Prevalence of depression and its association with quality of life among guardians of hospitalized psychiatric patients during the COVID-19 pandemic: a network perspective.

Background: The COVID-19 pandemic has greatly affected treatment-seeking behaviors of psychiatric patients and their guardians. Barriers to access of mental health services may contribute to adverse mental health consequences, not only for psychiatric patients, but also for their guardians. This study explored the prevalence of depression and its association with quality of life among guardians of hospitalized psychiatric patients during the COVID-19 pandemic. Methods: This multi-center, cross-sectional study was conducted in China. Symptoms of depression and anxiety, fatigue level and quality of life (QOL) of guardians were measured with validated Chinese versions of the Patient Health Questionnaire - 9 (PHQ-9), Generalized Anxiety Disorder Scale - 7 (GAD-7), fatigue numeric rating scale (FNRS), and the first two items of the World Health Organization Quality of Life Questionnaire - brief version (WHOQOL-BREF), respectively. Independent correlates of depression were evaluated using multiple logistic regression analysis. Analysis of covariance (ANCOVA) was used to compare global QOL of depressed versus non-depressed guardians. The network structure of depressive symptoms among guardians was constructed using an extended Bayesian Information Criterion (EBIC) model. Results: The prevalence of depression among guardians of hospitalized psychiatric patients was 32.4% (95% CI: 29.7-35.2%). GAD-7 total scores (OR = 1.9, 95% CI: 1.8-2.1) and fatigue (OR = 1.2, 95% CI: 1.1-1.4) were positively correlated with depression among guardians. After controlling for significant correlates of depression, depressed guardians had lower QOL than non-depressed peers did [F(1, 1,101) = 29.24, p < 0.001]. "Loss of energy" (item 4 of the PHQ-9), "concentration difficulties" (item 7 of the PHQ-9) and "sad mood" (item 2 of the PHQ-9) were the most central symptoms in the network model of depression for guardians. Conclusion: About one third of guardians of hospitalized psychiatric patients reported depression during the COVID-19 pandemic. Poorer QOL was related to having depression in this sample. In light of their emergence as key central symptoms, "loss of energy," "concentration problems," and "sad mood" are potentially useful targets for mental health services designed to support caregivers of psychiatric patients.

Low prevalence of SARS-CoV-2 among patients presenting at a Parisian psychiatry University Hospital Group.

We examine the prevalence of SARS-CoV-2 infections among patients admitted to a Parisian psychiatric University Hospital Group (GHU). A total of 548 patients were admitted to the GHU's full-time psychiatric wards between April 6 and May 3 2020. More than 80% were tested. A total of 7 patients tested positive for the SARS-Cov-2 (1.3%), with 5 patients (in 92, 5.4%) testing positive in the first week. GHU patients presented a low prevalence of SARS-CoV-2, even if all patients live in the hardest hit region in France. Social isolation and loneliness, as well as self-isolation of patients with symptoms could explain our results.

