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1.
CMAJ Open ; 9(4): E988-E997, 2021.
Article in English | MEDLINE | ID: covidwho-1524571

ABSTRACT

BACKGROUND: The extent to which heightened distress during the COVID-19 pandemic translated to increases in severe mental health outcomes is unknown. We examined trends in psychiatric presentations to acute care settings in the first 12 months after onset of the pandemic. METHODS: This was a trends analysis of administrative population data in Ontario, Canada. We examined rates of hospitalizations and emergency department visits for mental health diagnoses overall and stratified by sex, age and diagnostic grouping (e.g., mood disorders, anxiety disorders, psychotic disorders), as well as visits for intentional self-injury for people aged 10 to 105 years, from January 2019 to March 2021. We used Joinpoint regression to identify significant inflection points after the onset of the pandemic in March 2020. RESULTS: Among the 12 968 100 people included in our analysis, rates of mental health-related hospitalizations and emergency department visits declined immediately after the onset of the pandemic (peak overall decline of 30% [hospitalizations] and 37% [emergency department visits] compared to April 2019) and returned to near prepandemic levels by March 2021. Compared to April 2019, visits for intentional self-injury declined by 33% and remained below prepandemic levels until March 2021. We observed the largest declines in service use among adolescents aged 14 to 17 years (55% decline in hospitalizations, 58% decline in emergency department visits) and 10 to 13 years (56% decline in self-injury), and for those with substance-related disorders (33% decline in emergency department visits) and anxiety disorders (61% decline in hospitalizations). INTERPRETATION: Contrary to expectations, the abrupt decline in acute mental health service use immediately after the onset of the pandemic and the return to near prepandemic levels that we observed suggest that changes and stressors in the first 12 months of the pandemic did not translate to increased service use. Continued surveillance of acute mental health service use is warranted.


Subject(s)
COVID-19/epidemiology , Mental Health Services/statistics & numerical data , Mental Health Services/trends , Pandemics/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety Disorders/epidemiology , Child , Emergency Service, Hospital/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Mood Disorders/epidemiology , Ontario/epidemiology , Psychotic Disorders/epidemiology , SARS-CoV-2 , Self-Injurious Behavior/epidemiology , Substance-Related Disorders/epidemiology , Young Adult
2.
Psychiatry Res ; 302: 113999, 2021 08.
Article in English | MEDLINE | ID: covidwho-1492523

ABSTRACT

This study assesses for the impact of Covid-19 public health quarantine measures on acute care psychiatric admissions, by comparing admission data from the quarantine period to a comparator period. A chart review was conducted for all admissions to an urban acute care psychiatric centre from Mar 22 - June 5 2020 (quarantine) and January 5 - Mar 21 2020 (comparator). Data was collected on the number of admissions, demographics, patients' psychiatric history, characteristics of admissions, discharge information, patients' substance use and social factors. Data was analyzed using a student's t-test for continuous variables and Chi squared analyses for categorical variables. Results demonstrated 185 admissions during quarantine and 190 during the comparator, with no significant differences in the distribution of admissions across time periods. There was a significantly greater frequency of admissions in the 35-44 age bracket and admissions involving substance use during quarantine. Additionally, admissions during quarantine were significantly shorter, with increased frequency of involuntary status and use of seclusion. The data suggests a vulnerability specific to individuals in their 30-40s during quarantine and demonstrates a need to better understand factors impacting this group. It also suggests that quarantine is associated with changes to substance use, potentiating high acuity illness requiring admission.


Subject(s)
COVID-19/prevention & control , Hospitalization/statistics & numerical data , Mental Disorders/therapy , Mental Health Services/statistics & numerical data , Quarantine/psychology , Adult , Aged , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Nova Scotia/epidemiology , Public Health/legislation & jurisprudence , Retrospective Studies , Young Adult
3.
PLoS One ; 16(9): e0257270, 2021.
Article in English | MEDLINE | ID: covidwho-1416892

ABSTRACT

BACKGROUND: The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. METHODS: We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants' experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. FINDINGS: The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants' preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties' access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. DISCUSSION: Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.


