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.

Determinants of SARS-CoV-2 Infection in the Older Adult Population: Data From the LOST in Lombardia Study (preprint)

Most COVID-19-related fatalities occurred among older adults, however to date, evidence on determinants of SARS-CoV-2 infection in this population is limited and mostly based on case series without a comparison group. A telephone-based cross-sectional study was conducted in November 2020 on a representative sample of 4,400 Italians aged ≥65 years residing in the Lombardy region. We determined the prevalence of a history of SARS-CoV-2 infection in the period between the beginning of the pandemic and the time of the interview. Thorough unconditional multiple logistic regression models, we estimated odds ratios (OR) of SARS-CoV-2 infection and the corresponding 95% confidence intervals (CI). We also evaluated if the infection was a determinant of a worsening in mental health wellbeing. Overall, 4.9% of participants reported a history of SARS-CoV-2 infection. No significant relationship between sex and SARS-CoV-2 infection was observed. SARS-CoV-2 infection was less frequently reported in subjects aged ≥70 (OR=0.55; 95% 0.41-0.74) compared to 65-69 years. No trend was observed after 70 years of age. Those with at least one chronic condition reported a lower infection rate compared to healthy subjects (OR=0.68 95% CI: 0.49-0.93). Separated/divorced participants less frequently reported infection than married/cohabiting ones (OR=2.33 95% CI: 1.29-4.20). Self-reported history of SARS-CoV-2 infection resulted being a determinant of an increase in depressive symptoms (OR=1.57; 95% CI: 1.17-2.10). This first large representative study of people aged 65 years or over suggests that in Italy the oldest subjects and those having chronic conditions less frequently expose themselves to SARS-CoV-2 infection during the pandemic.