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

ABSTRACT

Introduction: The COVID-19 pandemic has affected mental health globally, but the impact on referrals and admissions to mental health services remains understudied. Objective(s) To assess patterns in psychiatric admissions, referrals, and suicidal behavior before and during the COVID-19 pandemic in Denmark. Method(s) Utilizing hospital and Emergency Medical Services (EMS) health records covering 46% of the Danish population, we compared 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) using negative binomial models. Result(s) The rate of psychiatric in-patients declined compared to pre-pandemic levels (RR = 0.95, 95% CI = 0.94 - 0.96, p < 0.01). Referrals 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). 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(s) The pandemic was associated with a decrease in psychiatric hospitalizations. No significant change was observed in referrals and suicidal behavior.