A 360degree view of psychiatric boarding in the emergency department

This dissertation utilizes a three article approach to examine the current status of psychiatric boarding in the emergency department (ED). The number of ED visits for mental health concerns in the United States has been increasing for the past several decades as the number of inpatient psychiatric beds has decreased. This has created a psychiatric boarding crisis where patients are waiting in ED for extended periods of time across the country. This dissertation provides a 360degree view of psychiatric boarding in the ED by critically examining the literature surrounding the effects of psychiatric boarding, analyzing the characteristics of patients undergoing psychiatric boarding through a large national dataset, and by analyzing mixed methods data from ED nurses who care for these patients.The first article presents a systematic review of the status of psychiatric boarding while also addressing the involvement of civil commitment during a psychiatric boarding stay in the ED. Boarding times in the selected 31 articles varied greatly and patients were rarely started on new psychiatric drugs while in the ED. Common diagnoses for patients included suicidal ideations or suicidal behaviors.The second article presents an analysis of the 2016-2017 combined Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Patients that had a psychiatric evaluation in the ED were considered at risk for psychiatric boarding. Patients that boarded for longer than one calendar day and had a psychiatric evaluation were compared to patients that had a psychiatric evaluation but it not ultimately board. Patients that boarded had a greater number of billable procedures performed compared to patients that did not board. The two most common diagnoses of patients undergoing psychiatric boarding for greater than one calendar day were chronic obstructive pulmonary disease with major complication or comorbidity and diabetes.The final article utilizes data gathered from ED nurses about their experience with psychiatric boarding at their hospital. Nurses that had greater positive attitudes toward patients undergoing psychiatric boarding were associated with greater perceived competency for providing care for persons with mental illness, and fewer stigmatizing attitudes of patients with mental illness. Through a mixed method approach, this study found that nurses perceptions of psychiatric boarding as a problem varied greatly as well as the different practices that can occur during a psychiatric boarding stay. Suggestions for improvement centered on improving the physical environment because of the high pressure and chaotic nature of the ED.Overall, the details about what occurs during psychiatric boarding in the ED are still poorly described. The lack of research on the short-term and long-term effects of spending extended periods of time in the ED is also concerning, given that this dissertation found that 54.55% of nurses believe that psychiatric boarding is currently a problem at their hospital. Future research that focuses on creating a best practices protocol for patients spending more than 24 hours in the ED is greatly needed to improve the experience and safety of psychiatric boarding for both patients and ED staff members. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Community Reintegration of Long-Stay Hospitalised Mental Health Consumers During COVID-19 Pandemic

Mandatory restrictions on social activities and access to services during the COVID-19 pandemic prevented discharge into the community of consumers from an extended-stay, hospital-based rehabilitation program. This article describes a revised discharge process that overcame the pandemic-related restrictions by replacing the graded and slow discharge process with a one-stage, full-time transition that facilitated the discharge of 16 adult consumers. No adverse mental health outcomes occurred during the process. The change of practice with its positive results reflected therapeutic risk-taking. The COVID-19 pandemic provided scope for creativity and innovation in mental health care and psychiatric rehabilitation. IMPLICATIONS Innovation and collaboration by service providers can promote consumers' positive risk-taking to return to a life in mainstream society after a prolonged stay in an inpatient rehabilitation unit. Community reintegration of consumers with enduring severe mental illness can occur under adverse public health and social situations like the COVID-19 pandemic with innovative hospital discharge planning.

Impact of COVID-19 pandemic on psychiatric patients at clinical trial sites

Introduction: Recent research on the COVID-19 pandemic suggests that individuals who suffer from serious mental illness (SMI) are at heightened risk of infection and have increased mortality due to their illness and/or lack of access to healthcare. Consequently, progress in developing new treatments for SMIs has been disrupted, with many interruptions to clinical trials in psychiatry due to concerns regarding the pandemic and its risks to patients with SMI. Objective: This study aimed to examine the impact of the COVID-19 pandemic on patients with SMI, specifically relating to psychiatric morbidity, pandemic-induced stress, and ability to cope with pandemic-related precautionary measures, restrictions, and disruptions to daily life. Design: A cross-sectional survey study of 94 clinical trial patients diagnosed with bipolar disorder, major depressive disorder (MDD), or schizophrenia was conducted in three geographically distinct clinical trial sites between June and September 2020. Prevalence rates were calculated for sample characteristics and demographics, and low versus high stress groups were compared on survey variables using Pearson's Chi-squared test of independence. Results: The results from the surveys indicated that COVID-19 knowledge, awareness, and the use of precautionary safety measures (e.g., handwashing, personal protective equipment [PPE], and social distancing) were robust and mirrored the general population. While the majority of patients reported experiencing moderate or extreme levels of distress (61.5%, n = 56), high levels of stress were correlated with positive coping skills. Conclusion: These findings suggest that clinical trial patients with SMI can safely participate in clinical trials despite the increase safety risks posed by the COVID-19 pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Dreaming during a pandemic: Low incorporation of COVID-19-specific themes and lucidity in dreams of psychiatric patients and healthy controls.