Subject(s)
COVID-19/prevention & control , Delivery of Health Care/statistics & numerical data , Mental Health Services/statistics & numerical data , Mental Health/statistics & numerical data , Telemedicine/statistics & numerical data , Adolescent , Adult , COVID-19/epidemiology , COVID-19/virology , Delivery of Health Care/methods , Female , Health Personnel/statistics & numerical data , Humans , Male , Mental Health/standards , Middle Aged , Pandemics , Quality of Health Care/standards , Quality of Health Care/statistics & numerical data , SARS-CoV-2/physiology , Surveys and Questionnaires/statistics & numerical data , Telemedicine/methods , Young Adult
4.
South Med J ; 114(9): 593-596, 2021 09.
Article in English | MEDLINE | ID: covidwho-1395358

ABSTRACT

OBJECTIVES: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, many US clinics have shifted some or all of their practice from in-person to virtual visits. In this study, we assessed the use of telehealth among primary care and specialty clinics, by targeting healthcare administrators via multiple channels. METHODS: Using an online survey, we assessed the use of, barriers to, and reimbursement for telehealth. Respondents included clinic administrators (chief executive officers, vice presidents, directors, and senior-level managers). RESULTS: A total of 85 complete responses were recorded, 79% of which represented solo or group practices and 63% reported a daily patient census >50. The proportion of clinics that delivered ≥50% of their consults using telehealth increased from 16% in March to 42% in April, 35% in May, and 30% in June. Clinics identified problems with telehealth reimbursement; although 63% of clinics reported that ≥75% of their telehealth consults were reimbursed, only 51% indicated that ≥75% of their telehealth visits were reimbursed at par with in-person office visits. Sixty-five percent of clinics reported having basic or foundational telehealth services, whereas only 9% of clinics reported advanced telehealth maturity. Value-based care participating clinics were more likely to report advanced telehealth services (27%), compared with non-value-based care clinics (3%). CONCLUSIONS: These findings highlight the adaptability of clinics to quickly transition and adopt telehealth. Uncertainty about reimbursement and policy changes may make the shift temporal, however.


Subject(s)
COVID-19/prevention & control , Medicine/statistics & numerical data , Mental Health Services/statistics & numerical data , Primary Health Care/statistics & numerical data , Telemedicine/statistics & numerical data , Health Care Surveys , Humans , Medicine/methods , Primary Health Care/methods , SARS-CoV-2 , Telemedicine/methods , Texas
5.
Psychiatr Q ; 92(4): 1785-1796, 2021 12.
Article in English | MEDLINE | ID: covidwho-1378979

ABSTRACT

The need for consultation-liaison psychiatry on COVID-19 wards has substantially increased since the start of the pandemic. In this cross-sectional study, we aimed to summarize the characteristics of patients admitted to the post-COVID-19 ward of the American University of Beirut Medical Center who received a psychiatric consultation. We collected relevant sociodemographic and medical data, information about past psychiatric history, psychiatry consultation details, hospital course, and disposition outcome. We also conducted chi-square and binary logistic regression analyses to assess the association between the different variables and disposition outcome. A total of 52 patients (mean age 57.33 years; equal gender distribution) were seen by the psychiatry consult-liaison team. Most had medical comorbidities and 21.2% required intubation. The most prevalent psychiatric diagnoses were delirium (30.8%), major depressive episode (15.4%), and other anxiety disorder (15.4%). Pharmacological management was implemented in 90.4% of cases and mainly included second-generation antipsychotics (36.5%). Non-pharmacological interventions consisted of those related to delirium and therapy for anxiety. Only intubation was significantly associated with disposition outcome (p = 0.004). This study highlights the various psychiatric themes emerging during the acute and post-acute periods of hospitalization for COVID-19. Hospitalized individuals recovering from the infection should be diligently screened and referred to the psychiatry consultation-liaison team to ensure the implementation of appropriate interventions.


Subject(s)
COVID-19 , Mental Disorders , Mental Health Services , Patients , Referral and Consultation , Adult , Aged , COVID-19/epidemiology , COVID-19/therapy , Cross-Sectional Studies , Female , Humans , Male , Mental Disorders/epidemiology , Mental Disorders/therapy , Mental Health Services/statistics & numerical data , Middle Aged , Patients/psychology , Patients/statistics & numerical data , Referral and Consultation/statistics & numerical data
6.
Medicine (Baltimore) ; 100(31): e26854, 2021 Aug 06.
Article in English | MEDLINE | ID: covidwho-1354342

ABSTRACT

ABSTRACT: Prompted by the need to measure the impact of the coronavirus disease 2019 on main areas of quality of life related to mental health (MH), the COV-19-impact on quality of life (COV19-QoL) scale has been developed recently. We measured how patients seeking face-to-face MH care perceived the coronavirus disease 2019 impact on QoL and how socio-demographic factors, stress, and personality contributed to QoL in this diagnostically diverse population.Patients aged 18 to 65 years (n = 251) who came for the first time to the outpatient units during the 6-week index-period (May 21-July 1, 2020) were included. The cross-sectional assessment involved sociodemographic variables, working diagnosis, personality traits (7-dimension model, including HEXACO and DELTA), stress (list of threatening experiences and proximity to virus), and COV19-QoL.The perceived impact of the pandemic on QoL was above the theoretical mean of a 5-point scale (COV19-Qol = 3.1 ±â€Š1.2). No association between total COV19-QoL score, sociodemographic parameters, and working diagnoses was found in the present sample. After testing whether positional (threatening experiences), or dispositional (personality) factors were predominant in the perceived impact of COV-19 on QoL, significant predictors of the outcome were personality traits Disintegration (B = 0.52; P < .01) and Emotionality (B = 0.18; P < .05).It seems that pervasiveness and uncertainty of the pandemic threat triggers-especially in those high on Disintegration trait-a chain of mental events with the decrease of QoL as a final result. Present findings could be used to establish a profile of MH help seeking population in relation to this biological disaster, and to further explore QoL and personality in different contexts.


