Child and Adolescent Mental Health during the COVID-19 Pandemic: Challenges of Psychiatric Outpatient Clinics.

BACKGROUND: Worldwide national surveys show a rising mental health burden among children and adolescents (C&A) during COVID-19. The objective of the current study is to verify the expected rise in visits to psychiatric outpatient clinics of C&A, especially of new patients. METHODS: a cross-sectional study focusing on visits as recorded in electronic medical records of eight heterogeneous C&A psychiatric outpatient clinics. The assessment was based on visits held from March to December of 2019 (before the pandemic) in comparison to visits held in 2020 (during the pandemic). RESULTS: The number of visits was similar for both periods. However, in 2020, 17% of the visits used telepsychiatry (N = 9885). Excluding telepsychiatry reveals a monthly decrease in traditional in-person activities between 2020 and 2019 (691.6 ± 370.8 in 2020 vs. 809.1 ± 422.8 in 2019, mean difference = -117.5, t (69) = -4.07, p = 0.0002, Cohen's d = -0.30). Acceptation of new patients declined during 2020, compared to 2019 (50.0 ± 38.2 in 2020 vs. 62.8 ± 42.9 in 2019; Z = -3.12, p = 0.002, r = 0.44). Telepsychiatry was not used for new patients. CONCLUSIONS: The activity of C&A psychiatric outpatient clinics did not rise but was guarded due to the use of telepsychiatry. The decline in visits of new patients was explained by the lack of use of telepsychiatry for these patients. This calls for expanding the use of telepsychiatry, especially for new patients.

Pediatric psychiatric emergency rooms during COVID-19: a multi-center study.

BACKGROUND: The COVID-19 (SARS-CoV-2) pandemic has been a major stressor for the mental health and well-being of children and adolescents. Surveys and reports from hotlines indicate a significant rise in mental health problems. As the psychiatric emergency room (ER) is a first-line free-of-charge facility for psychiatric emergencies, we expected to see a significant increase in visits, specifically of new patients suffering from anxiety, depression, or stress-related disorders. METHODS: Data from two psychiatric hospital ERs and one general hospital were included. All visits of children and adolescents from the computerized files between March and December of 2019 were analyzed anonymously and compared to the same months in 2020, using multilevel linear modeling. RESULTS: There was a significant decline in the total number of visits (p = .017), specifically among those diagnosed as suffering from stress-related, anxiety, and mood disorder groups (p = .017), and an incline in the proportion of visits of severe mental disorders (p = .029). DISCUSSION: The limited use of child and adolescent psychiatric emergency facilities during the pandemic highlights the importance of tele-psychiatry as part of emergency services. It also suggests the importance of the timeline of the emergence of clinically relevant new psychiatric diagnoses related to the pandemic. Future studies are needed to establish the long-term effects of the pandemic and the expeditious use of tele-psychiatry.

Youth Psychiatric Hospitalization in Israel during COVID-19: A Multi-Center Study.

During the COVID-19 pandemic there have been numerous reports of increases in psychiatric morbidity and a deterioration of status among existing patients. There is little information about how this increase has affected youth and rates of adolescent psychiatric hospitalization. Our study was aimed at examining trends in youth psychiatric hospitalization during the first year of the COVID-19 pandemic. Method: We used medical records to compare trends in hospitalization rates from 2019 to 2020, among psychiatric youth wards from five different centers in Israel. Results: The number of patients that were hospitalized in youth psychiatric wards decreased significantly from 2019 (Mean ± SD=52.2 ± 28.6 per month) to 2020 (M ± SD = 40.8 ± 22.0; unstandardized B = −11.4, 95% CI = −14.4 to −8.3, p < 0.0001). There was a significant decrease in the number of patients that were hospitalized due to internalizing disorders from 2019 (M ± SD = 22.3 ± 9.3 per month) to 2020 (M ± SD = 16.8 ± 7.7; B = −5.5, 95% CI = −8.0 to −3.0, p = 0.0002) and a marginally significant increase in the number of restraints per month (2019: M ± SD = 2.8 ± 6.8, 2020: M ± SD = 9.0 ± 14.5; Z = −1.96, Rosenthal's r = 0.36, p = 0.07). Conclusions: There was a significant decline in psychiatric hospitalizations during the pandemic, specifically among patients suffering from internalizing disorders. The reasons for this decline, and the future impact these changes had on hospitalizations during the pandemic demand further research. Study limitations: This is a retrospective multicenter study from five medical centers in Israel, therefore generalizability of our findings is limited.

Increase in Referrals of Children and Adolescents to the Psychiatric Emergency Room Is Evident Only in the Second Year of the COVID-19 Pandemic-Evaluating 9156 Visits from 2010 through 2021 in a Single Psychiatric Emergency Room.

Introduction: The COVID-19 pandemic affected the wellbeing of children and adolescents. The psychiatric emergency room (ER) is the hub of psychiatric emergencies and reflects clinically significant mental problems. Previous studies compared 2019 and 2020 and observed a decline in ER referrals. The current study focused on the continuous trend of referrals from 2010 to the end of 2021. Method: In our observational retrospective study, we procured data from 9156 child and adolescent referrals to our psychiatric ER. The comparison was made based on similar months of each year. Results: There was a significant positive trend in monthly referrals between 2010 and 2021, representing a similar increase in referrals per month in comparison to that month in the preceding year (unstandardized ß = 4.21, 95% CI = 3.44 to 4.98, p < 0.0001). Between March 2020 and February 2021 (monthly visits = 72.5 + 16.6 [median = 79.5], annual referrals = 870), we observed no additive effect beyond this general trend after controlling for population growth. Conversely, between March and December 2021 (monthly referrals = 106.1 + 31.8 [median = 105.5], overall referrals = 1061) we observed a significant additive effect beyond the projected incline, as predicted by previous years (ß = 21.61, 95% CI = 12.12 to 31.06, p < 0.0001). Conclusions: The first year of the COVID-19 pandemic was no different from the continuous decade long rise of referrals to the children and adolescents' psychiatric ER. Conversely, the second year showed an additional incline beyond the general trend. The complexity in this rising need demands the awareness of clinicians and policy makers alike.

Unanticipated death of a partner: the loss experience of bereaved girlfriends of fallen Israeli soldiers.

This qualitative study examined the loss experience of 15 Israeli bereaved girlfriends of fallen soldiers. The girlfriends of fallen Israeli soldiers are socially unacknowledged as being bereaved. This disenfranchised experience of grief is conveyed through social exclusion components and personal experiences of grief that were conceptualized into four themes: (a) learning about the loss; (b) loneliness and lack of social support; (c) intensifying initial experiences while creating alternative social networks; and (d) missed opportunities. The results provide new insight into the concept of disenfranchised grief suggesting it is a multidimensional experience that includes personal, interpersonal, and social dimensions, each of which falls along a continuum ranging from a sense of acceptance to a sense of exclusion. Results also suggest that there are various depths to the experience of disenfranchised grief, which changes over time. Thus, disenfranchised grief is an ongoing and temporal personal, interpersonal, and social experience. Practical implications are discussed.