The present study examined the impact of the COVID-19 pandemic on the emotional quality of dreams, the incorporation of pandemic-related themes, and the occurrence of lucid dreaming. Dream reports and lucidity ratings of psychiatric outpatients (n = 30) and healthy controls (n = 81) during two lockdowns in Germany were compared to those of healthy controls (n = 33) before the pandemic. Results confirmed previous reports that pandemic-specific themes were incorporated into dreams. Overall, however, incorporation into dreams was rare. Contrary to expectations, psychiatric outpatients did not differ from controls in the frequency of dream incorporation of pandemic-related content. Moreover, incorporation was independent of psychiatric symptoms and loneliness. Loneliness was, however, associated with threat-related content, suggesting that it represents a risk for bad dreams but not for crisis-specific dream incorporation. Regarding lucid dreaming, both groups had similar scores for its underlying core dimensions, i.e., insight, control, and dissociation, during the two lockdowns. Scores for control and dissociation but not insight were lower compared to the pre-pandemic sample. Our working hypothesis is that REM sleep during lockdowns intensified as a means of increased emotional consolidation, rendering the associated mental state less hybrid and thereby less lucid.

Prioritization of patients with psychiatric comorbidities in vaccination during COVID- 19 pandemic

This article explores that vaccination appears to be safe in psychiatric patient population as well as the general population. Studies performed by Psychiatric Association of Turkey emphasize the need for vaccination in psychiatric patients similar to other patients with chronic medical comorbidities by analyzing studies performed especially in European countries. To conclude, we recommend prioritization of patients with psychiatric comorbidities during vaccination period and increased effort to vaccinate psychiatric inpatients. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Perinatal patients with symptoms of anxiety

This chapter provides descriptions, typical clinical presentations, and case reviews of perinatal anxiety and perinatal obsessive-compulsive disorder. The discussed anxiety disorders include generalized anxiety disorder, panic disorder, and illness anxiety disorder as encountered in the perinatal period including pregnancy and 12 months' postpartum. Suggestions for provider advocacy during increased rates of intimate partner violence during COVID-19 are provided. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Insomnia and related factors in patients with pre-existing psychiatric disorders compared to the general population during the COVID-19 lockdown: Findings from the multicentric COMET study.

BACKGROUND: The COVID-19 pandemic has heavily impacted social, economic and health systems worldwide. Necessary confinement measures have, in turn, contributed to the occurrence of several stress-related conditions and deterioration of pre-existing mental conditions, including insomnia. OBJECTIVE: The present study sought to investigate the occurrence and severity of insomnia during the COVID-19 lockdown among psychiatric patients and in the general population in the largest Italian sample examined to date. Potential factors associated with a risk of developing insomnia in the global sample were examined as well. METHODS: A sample of 20,720 people (5.5% of them being psychiatric patients) was assessed through an online survey conducted during lockdown between March and May 2020. To investigate the occurrence and severity of sleep related issues, the Insomnia Severity Index (ISI) was used. In order to evaluate factors associated with the severity of insomnia in the global sample, multivariate linear regression models were performed. RESULTS: During the lockdown, patients with pre-existing mental disorders reported a mean higher score on the ISI scale (p < 0.001) compared to the general population. According to the multivariate regression models, the first three weeks of lockdown were significantly associated with a higher risk of insomnia, but the risk disappeared in the fourth week. Other associated factors included: the presence of a pre-existing mental disorder, ages 24 to 64 years old, and/or being female (p < 0.001). CONCLUSIONS: Although containment measures represent essential public health strategies to avoid the spread of the COVID-19 pandemic, sleep was one of the aspects affected during the early stages of the lockdown in both people with pre-existing mental disorders and general population. As an integral part of COVID-19 intervention, it is useful to raise awareness about these issues and to adopt both preventive and therapeutic interventions.

Distress and Well-Being Among Psychiatric Patients in the Aftermath of the First COVID-19 Lockdown in Israel: A Longitudinal Study.