Subject(s)
COVID-19/complications , Mental Health Services/statistics & numerical data , Quality of Life/psychology , Social Isolation/psychology , Adolescent , Adult , Aged , COVID-19/prevention & control , COVID-19/psychology , Cross-Sectional Studies , Humans , Male , Middle Aged , Surveys and Questionnaires
7.
PLoS One ; 16(7): e0255350, 2021.
Article in English | MEDLINE | ID: covidwho-1329137

ABSTRACT

The aims of this study are to evaluate and describe mental health workforce and capacity, and to describe the relationship between workforce capacity and patterns of care in local areas. We conducted a comparative demonstration study of the applicability of an internationally validated standardised service classification instrument-the Description and Evaluation of Services and Directories-DESDE-LTC) using the emerging mental health ecosystems research (MHESR) approach. Using DESDE-LTC as the framework, and drawing from international occupation classifications, the workforce was classified according to characteristics including the type of care provided and professional background. Our reference area was the Australian Capital Territory, which we compared with two other urban districts in Australia (Sydney and South East Sydney) and three benchmark international health districts (Helsinki-Uusima (Finland), Verona (Italy) and Gipuzkoa (Spain)). We also compared our data with national level data where available. The Australian and Finnish regions had a larger and more highly skilled workforce than the southern European regions. The pattern of workforce availability and profile varied, even within the same country, at the local level. We found significant differences between regional rates of identified rates of psychiatrists and psychologists, and national averages. Using a standardised classification instrument at the local level, and our occupational groupings, we were able to assess the available workforce and provide information relevant to planners about the actual capacity of the system. Data obtained at local level is critical to providing planners with reliable data to inform their decision making.


Subject(s)
Mental Health Services/statistics & numerical data , Workforce/statistics & numerical data , Australia , Humans , Nurses/statistics & numerical data , Psychiatry/statistics & numerical data , Social Workers/statistics & numerical data
8.
Am J Mens Health ; 15(4): 15579883211030021, 2021.
Article in English | MEDLINE | ID: covidwho-1299308

ABSTRACT

The COVID-19 pandemic continues to be a source of stress and have important mental health implications for all persons but may have unique implications for men. In addition to the risk of contracting and dying from COVID-19, the rising COVID-19 death toll, ongoing economic uncertainty, loneliness from social distancing, and other changes to our lifestyles make up the perfect recipe for a decline in mental health. In June 2020, men reported slightly lower rates of anxiety than women, but had higher rates of depressive symptoms and suicidal ideation. As of September 2020, men sought mental health care at a higher rate than women for family and relationships, with year-over-year visits up 5.5 times and total virtual mental health care visits monthly growth in 2020 was up 79% since January. Because men are not a homogeneous group, it is important to implement strategies for groups of men that may have particularly unique needs. In this paper, we discuss considerations for intervening in men's mental health during and in response to the COVID-19 pandemic, including current technology-based cyberpsychology options.


Subject(s)
COVID-19/psychology , Help-Seeking Behavior , Men's Health/statistics & numerical data , Mental Health Services/statistics & numerical data , Patient Acceptance of Health Care/psychology , Anxiety/psychology , Depression/psychology , Humans , Loneliness/psychology , Male , Mental Health/statistics & numerical data , Suicidal Ideation
9.
J Korean Med Sci ; 36(25): e184, 2021 Jun 28.
Article in English | MEDLINE | ID: covidwho-1286919

