19 a limited amount of deaths during the outbreak. Aim of this study is to assess the excess mortality (EM) during COVID-19 outbreak in highly impacted areas of northern Italy. MethodsWe analyzed data on deaths occurred in the first four months of 2020 in health protection agencies (HPA) of Bergamo and Brescia (Lombardy), building a time-series of daily number of deaths and predicting the daily standardized mortality ratio (SMR) and cumulative number of excess deaths (ED) through a Poisson generalized additive model of the observed counts in 2020, using 2019 data as a reference. ResultsWe estimated 5740 (95% Credible Set (CS): 5552-5936) ED in the HPA of Bergamo and 3703 (95% CS: 3535 - 3877) in Brescia, corresponding to 2.55 (95% CS: 2.50-2.61) and 1.93 (95% CS: 1.89-1.98) folds increase in the number of deaths. The ED wave started a few days later in Brescia, but the daily estimated SMR peaked at the end of March in both HPAs, roughly two weeks after the introduction of lock-down measures, with significantly higher estimates in Bergamo (9.4, 95% CI: 9.1-9.7). ConclusionEM was significantly larger than that officially attributed to COVID-19, disclosing its hidden burden likely due to indirect effects on health system. Time-series analyses highlighted the impact of lockdown restrictions, with a lower EM in the HPA where there was a smaller delay between the epidemic outbreak and their enforcement.