目标:世卫组织宣布,精神卫生保健应被视为在2019年冠状病毒病(COVID-19)大流行期间维持的一项基本卫生服务。这项研究旨在描述意大利COVID-19大流行导致的封锁和限制对精神卫生服务利用的影响,通过考虑精神病诊断和心理健康接触类型。
方法:这项研究是在维罗纳集水区进行的,位于威尼托地区(意大利东北部)。对于每个病人来说,心理健康接触者分为:(1)门诊护理,(2)社会和支持性干预措施,(3)康复干预措施,(4)多专业评估,(5)日托。使用了“差异差异”方法:将2019年至2020年在封锁和中间限制周的接触数量差异与无限制或减少限制周的相同差异进行比较,这种差异被解释为限制的影响。对所有联系人进行全局回归,并对每种类型的服务进行单独回归,并计算发生率比率(IRR)。
结果:在2020年,发现有心理健康接触的患者数量显着减少,总体上和考虑的大多数患者特征(除了18-24岁的外国出生人群和诊断为精神分裂症的人群。此外,2020年,心理健康接触者比2019年减少了57096人(-33.9%);在考虑的各种类型的接触者中,这种差异仍然显著,康复干预和日托显示出最大的减少。负二项回归显示了锁定的统计显着影响,但不是中间限制,在减少接触数量方面。封锁期导致接触总数减少32.7%(IRR0.673;p值<0.001)。所有类型的心理健康联系人都显示出可归因于封锁的减少,除了社会和支持性干预措施。
结论:尽管在大流行期间获得社区精神卫生保健的机会总体上减少了,维罗纳集水区的精神卫生系统能够为更脆弱和重病患者提供支持,通过社会和支持性干预提供持续的护理和日常支持。
OBJECTIVE: WHO declared that mental health care should be considered one essential health service to be maintained during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to describe the effect of lockdown and restrictions due to the COVID-19 pandemic in Italy on mental health services\' utilisation, by considering psychiatric diagnoses and type of mental health contacts.
METHODS: The study was conducted in the Verona catchment area, located in the Veneto region (northeastern Italy). For each patient, mental health contacts were grouped into: (1) outpatient care, (2) social and supportive interventions, (3) rehabilitation interventions, (4) multi-professional assessments, (5) day care. A \'difference in differences\' approach was used: difference in the number of contacts between 2019 and 2020 on the weeks of lockdown and intermediate restrictions was compared with the same difference in weeks of no or reduced restrictions, and such difference was interpreted as the effect of restrictions. Both a global regression on all contacts and separate regressions for each type of service were performed and Incidence Rate Ratios (IRRs) were calculated.
RESULTS: In 2020, a significant reduction in the number of patients who had mental health contacts was found, both overall and for most of the patients\' characteristics considered (except for people aged 18-24 years for foreign-born population and for those with a diagnosis of schizophrenia. Moreover, in 2020 mental health contacts had a reduction of 57 096 (-33.9%) with respect to 2019; such difference remained significant across the various type of contacts considered, with rehabilitation interventions and day care showing the greatest reduction. Negative Binomial regressions displayed a statistically significant effect of lockdown, but not of intermediate restrictions, in terms of reduction in the number of contacts. The lockdown period was responsible of a 32.7% reduction (IRR 0.673; p-value <0.001) in the overall number of contacts. All type of mental health contacts showed a reduction ascribable to the lockdown, except social and supportive interventions.
CONCLUSIONS: Despite the access to community mental health care during the pandemic was overall reduced, the mental health system in the Verona catchment area was able to maintain support for more vulnerable and severely ill patients, by providing continuity of care and day-by-day support through social and supportive interventions.