Ham Elke, Hilton N Zoe, Crawford Jennifer, Kim Soyeon
Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont.
CMAJ Open. 2023 Oct 24;11(5):E988-E994. doi: 10.9778/cmajo.20220158. Print 2023 Sep-Oct.
The COVID-19 pandemic was associated with increased mental health problems in the general population, yet psychiatric hospital admissions decreased. Early evidence suggested that psychiatric admissions normalized within weeks; we sought to examine the longer-lasting impacts on the psychiatric inpatient population beyond this initial period.
We compared Ontario Mental Health Reporting System admission data for patients admitted to 8 psychiatric hospitals in Ontario, Canada, between 3 time periods - before restrictions were imposed (June 22, 2019, to Mar. 16, 2020), during restrictions (Mar. 17 to June 21, 2020) and after restrictions were lifted (June 22, 2020, to Mar. 16, 2021) for changes in involuntary status, diagnoses and clinical presentation using descriptive analysis. For clinical presentation, we extracted scores on 4 Resident Assessment Instrument-Mental Health symptom scales (Depressive Severity Index, Cognitive Performance Scale, Positive Symptoms Scale-Long Version and Social Withdrawal Scale), and 2 behaviour scales (Aggressive Behavior Scale and Violence Sum).
A cross-sectional sample of 9848 patients was included in the analysis. The mean number of daily admissions decreased 19% from 16.4 (standard deviation [SD] 8.0) before the restriction period to 13.3 (SD 6.1) during the restriction period, and was still 6% below prerestriction levels after restrictions were lifted 15.4 (SD 6.8), with standard error difference of 1.03 (95% confidence interval -0.22 to 2.29). From the pre- to the postrestriction periods, the proportion of involuntary patients increased by 6 percentage points, and the proportions of patients diagnosed with a psychotic disorder or personality disorder increased by 4 percentage points and 1 percentage point, respectively.
Psychiatric admissions did not fully return to prerestriction levels in absolute rates and patient acuity after COVID-19 restrictions were lifted. Psychiatric services must prepare to appraise and respond to any increased acuity through interventions for patients, workforce planning and mental health support for staff.
2019冠状病毒病疫情与普通人群心理健康问题增加有关，但精神病医院住院人数却有所减少。早期证据表明，精神病住院人数在数周内恢复正常；我们试图研究在此初始阶段之后对精神病住院患者群体产生的更持久影响。
我们比较了加拿大安大略省8家精神病医院在3个时间段（限制措施实施前，即2019年6月22日至2020年3月16日；限制措施实施期间，即2020年3月17日至6月21日；以及限制措施解除后，即2020年6月22日至2021年3月16日）收治患者的安大略省心理健康报告系统住院数据，采用描述性分析方法研究非自愿住院状态、诊断和临床表现的变化。对于临床表现，我们提取了4项住院患者评估工具-心理健康症状量表（抑郁严重程度指数、认知表现量表、阳性症状量表-长版和社交退缩量表）以及2项行为量表（攻击行为量表和暴力总和量表）的评分。
分析纳入了9848例患者的横断面样本。每日平均住院人数从限制期前的16.4例（标准差[SD]8.0）下降了19%，至限制期期间的13.3例（SD 6.1），限制措施解除后仍比限制期前水平低6%，为15.4例（SD 6.8），标准误差差异为1.03（95%置信区间-0.22至2.29）。从限制期前到限制期后，非自愿住院患者的比例增加了6个百分点，被诊断患有精神障碍或人格障碍的患者比例分别增加了4个百分点和1个百分点。
2019冠状病毒病限制措施解除后，精神病住院人数在绝对率和患者病情严重程度方面并未完全恢复到限制期前水平。精神科服务机构必须做好准备，通过对患者的干预、劳动力规划以及为工作人员提供心理健康支持，来评估并应对任何病情严重程度的增加。