Objectives: Studies assessing the effect of the COVID-19 pandemic on psychiatric patients have mostly focused on cross-sectional evaluations of differences in levels of distress. In this study, we aimed to assess changes in distress and well-being following the COVID-19 pandemic outbreak as compared with pre-pandemic levels, as well as potential predictors of symptomatic deterioration, among psychiatric outpatients treated in a public mental health hospital in Israel. Methods: Patients evaluated for distress and well-being before the pandemic (n = 55) were re-evaluated at the end of the first lockdown in Israel. Results: Analyses revealed a significant decrease in the patients' sense of personal growth. Increases in distress were significantly associated with fear of COVID-19 beyond patient characteristics. Conclusion: These results suggest that the pandemic has a short-term effect on patients' well-being, and that fear of the pandemic is associated with elevations in distress.

The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events.

The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.

Increasing COVID-19 Vaccination Rates Among Patients With Serious Mental Illness: A Pilot Intervention Study.

OBJECTIVE: This pilot project aimed to maximize COVID-19 vaccine uptake among patients with serious mental illness. Psychiatric providers were engaged to directly address COVID-19 vaccine-related concerns with patients during outpatient visits. METHODS: A quality improvement project encouraged COVID-19 vaccinations in a cohort of outpatients treated with clozapine (N=193, ages 19-81 years, mean age=46.4 years) at a community mental health center. In-service education was provided to clinicians to identify vaccine-hesitant patients and build vaccine confidence. A vaccination-monitoring tool was created and embedded in patients' electronic medical records. Starting in February 2021, the tool guided semistructured interviews at each visit and supported population-based management. RESULTS: The full COVID-19 vaccination rate by June 30, 2021, was 84% among the outpatients, compared with the estimated state rate on the same date of between 62.1% and 77.3%. CONCLUSIONS: The active involvement of psychiatric providers in preventive health care can help increase vaccination rates among patients with serious mental illness.

Network Analysis of Depression, Anxiety, Posttraumatic Stress Symptoms, Insomnia, Pain, and Fatigue in Clinically Stable Older Patients With Psychiatric Disorders During the COVID-19 Outbreak.

OBJECTIVES: The Coronavirus Disease 2019 (COVID-19) pandemic has profound negative effects on the mental health of clinically stable older patients with psychiatric disorders. This study examined the influential nodes of psychiatric problems and their associations in this population using network analysis. METHODS: Clinically stable older patients with psychiatric disorders were consecutively recruited from four major psychiatric hospitals in China from May 22 to July 15, 2020. Depressive and anxiety syndromes (depression and anxiety hereafter), insomnia, posttraumatic stress symptoms (PTSS), pain, and fatigue were measured using the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist - Civilian Version, and Numeric Rating Scales for pain and fatigue, respectively. RESULTS: A total of 1063 participants were included. The network analysis revealed that depression was the most influential node followed by anxiety as indicated by the centrality index of strength. In contrast, the edge connecting depression and anxiety was the strongest edge, followed by the edge connecting depression and insomnia, and the edge connecting depression and fatigue as indicated by edge-weights. The network structure was invariant by gender based on the network structure invariance test (M = .14, P = .20) and global strength invariance tests (S = .08, P = .30). CONCLUSIONS: Attention should be paid to depression and its associations with anxiety, insomnia, and fatigue in the screening and treatment of mental health problems in clinically stable older psychiatric patients affected by the COVID-19 pandemic.

Adolescent patient engagement through telepsychiatry: A case report application

The COVID-19 pandemic has changed psychopharmacological prescribing and management of patients around the world. Social distancing requirements led to a transition from face-to-face patient visits to telepsychiatry. Relaxed federal reimbursement policies during the COVID-19 pandemic expanded patient awareness and access to virtual care. For many psychiatric advanced practice RNs (APRNs), the transition to telepsychiatry was intended as a temporary solution until it is possible to return to in-person patient care. Instead, virtual care has become an expectation of patients and agencies. The current article presents a case study example of an adolescent psychiatric patient, exploring the challenges of therapeutic alliance, patient engagement, psychiatric evaluation, laboratory orders, deprescribing, and psychopharmacological adherence. The case study discusses considerations for APRNs who use telemental health in child and adolescent psychiatry and resources for clinical practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