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is different from previous disasters in that it continues to the present and has affected all aspects of family life. During epidemics, psychosocial support is not less important than infection control. During COVID-19-related school closures, prolonged partial closures of schools could have detrimental social and health consequences for children and may increase the burden on the family. Based on a community sample in Korea, this study identified parental concerns, children's media usage, other various factors and examined whether parental stress level or depression were positively associated with problem behaviors, media exposure, and sleep problems of the primary school children during school closure under COVID-19. METHODS: Participants were 217 parents residing in Suwon, South Korea, who had primary school children and responded to a web-based questionnaire on parental concerns from school closure under COVID-19, subjective stress, depression, whether having received mental health services, and family characteristics; children's sleep patterns, problem behaviors, media usage during the online-only class period, and changes in activity level following the pandemic. RESULTS: During school closure, children gained body weight, spent less time in physical activities and more in media usage. Besides online learning content (97.2%), YouTube was highly used content (87.6%), and games followed (78.3%). Parental subjective stress index was highly associated with parental depression (Pearson correlation 0.439, P < 0.001), children's sleep problems (0.283, P < 0.001), tablet time (0.171, P = 0.012) and behavior problems (0.413, P < 0.001). Parental depression was associated with children's sleep problems (0.355, P < 0.001), TV time (0.153, P = 0.024), tablet time (0.159, P = 0.019), and behavior problems (0.524, P < 0.001). Parents who previously received mental services seemed to be more concerned about the problems their children already have getting worse because of COVID-19 than the disease itself. Children's sleep problem was associated with tablet (0.172, P = 0.011) and smartphone time (0.298, P < 0.001), but not its frequency. CONCLUSION: During COVID-19-related school closures, many parents and children had various difficulties relating to mental health. Ongoing monitoring of mental health of high-risk groups and multiple support systems may need to be expanded to cover those parents having difficulty in caring for their children.


Subject(s)
COVID-19/epidemiology , Mass Media , Pandemics , Parents/psychology , Psychology, Child , SARS-CoV-2 , Schools , Social Isolation , Adult , Body Mass Index , Child , Child Behavior Disorders/epidemiology , Child Behavior Disorders/etiology , Child Care , Depression/epidemiology , Depression/etiology , Education, Distance , Exercise , Female , Humans , Income , Leisure Activities , Male , Mental Health Services/statistics & numerical data , Parent-Child Relations , Procedures and Techniques Utilization , Quarantine , Republic of Korea/epidemiology , Sedentary Behavior , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/etiology , Social Support , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Surveys and Questionnaires
10.
J Med Internet Res ; 23(4): e26994, 2021 04 16.
Article in English | MEDLINE | ID: covidwho-1256255

ABSTRACT

BACKGROUND: Accompanying the rising rates of reported mental distress during the COVID-19 pandemic has been a reported increase in the use of digital technologies to manage health generally, and mental health more specifically. OBJECTIVE: The objective of this study was to systematically examine whether there was a COVID-19 pandemic-related increase in the self-reported use of digital mental health tools and other technologies to manage mental health. METHODS: We analyzed results from a survey of 5907 individuals in the United States using Amazon Mechanical Turk (MTurk); the survey was administered during 4 week-long periods in 2020 and survey respondents were from all 50 states and Washington DC. The first set of analyses employed two different logistic regression models to estimate the likelihood of having symptoms indicative of clinical depression and anxiety, respectively, as a function of the rate of COVID-19 cases per 10 people and survey time point. The second set employed seven different logistic regression models to estimate the likelihood of using seven different types of digital mental health tools and other technologies to manage one's mental health, as a function of symptoms indicative of clinical depression and anxiety, rate of COVID-19 cases per 10 people, and survey time point. These models also examined potential interactions between symptoms of clinical depression and anxiety, respectively, and rate of COVID-19 cases. All models controlled for respondent sociodemographic characteristics and state fixed effects. RESULTS: Higher COVID-19 case rates were associated with a significantly greater likelihood of reporting symptoms of depression (odds ratio [OR] 2.06, 95% CI 1.27-3.35), but not anxiety (OR 1.21, 95% CI 0.77-1.88). Survey time point, a proxy for time, was associated with a greater likelihood of reporting clinically meaningful symptoms of depression and anxiety (OR 1.19, 95% CI 1.12-1.27 and OR 1.12, 95% CI 1.05-1.19, respectively). Reported symptoms of depression and anxiety were associated with a greater likelihood of using each type of technology. Higher COVID-19 case rates were associated with a significantly greater likelihood of using mental health forums, websites, or apps (OR 2.70, 95% CI 1.49-4.88), and other health forums, websites, or apps (OR 2.60, 95% CI 1.55-4.34). Time was associated with increased odds of reported use of mental health forums, websites, or apps (OR 1.20, 95% CI 1.11-1.30), phone-based or text-based crisis lines (OR 1.20, 95% CI 1.10-1.31), and online, computer, or console gaming/video gaming (OR 1.12, 95% CI 1.05-1.19). Interactions between COVID-19 case rate and mental health symptoms were not significantly associated with any of the technology types. CONCLUSIONS: Findings suggested increased use of digital mental health tools and other technologies over time during the early stages of the COVID-19 pandemic. As such, additional effort is urgently needed to consider the quality of these products, either by ensuring users have access to evidence-based and evidence-informed technologies and/or by providing them with the skills to make informed decisions around their potential efficacy.


