Consequences of the COVID-19 pandemic on admissions to general hospital psychiatric wards in Italy. Reduced psychiatric hospitalizations and increased suicidality

AIMS: The present investigation aimed at evaluating differences in psychiatric hospitalizations in Italy during and after the lockdown due to the novel coronavirus disease 2019 (COVID-19), compared to the same periods in 2018 and 2019.METHODS: We obtained and analyzed anonymized data on psychiatric admissions (n=4550) from 12 general hospital psychiatric wards (GHPWs) in different Italian regions (catchment area=3.71 millions of inhabitants). Using a mixed-effects Poisson regression model, we compared admission characteristics across three periods: (a) March 1-June 30, 2018 and 2019; (b) March 1-April 30, 2020 (i.e., lockdown); and (c) May 1-June 30, 2020 (i.e., post-lockdown).RESULTS: During the COVID-19 lockdown, there was a 41% reduction (IRR=0.59; p<0.001, CI: 0.45-0.79) in psychiatric admissions in the enrolled GHPWs with respect to the 2018 and 2019 control period. Conversely, admission rates in the post-lockdown period were similar to those observed in the control period. Notably, a consistent and significant reduction in psychiatric hospitalizations of older patients (aged >65years) was observed in the lockdown (40%; IRR=0.60; 95% CI: 0.44-0.82) and post-lockdown (28%; IRR=0.72; 95% CI: 0.54-0.96) periods. Long-stay admissions (>14days) increased (63%; IRR=1.63; 95% CI: 1.32-2.02) during the lockdown and decreased by 39% thereafter (IRR=0.61; 95% CI: 0.49-0.75). A significant 35% increase in patients reporting suicidal ideation was observed in the post-lockdown period, compared to the rate observed in the 2018 and 2019 control period (IRR=1.35; 95% CI: 1.01-1.79).CONCLUSION: The COVID-19 lockdown was associated with changes in the number of psychiatric admissions, particularly for older patients and long-stay hospitalizations. Increased admission of patients reporting suicidal ideation in the post-lockdown period merits special attention. Further studies are required to gain insight into the observed phenomena.