A 360degree view of psychiatric boarding in the emergency department

This dissertation utilizes a three article approach to examine the current status of psychiatric boarding in the emergency department (ED). The number of ED visits for mental health concerns in the United States has been increasing for the past several decades as the number of inpatient psychiatric beds has decreased. This has created a psychiatric boarding crisis where patients are waiting in ED for extended periods of time across the country. This dissertation provides a 360degree view of psychiatric boarding in the ED by critically examining the literature surrounding the effects of psychiatric boarding, analyzing the characteristics of patients undergoing psychiatric boarding through a large national dataset, and by analyzing mixed methods data from ED nurses who care for these patients.The first article presents a systematic review of the status of psychiatric boarding while also addressing the involvement of civil commitment during a psychiatric boarding stay in the ED. Boarding times in the selected 31 articles varied greatly and patients were rarely started on new psychiatric drugs while in the ED. Common diagnoses for patients included suicidal ideations or suicidal behaviors.The second article presents an analysis of the 2016-2017 combined Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Patients that had a psychiatric evaluation in the ED were considered at risk for psychiatric boarding. Patients that boarded for longer than one calendar day and had a psychiatric evaluation were compared to patients that had a psychiatric evaluation but it not ultimately board. Patients that boarded had a greater number of billable procedures performed compared to patients that did not board. The two most common diagnoses of patients undergoing psychiatric boarding for greater than one calendar day were chronic obstructive pulmonary disease with major complication or comorbidity and diabetes.The final article utilizes data gathered from ED nurses about their experience with psychiatric boarding at their hospital. Nurses that had greater positive attitudes toward patients undergoing psychiatric boarding were associated with greater perceived competency for providing care for persons with mental illness, and fewer stigmatizing attitudes of patients with mental illness. Through a mixed method approach, this study found that nurses perceptions of psychiatric boarding as a problem varied greatly as well as the different practices that can occur during a psychiatric boarding stay. Suggestions for improvement centered on improving the physical environment because of the high pressure and chaotic nature of the ED.Overall, the details about what occurs during psychiatric boarding in the ED are still poorly described. The lack of research on the short-term and long-term effects of spending extended periods of time in the ED is also concerning, given that this dissertation found that 54.55% of nurses believe that psychiatric boarding is currently a problem at their hospital. Future research that focuses on creating a best practices protocol for patients spending more than 24 hours in the ED is greatly needed to improve the experience and safety of psychiatric boarding for both patients and ED staff members. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Risk Perception among Psychiatric Patients during the COVID-19 Pandemic.

The fear of the new coronavirus infection has driven many non-COVID-19 patients away from essential healthcare. Our study aimed to investigate the perception of risk and feelings of danger for the contagion in a sample of Italian psychiatric patients. We conducted a cross-sectional observational study during the second wave of the COVID-19 pandemic and the lockdown in Italy. The risk perception and risk-related variables were assessed in a sample of 150 consecutive patients with a previous diagnosis of major depression (50), bipolar I disorder (50), and schizophrenia seeking ambulatory care using a questionnaire previously administered to the general Italian population. Our results showed that patients were more concerned about economic, psychological, and interpersonal consequences of COVID-19 pandemic, rather than about their own health. At the multiple regression analysis, the likelihood of COVID-19 resolution was positively influenced by the diagnosis of schizophrenia, the increased perceived effectiveness, and the presence of positive emotions. Indeed, positive emotions and uncertainty positively influenced interpersonal risk. Our study highlights the need to provide more support to psychiatric patients during emergency events to prevent them from engaging in risky behaviors.

Buffering effect of in-patient psychiatric care on the link between fear of covid-19 and mental health consequences.