Subject(s)
COVID-19/psychology , Mental Health Services/statistics & numerical data , Mental Health , Telemedicine/statistics & numerical data , Adult , COVID-19/epidemiology , Female , Humans , Male , Mental Disorders/therapy , Pandemics , SARS-CoV-2/isolation & purification , Surveys and Questionnaires , Technology , United States/epidemiology
11.
Recenti Prog Med ; 112(5): 360-370, 2021 05.
Article in Italian | MEDLINE | ID: covidwho-1232490

ABSTRACT

BACKGROUND: During the first semester 2020 almost all country implemented rigid measures of social distances, including schools closure, to limit the transmission of SARS-CoV-2 infection. Up to now, however, the efficacy of school closure to reduce the spread of the disease in the community still remains unclear and no much is known about the potential negative effects of such measures on physical health and psychological wellbeing of youths, mainly if protracted for long periods. OBJECTIVE: To summarize the data of a systematic review on the impact of the 2020 school closure and social distances measures implemented in response to covid-19 pandemic on youths' physical health and psychological wellbeing. In the present paper we describe the impact on psychological wellbeing. METHODS: We searched 11 international databases up to 1st September 2020 to retrieve cohort studies, cross sectional surveys, uncontrolled pre-post studies and modelling studies. Methodological quality of included studies has been assessed with validated checklists. RESULTS: Sixty-four studies have been included; 27 assessed the impact on psychological wellbeing. All the studies have been conducted during the first wave of pandemic and assessed the short-term effect of social distances measures implemented for relatively short periods. The majority of the studies were conducted in the UK (37,6%) and China (27%). The 42.3% has been judged of high methodological quality. Two studies reported an increase of suicides, while two studies reported a reduction of the access to Psychiatric Emergency Department, Maltreatment allegations decreased substantially, likely due to a reduction in reports rather than actual incidence. Prevalence of anxiety among adolescents ranged between 19% and 64%, depression between 22.3% and 43.7%. Among children 5-12 years old, prevalence of anxiety varied between 19% and 78%, while depression between 6.3% and 22.6%. Among pre-school children, some studies found worsening of behavioural and emotional problems while others did not. CONCLUSIONS: Most of the studies reported relevant worsening of the psychological wellbeing, mainly among adolescents. If school closure and rigid social distances measures will extend for a long time, an even more pronounced negative effect can be expected. Further studies are needed on the long-term effect of prolonged social distances measures, as well as a careful harm-benefit analysis of the impact of such measures.


Subject(s)
COVID-19/prevention & control , Mental Health , Pandemics , Physical Distancing , Adolescent , Anxiety/epidemiology , COVID-19/epidemiology , Child , Child Behavior Disorders/epidemiology , Child, Preschool , Depression/epidemiology , Health Services Accessibility/statistics & numerical data , Humans , Infant , Mental Health Services/statistics & numerical data , Physical Abuse/statistics & numerical data , Prevalence , Psychology, Adolescent , Psychology, Child , Quarantine , Schools , Stress, Psychological/epidemiology , Suicide/statistics & numerical data , Time Factors , Young Adult
12.
J Clin Psychiatry ; 82(2)2021 03 03.
Article in English | MEDLINE | ID: covidwho-1225878

ABSTRACT

OBJECTIVE: The early COVID-19 pandemic resulted in great psychosocial disruption and stress, raising speculation that psychiatric disorders may worsen. This study aimed to identify patients vulnerable to worsening mental health during the COVID-19 pandemic. METHODS: This retrospective observational study used electronic health records from March 9 to May 31 in 2019 (n = 94,720) and 2020 (n = 94,589) in a large, community-based health care system. Percent change analysis compared variables standardized to the average patient population for the respective time periods. RESULTS: Compared to 2019, psychiatric visits increased significantly (P < .0001) in 2020, with the majority being telephone/video-based (+264%). Psychiatric care volume increased overall (7%), with the greatest increases in addiction (+42%), behavioral health in primary care (+17%), and adult psychiatry (+5%) clinics. While patients seeking care with preexisting psychiatric diagnoses were mainly stable (−2%), new patients declined (−42%). Visits for substance use (+51%), adjustment (+15%), anxiety (+12%), bipolar (+9%), and psychotic (+6%) disorder diagnoses, and for patients aged 18­25 years (+4%) and 26­39 years (+4%), increased. Child/adolescent and older adult patient visits decreased (−22.7% and −5.5%, respectively), and fewer patients identifying as White (−3.8%) or male (−5.0) or with depression (−3%) or disorders of childhood (−2%) sought care. CONCLUSIONS: The early COVID-19 pandemic was associated with dramatic changes in psychiatric care facilitated by a rapid telehealth care transition. Patient volume, demographic, and diagnostic changes may reflect comfort with telehealth or navigating the psychiatric care system. These data can inform health system resource management and guide future work examining how care delivery changes impact psychiatric care quality and access.


