Sculco Camilla, Bano Beatrice, Prina Eleonora, Tedeschi Federico, Bartucz Monica Bianca, Barbui Corrado, Purgato Marianna, Albanese Emiliano
Institute of Public Health, Universita della Svizzera italiana, Lugano, Ticino, Switzerland
Institute of Public Health, Universita della Svizzera italiana, Lugano, Ticino, Switzerland.
BMJ Open. 2025 Mar 12;15(3):e091342. doi: 10.1136/bmjopen-2024-091342.
To quantify access to health services during the COVID-19 pandemic and measure the change in use between the prepandemic and the pandemic periods in a population with assessment of psychological distress or diagnosis of mental disorders.
We developed and piloted a search syntax and adapted it to enter the following databases from 1 January 2020 to 31 March 2023: PubMed/MEDLINE, PsycINFO, Web of Science, Epistemonikos and the WHO International Clinical Trials Registry Platform. We reran the searches from the end of the original search to 3 December 2024.
We systematically screened titles, abstracts and full texts of retrieved records.
We included observational studies on any populations and regions, covering health services such as doctor visits, hospital admissions, diagnostic examinations, pharmaceutical therapies and mental health (MH) services. Only studies using validated scales to assess psychological distress or mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders were included.
We extracted data using a purposefully designed form and evaluated the studies' quality with the Newcastle-Ottawa Scale. We measured the incidence rate (IR) of access to health services and the IR ratio (IRR) between the prepandemic and the pandemic periods. We calculated contacts days and catchment areas in the different periods. We used the random effects DerSimonian-Laird inverse-variance model and calculated heterogeneity with statistics I² and τ². We computed pooled IR and pooled IRR and tested the hypothesis of no variation (IRR=1).
We retrieved 10 014 records and examined the full text of 580 articles. We included 136 primary studies of which 44 were meta-analysed. The IR of access to services during the pandemic was 2.59 contact months per 10 000 inhabitants (IR=2.592; 95% CI: 1.301 to 5.164). We observed a reduction of 28.5% in the use of services with negligible differences by age group and type of services (IRR=0.715; 95% CI: 0.651 to 0.785). We observed significant differences in effect sizes across studies (τ=5.44; p<0.001 and τ=0.090; p<0.001).
By considering MH, our study provides consolidated evidence and quantifies the reduction in the use of health services during the COVID-19 pandemic.
CRD42023403778.
量化2019冠状病毒病（COVID-19）大流行期间获得卫生服务的情况，并衡量在有心理困扰评估或精神障碍诊断的人群中，大流行前和大流行期间卫生服务使用情况的变化。
我们制定并试用了一种检索语法，并对其进行调整，以便在2020年1月1日至2023年3月31日期间检索以下数据库：PubMed/MEDLINE、PsycINFO、科学网、Epistemonikos和世界卫生组织国际临床试验注册平台。我们从原检索结束时重新检索至2024年12月3日。
我们系统地筛选了检索记录的标题、摘要和全文。
我们纳入了关于任何人群和地区的观察性研究，涵盖诸如就诊、住院、诊断检查、药物治疗和心理健康（MH）服务等卫生服务。仅纳入使用经过验证的量表来评估《精神障碍诊断与统计手册》中定义的心理困扰或精神障碍的研究。
我们使用专门设计的表格提取数据，并使用纽卡斯尔-渥太华量表评估研究质量。我们测量了获得卫生服务的发病率（IR）以及大流行前和大流行期间的IR比值（IRR）。我们计算了不同时期的接触天数和服务覆盖区域。我们使用随机效应DerSimonian-Laird逆方差模型，并使用统计量I²和τ²计算异质性。我们计算合并IR和合并IRR，并检验无变化假设（IRR = 1）。
我们检索到10014条记录，并审查了580篇文章的全文。我们纳入了136项原发性研究，其中44项进行了荟萃分析。大流行期间获得服务的IR为每10000名居民2.59个接触月（IR = 2.592；95%CI：1.301至5.164）。我们观察到服务使用减少了28.5%，按年龄组和服务类型的差异可忽略不计（IRR = 0.715；95%CI：0.651至0.785）。我们观察到各研究的效应大小存在显著差异（τ = 5.44；p < 0.001和τ = 0.090；p < 0.001）。
通过考虑心理健康，我们的研究提供了综合证据，并量化了COVID-19大流行期间卫生服务使用的减少情况。
PROSPERO注册号：CRD42023403778。