BACKGROUND& AIMES: Psychiatric admissions during the covid-19 pandemic were limited, overlooking their possible benefit. This study focused on assessing the effect of the fear of covid on the mental health and well-being of inpatients as opposed to outpatients. METHODS: During the first lockdown, forty-four inpatients and day care patients (inpatient group) and 74 outpatients (outpatient group) were recruited after an informed consent procedure. Fear of the infection was assessed using the Fear of COVID-19 (FCV-19S); severity of mental health symptomatology was evaluated with the outcome questionnaire-45 (OQ-45); wellbeing was assessed with the Psychological well-being scale (PWB). OUTCOMES: There was no difference between the inpatient group and outpatient group in their fear of COVID-19 levels.FCV-19 predicted changes in the outpatient OQ total score (B â€‹= â€‹2.21, p â€‹< 0.001), OQ interpersonal relation subscale (B â€‹= â€‹0.34, p â€‹= 0.01), PWB total score (B â€‹= â€‹-0.05, p â€‹< 0.001), PWB environmental mastery subscale (B â€‹= â€‹-0.07, p â€‹< 0.001) and PWB positive relation subscale (B â€‹= â€‹-0.05, p â€‹< 0.001), but not in the inpatient group. CONCLUSIONS: Mental health and wellbeing of the outpatient group, which had less therapeutic contact than the inpatient group, correlated with the fear of covid, supporting the hypothesis that intensive psychiatric therapy had a protective effect on the mental health consequences of "fear of covid".

Subjective experience on group activities of patients admitted in a psychiatric facility during the COVID-19 epidemic: "the Santi's Magazine"

Objectives Italy is one of the most affected countries in the world during the COVID-19 pandemic. The recurring waves of the epidemic largely compromised routine activities of the Italian Departments of Mental Health, significantly reducing outpatient and day service activities. Psychiatric facility and hospital treatments have also been maintained. albeit widely remodeled and conditioned by the fear of contagion. The aim of this paper was to report the subjective experiences on group activities offered in an Italian psychiatric facility for intensive interventions (the Santi Center) during the second wave of the pandemic in the fall of 2020. Methods The format of these group activities included weekly face-to-face meetings using supportive, psychoeducational motor and relaxing techniques, all conducted by mental health professionals. Here we reported the participants' subjective experiences written during the two months of these meetings, all of which merged into the special 2020 Christmas edition of the Santi's magazine. Results All participants (8 out of 12 inpatients hospitalized in the facility at that time) were affected by psychotic disorders. Patients' experiences on group activities were uniformly positive. In this paper we reported the most significant passages. Conclusions Inpatients with psychotic disorder found our group activities very beneficial. Our real-world experience is a useful witness to contrast the general paralysis of mental healthcare interventions, which too much often affected Italian mental healthcare services during the pandemic. Moreover it advances our understanding of the usefulness of group activities for increasing patient's resilience also in an epidemic era and in a forced social isolation.

Psychiatric hospitalization in Korea, 2011-2020: the impact of the Mental Health Act revision of 2017 in consideration of the COVID-19 pandemic.

OBJECTIVE: This study was performed to examine the changes in psychiatric hospitalization in Korea after the mental health law revision of 2017 with consideration of the COVID-19 pandemic. METHODS: The data were obtained from National Health Insurance and Medical Aid statistical yearbooks of 2011-2020. The changes in the inpatient and outpatient utilization for schizophrenia from 2011 to 2020 were compared with those for other psychiatric disorders and the general population. With difference-in-differences analysis, the changes in utilization of inpatient and outpatient care for schizophrenia after the law revision of 2017 were analyzed with two comparison groups. RESULTS: While the number of inpatients and inpatient days for schizophrenia decreased between 2017 and 2019, the number of outpatients and outpatient visits for schizophrenia increased during the period. Inpatient care utilization in two comparison groups increased during the same period. Whereas the COVID-19 pandemic of 2020 led to a general decrease in health care use among the population including inpatient care for schizophrenia, the number of outpatients for schizophrenia increased slightly after the pandemic. Difference-in-differences analysis showed that the law revision was associated with the decrease in the use of inpatient care for schizophrenia after adjustment for the effect of the COVID-19 pandemic. CONCLUSIONS: The mental health law revision in Korea led to a significant decrease in hospitalization for schizophrenia. However, the limited effect of revision on the Medical Aid beneficiaries suggests that the revision was not followed by the provision of the proper alternatives which can replace hospitalization of the most vulnerable population.