Subject(s)
COVID-19 , Community Health Services/statistics & numerical data , Mental Disorders/epidemiology , Mental Disorders/therapy , Mental Health Services/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Primary Health Care/statistics & numerical data , Telemedicine/statistics & numerical data , Adolescent , Adult , Child , Electronic Health Records , Female , Humans , Male , Mental Disorders/diagnosis , Middle Aged , Retrospective Studies , Young Adult
13.
Global Health ; 17(1): 51, 2021 04 26.
Article in English | MEDLINE | ID: covidwho-1204093

ABSTRACT

BACKGROUND: Due to the implementation of social distancing and quarantine measures, loneliness has been a major public health concern during the COVID-19 pandemic. However, few studies have examined loneliness in Chinese residents during the COVID-19 epidemic, as well as its associations with mental health needs and services utilization. METHODS: The present study was a cross-sectional survey during the COVID-19 outbreak in China. A total of 7741 adults were invited and completed an online self-administered questionnaire. The Chinese 12-item General Health Questionnaire was used to screen for common mental health problems, loneliness was measured with a single-item self-report question ("How often do you feel lonely in recent days?"), and two standardized questions were used to assess perceived needs for and use of mental health services. RESULTS: In total, 24.2 % of the participants felt lonely in recent days. Age of 16-29 years (OR = 1.36, P = 0.020), marital status of never-married (OR = 1.47, P < 0.001), marital status of "others" (re-married, co-habiting, separated, divorced, and widowed) (OR = 1.72, P < 0.001), having infected family members or close relatives (OR = 1.64, P = 0.026), and having infected colleagues, friends, or classmates (OR = 1.62, P < 0.001) were significant correlates of loneliness. Rates of mental health needs (17.4 % vs. 4.9 %, P < 0.001) and services utilization (2.7 % vs. 1.0 %, P < 0.001) were significantly higher in lonely than not lonely participants. After adjusting for socio-demographic and epidemic characteristics and common mental health problems, loneliness was still significantly associated with mental health needs (OR = 2.50, P < 0.001) and services utilization (OR = 1.62, P = 0.020). CONCLUSIONS: Feelings of loneliness are prevalent among Chinese residents affected by the COVID-19 epidemic and the presence of loneliness is associated with high levels of mental health needs and greater services utilization. Effective measures aiming at preventing or reducing loneliness are potentially beneficial for the mental wellbeing of COVID-19-affected population and reducing the use of the limited mental health service resources during the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Epidemics , Facilities and Services Utilization/statistics & numerical data , Health Services Needs and Demand , Loneliness/psychology , Mental Health Services/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , China/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Surveys and Questionnaires , Young Adult
14.
Australas Psychiatry ; 29(3): 340-343, 2021 06.
Article in English | MEDLINE | ID: covidwho-1186470

ABSTRACT

OBJECTIVE: It has been widely predicted that the COVID-19 pandemic will have a detrimental impact on the mental health (MH) of individuals. This has been dubbed as the MH 'second wave'. In Australia, these impacts have been partly mitigated by institutional responses such as increased access to psychotherapy. Consultation Liaison (CL) psychiatry services provide MH care to acutely unwell patients in general hospitals. It was hypothesised that the number of referrals to the studied service had increased since the start of the pandemic. METHODS: From the Electronic medical records (eMRs), the authors collected daily referral numbers, over 3 consecutive years, to a large CL service in metropolitan Sydney. RESULTS: Referrals were significantly increased by 25%, 95% CI [1.14, 1.36], p < .001 since the start of the pandemic. This increase was delayed, and remained elevated despite a reduction in COVID-19 infections. CONCLUSION: This study adds evidence to the existence of the MH 'second wave', highlights a key impact on healthcare workers' well-being and will assist in guiding resource allocation decisions in the near future.


Subject(s)
COVID-19 , Hospitals, General/statistics & numerical data , Mental Disorders/therapy , Mental Health Services/statistics & numerical data , Psychiatry/statistics & numerical data , Referral and Consultation/statistics & numerical data , Electronic Health Records/statistics & numerical data , Humans , New South Wales
16.
J Med Internet Res ; 23(4): e26994, 2021 04 16.
Article in English | MEDLINE | ID: covidwho-1171242

