key: cord-0686373-tr6k49j1 authors: Julien, Flament; Nathan, Scius; Nicolas, Zdanowicz; Maxime, Regnier; Louis, De Cannière; Henri, Thonon title: Influence of post-COVID-19 deconfinement on psychiatric visits to the emergency department date: 2021-05-06 journal: Am J Emerg Med DOI: 10.1016/j.ajem.2021.05.014 sha: 15c84fc630efa4b03cf2dd3ebac645a9bfa8493f doc_id: 686373 cord_uid: tr6k49j1 OBJECTIVE: During the deconfinement period after the coronavirus disease-2019 (COVID-19) pandemic, the number and characteristics of psychiatric visits changed in our emergency department (ED). We aimed to assess changes in the number of visits and characterize the profiles of these patients. METHODS: In this retrospective observational study, we examined the number of psychiatric ED visits and their proportion among the total number of ED visits. We also evaluated psychiatric visits characteristics during a one-month period after the declaration of deconfinement, and we compared those characteristics to characteristics observed during the same month over the previous 4 years. RESULTS: The number of psychiatric visits to our emergency department during deconfinement was similar to the number observed in the same month of previous years. However, the proportion of psychiatric visits to our emergency department among all visits to the ED rose during deconfinement to a level never before observed. The mean proportion of psychiatric admissions to all ED admissions rose from 3.5% in past years to 5.3% during deconfinement (p = 0.013). Moreover, during deconfinement, more visits (80%) were without an acute intoxication compared to past years (58.5%; p = 0.031). Also, in the deconfinement period, more visits lacked a follow-up consultation organized at discharge (40%) compared to the historical period (25%, p = 0.036). CONCLUSIONS: The deconfinement period after the first wave COVID-19 changed the number and type of psychiatric emergency medicine consultations at our hospital, suggesting a psychiatric impact of confinement during this pandemic. These findings will be of interest to practitioners and politicians in the coming months. After the first wave of coronavirus disease-2019 (COVID-19) outbreak, the Belgian government decided that the confinement measures would be de-escalated in successive stages. Deconfinement was announced in Belgium on April 24, 2020, and it was implemented gradually [1] . On May 4, outdoor activities were allowed for a maximum of two people [2] . On May 18, several institutions were reopened, including schools and cultural attractions; the economy was restarted by allowing professions that required close contact to resume activities; and sports and leisure activities were allowed to resume [3] . In the last phase, starting June 3, all activities were allowed to resume, as described by a spokeperson of the Belgian government of the Belgian government: "freedom is the rule, and what is not allowed is the exception" [4] . symptoms (PTSS). Indeed, indicators of PTSS and symptoms of depression have increased after the COVID-19 outbreak [8] . These observations were consistent with past reactions observed in populations that experienced quarantine (e.g., 2003 SARS or Ebola) [9] . The world is expected to change with an economic recession, and the rise in unemployment is expected to be associated with a rise in the suicide rate [10] . In our emergency department (ED), during the month of May, the authors hypothesized that deconfinement might have led to changes in the number and profiles of psychiatric visits. The present retrospective observational study was conducted to test two main hypotheses. First, we hypothesized that the number of psychiatric visits to our ED would increase. Second, we hypothesized that the characteristics of these visits would be different. This retrospective observational single-center study analyzed psychiatric visits to the ED of a university hospital on the outskirts of a city of 200,000 inhabitants. We performed a retrospective chart review. We compared our observations during a 31-day period in May 2020 to past observations in May of the previous 4 years. We chose the month of May, because it corresponded to the time when confinement restrictions were lifted (deconfinement) in Belgium. We decided to end the study period on the 31 st of May, because, on one hand, we were not sure how to define a clear stopping point for the deconfinement; and on the other hand, in this special healthcare period during the pandemic, the abstractors had time to perform the analyses in June. Therefore, in view of the seasonal character of psychiatric consultations [11] , we compared current observations to averaged observations for the one-month period in May of the 4 preceding years (historical period). Journal Pre-proof After gaining approval from the Ethics Committee, data were obtained by searching our medical records to identify visits to our ED for a reason encoded as psychiatric. Every patient that had an emergency consultation in our ED was administratively categorized at admission as psychiatric, medical, surgical, or pediatric. Additionally, we noted the total number of non-psychiatric visits made during the study period, by searching the database established for the emergency department. Of the 259 psychiatric visits included in the study, 9 were excluded, due to: encoding errors, declined examination and specific requests for child psychiatry. In some instances, there were several consultations for the same patient and they have all been encoded. These re-visits were scattered over time and were not the specific fact of the deconfinement period. Two authors (JF and NS) abstracted the data. They were trained to perform abstraction and used a standardized abstraction form. Before starting the extraction of