ABSTRACT

BACKGROUND: Accompanying the rising rates of reported mental distress during the COVID-19 pandemic has been a reported increase in the use of digital technologies to manage health generally, and mental health more specifically. OBJECTIVE: The objective of this study was to systematically examine whether there was a COVID-19 pandemic-related increase in the self-reported use of digital mental health tools and other technologies to manage mental health. METHODS: We analyzed results from a survey of 5907 individuals in the United States using Amazon Mechanical Turk (MTurk); the survey was administered during 4 week-long periods in 2020 and survey respondents were from all 50 states and Washington DC. The first set of analyses employed two different logistic regression models to estimate the likelihood of having symptoms indicative of clinical depression and anxiety, respectively, as a function of the rate of COVID-19 cases per 10 people and survey time point. The second set employed seven different logistic regression models to estimate the likelihood of using seven different types of digital mental health tools and other technologies to manage one's mental health, as a function of symptoms indicative of clinical depression and anxiety, rate of COVID-19 cases per 10 people, and survey time point. These models also examined potential interactions between symptoms of clinical depression and anxiety, respectively, and rate of COVID-19 cases. All models controlled for respondent sociodemographic characteristics and state fixed effects. RESULTS: Higher COVID-19 case rates were associated with a significantly greater likelihood of reporting symptoms of depression (odds ratio [OR] 2.06, 95% CI 1.27-3.35), but not anxiety (OR 1.21, 95% CI 0.77-1.88). Survey time point, a proxy for time, was associated with a greater likelihood of reporting clinically meaningful symptoms of depression and anxiety (OR 1.19, 95% CI 1.12-1.27 and OR 1.12, 95% CI 1.05-1.19, respectively). Reported symptoms of depression and anxiety were associated with a greater likelihood of using each type of technology. Higher COVID-19 case rates were associated with a significantly greater likelihood of using mental health forums, websites, or apps (OR 2.70, 95% CI 1.49-4.88), and other health forums, websites, or apps (OR 2.60, 95% CI 1.55-4.34). Time was associated with increased odds of reported use of mental health forums, websites, or apps (OR 1.20, 95% CI 1.11-1.30), phone-based or text-based crisis lines (OR 1.20, 95% CI 1.10-1.31), and online, computer, or console gaming/video gaming (OR 1.12, 95% CI 1.05-1.19). Interactions between COVID-19 case rate and mental health symptoms were not significantly associated with any of the technology types. CONCLUSIONS: Findings suggested increased use of digital mental health tools and other technologies over time during the early stages of the COVID-19 pandemic. As such, additional effort is urgently needed to consider the quality of these products, either by ensuring users have access to evidence-based and evidence-informed technologies and/or by providing them with the skills to make informed decisions around their potential efficacy.


Subject(s)
COVID-19/psychology , Mental Health Services/statistics & numerical data , Mental Health , Telemedicine/statistics & numerical data , Adult , COVID-19/epidemiology , Female , Humans , Male , Mental Disorders/therapy , Pandemics , SARS-CoV-2/isolation & purification , Surveys and Questionnaires , Technology , United States/epidemiology
17.
MMWR Morb Mortal Wkly Rep ; 70(13): 490-494, 2021 Apr 02.
Article in English | MEDLINE | ID: covidwho-1168279

ABSTRACT

The spread of disease and increase in deaths during large outbreaks of transmissible diseases is often associated with fear and grief (1). Social restrictions, limits on operating nonessential businesses, and other measures to reduce pandemic-related mortality and morbidity can lead to isolation and unemployment or underemployment, further increasing the risk for mental health problems (2). To rapidly monitor changes in mental health status and access to care during the COVID-19 pandemic, CDC partnered with the U.S. Census Bureau to conduct the Household Pulse Survey (HPS). This report describes trends in the percentage of adults with symptoms of an anxiety disorder or a depressive disorder and those who sought mental health services. During August 19, 2020-February 1, 2021, the percentage of adults with symptoms of an anxiety or a depressive disorder during the past 7 days increased significantly (from 36.4% to 41.5%), as did the percentage reporting that they needed but did not receive mental health counseling or therapy during the past 4 weeks (from 9.2% to 11.7%). Increases were largest among adults aged 18-29 years and among those with less than a high school education. HPS data can be used in near real time to evaluate the impact of strategies that address mental health status and care of adults during the COVID-19 pandemic and to guide interventions for groups that are disproportionately affected.


Subject(s)
Anxiety/epidemiology , Anxiety/therapy , COVID-19/psychology , Depressive Disorder/epidemiology , Depressive Disorder/therapy , Mental Health Services/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Risk Factors , Socioeconomic Factors , United States/epidemiology , Young Adult
18.
BMJ Open ; 11(3): e046365, 2021 03 30.
Article in English | MEDLINE | ID: covidwho-1160430

ABSTRACT

OBJECTIVES: The recent COVID-19 pandemic has disrupted mental healthcare delivery, with many services shifting from in-person to remote patient contact. We investigated the impact of the pandemic on the use of remote consultation and on the prescribing of psychiatric medications. DESIGN AND SETTING: The Clinical Record Interactive Search tool was used to examine deidentified electronic health records of people receiving mental healthcare from the South London and Maudsley (SLaM) NHS Foundation Trust. Data from the period before and after the onset of the pandemic were analysed using linear regression, and visualised using locally estimated scatterplot smoothing. PARTICIPANTS: All patients receiving care from SLaM between 7 January 2019 and 20 September 2020 (around 37 500 patients per week). OUTCOME MEASURES: (i) The number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals per week.(ii) Prescribing of antipsychotic and mood stabiliser medications per week. RESULTS: Following the onset of the pandemic, the frequency of in-person contacts was significantly reduced compared with that in the previous year (ß coefficient: -5829.6 contacts, 95% CI -6919.5 to -4739.6, p<0.001), while the frequency of remote contacts significantly increased (ß coefficient: 3338.5 contacts, 95% CI 3074.4 to 3602.7, p<0.001). Rates of remote consultation were lower in older adults than in working age adults, children and adolescents. Despite this change in the type of patient contact, antipsychotic and mood stabiliser prescribing remained at similar levels. CONCLUSIONS: The COVID-19 pandemic has been associated with a marked increase in remote consultation, particularly among younger patients. However, there was no evidence that this has led to changes in psychiatric prescribing. Nevertheless, further work is needed to ensure that older patients are able to access mental healthcare remotely.


Subject(s)
COVID-19/psychology , Drug Prescriptions , Mental Health Services/statistics & numerical data , Practice Patterns, Physicians' , Telemedicine , Adolescent , Aged , COVID-19/epidemiology , Child , Delivery of Health Care , Electronic Health Records , Humans , London , Pandemics , Psychiatry/trends , SARS-CoV-2
19.
Psychiatr Serv ; 72(6): 708-711, 2021 06.
Article in English | MEDLINE | ID: covidwho-1140398

ABSTRACT

OBJECTIVE: This study aimed to examine differences in completion rates between telepsychiatry and in-person visits during the COVID-19 pandemic and a prior reference period. METHODS: The authors used electronic medical record data along with chi-squared or t tests to compare patients' demographic characteristics. Generalized estimating equations for estimating the odds of primary and secondary outcomes were used, controlling for demographic characteristics. RESULTS: During COVID-19, the odds of completing a telepsychiatry visit (N=26,715) were 6.68 times the odds of completing an in-person visit (N=11,094). The odds of completing a telepsychiatry visit during COVID-19 were 3.00 times the odds of completing an in-person visit during the pre-COVID-19 reference period (N=40,318). CONCLUSIONS: In this cross-sectional study, outpatient adult mental health clinic telepsychiatry appointments, largely by telephone, were strongly associated with a higher rate of visit completion compared with in-person visits during and prior to the COVID-19 pandemic. Regulators should consider permanently enabling reimbursement for telephone-only telepsychiatry visits.


Subject(s)
COVID-19 , Mental Health Services/statistics & numerical data , Psychiatry/methods , Psychiatry/statistics & numerical data , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Telephone , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Demography , Electronic Health Records , Female , Humans , Male , Middle Aged , Outpatients/statistics & numerical data , Pandemics , Time Factors , United States/epidemiology
20.
Psychiatry Res ; 299: 113848, 2021 05.
Article in English | MEDLINE | ID: covidwho-1117504

ABSTRACT

Whilst telehealth may overcome some traditional barriers to care, successful implementation into service settings is scarce, particularly within youth mental health care. This study aimed to leverage the rapid implementation of telehealth due to COVID-19 to understand the perspectives of young people and clinicians on how telehealth impacts service delivery, service quality, and to develop pathways for future uses. Youth mental health service users (aged 12-25) and clinicians took part in an online survey exploring service provision, use, and quality following the adoption of telehealth. Service use data from the period were also examined. Ninety-two clinicians and 308 young people responded to the survey. Service use was reduced compared to the same period in 2019, however, attendance rates were higher. Across eight domains of service quality, the majority of young people reported that telehealth positively impacted service quality, and were significantly more likely to rate telehealth as having a positive impact on service quality than clinicians. There was high interest in continuing to use telehealth as part of care beyond the pandemic, supporting its permanent role in youth mental health care for a segment of service users. Future work should explore how best to support its long-term implementation.


Subject(s)
COVID-19/psychology , Delivery of Health Care/methods , Mental Health Services/statistics & numerical data , Quality of Health Care , Telemedicine/statistics & numerical data , Adolescent , Adult , Child , Diffusion of Innovation , Female , Humans , Male , Mental Health Services/organization & administration , Mental Health Services/trends , Pandemics , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine/organization & administration , Young Adult
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