data, they completed a trial process, with each abstractor performing separately, and then, performing together. They collected data on psychiatric visit characteristics, including age, sex, current and past domiciles, co-habitants at home and any eventual conflicts with co-habitants, psychological or psychiatric medical history. They also collected data on the characteristics of the visits, including the main symptom justifying the ED visit, psychiatric medications, acute intoxication, follow-up appointments before and after emergency discharge, diagnosis, and destination after the visit. The use of psychiatric drugs was defined as the use of antipsychotics, antidepressants, hypnotics, sedatives, or anxiolytics. Acute intoxication was defined as excess consumption of alcohol or stronger drugs on the day or the day before of the visit. For group comparisons, we performed the student's statistical T-test to compare the average numbers of visits/day admitted for psychiatric reasons, and we performed the statistical chi-square test to compare the proportions of visits for psychiatric reasons. We checked the main symptom justifying the psychiatric visits to the ED during deconfinement compared to historical reasons for psychiatric visits to our ED. We compared differences between groups in terms of the characteristics of the psychiatric emergency visits. We performed the chisquare test to compare the proportions of each characteristic between the historical period and the deconfinement period. Missing data were encoded as "Non Available" and omitted from the analyses. All analyses were performed with R4.0.1 (R Foundation for Statistical Computing, Vienna). The average number of visits to the ED was low during the deconfinement period compared to the mean number of visits in previous years (from a mean of 45.6 admissions/day historically to a mean of 30.2 during deconfinement, p <0.0001). However, the number of visits for psychiatric reasons were the same during the deconfinement period and the historical period (mean 50 patients per month). Thus, the proportion of visits for psychiatric reasons increased during the deconfinement There were two significant differences in the characteristics between the groups. First, more visits in the deconfinement group were without acute intoxication (80% were not intoxicated at admission) compared to those in the historical group (58.5%, p=0.031; Figure B ). Second, more visits in the deconfinement group did not have a follow-up consultation organized at discharge (40% did not require follow-up), compared to the historical group (25%, p=0.036). The age difference between groups was borderline significant. In the deconfinement group, a larger proportion of visits was with patients under 30 years old (32%) than in the historical group (19.5%, p=0.056). There were no statistical differences between the two groups in the other variables. The proportion of females was the same in the two groups (42% for both, p=1); the majority of visits were from patients who lived in a house or an apartment (94.5% historically; 92% during deconfinement, p=0.646), and came from their domicile (88.5% historically; 86% during deconfinement, p=0.627), rather than an institution or a public space. The two groups were also similar for: visits from patients with past psychiatric/psychologic follow ups (39.5% historically; 38% during deconfinement, p=0.512), visits from patients with psychiatric medical histories (19% historically; 14% during deconfinement period , p=0.297), and visits from patients taking regular psychiatric drugs (28% historically; 24% during deconfinement, p=0.481). In addition, in both groups, most visits were from patients who did not receive psychiatric drugs during the emergency visit (73.5% historically; 76% J o u r n a l P r e -p r o o f Journal Pre-proof during deconfinement, p=0.718), did not live alone or have conflicts with co-habitants (62% historically; 68% during deconfinement, p=0.713), returned home after the visit (65% historically; 68% during deconfinement, p=0.751), and were unlikely to receive psychiatric drug treatment at discharge (70.5% historically; 58% during deconfinement, p=0.081). The main symptoms justifying ED visits were not significantly different between groups. These reasons included depressive symptoms (29% historically;32% during deconfinement, p=0.663), suicide attempt (20% historically;24% during deconfinement, p=0.521), anxiety (14%, both historically and during deconfinement, p=1), and a personality/comportment disorder (19% historically,12% during deconfinement, p=0.234). The final diagnoses were not significantly different between the two groups. The most common diagnosis was mood disorder (33% historically;40% during deconfinement, p=0.359). The second most common diagnosis was adjustment disorder (17% historically;10% during deconfinement, p=0.216). These were followed by: toxic consumption disorder (14.5% historically;8% during deconfinement, p=0.219), schizophrenia (11% historically;8% during deconfinement, p=0.526), anxiety disorder (11% historically;8% during deconfinement, p=0.708), adolescent disorder (4% historically;10% during deconfinement, p=0.089), somatoform disorder (4% historically;8% during deconfinement, p=0.240), organic mental disorder (1% historically;4% during deconfinement, p=0.132), and others (4% historically;4% during deconfinement, p=1). Federal Public Service (FPS) Chancellery of the Prime Minister Federal Public Service (FPS) Health, Food Chain Safety and Environment. Coronavirus COVID-19 information website Federal Public Service (FPS) Health, Food Chain Safety and Environment. Coronavirus COVID-19 information website Federal Public Service (FPS) Health, Food Chain Safety and Environment. Coronavirus COVID-19 information website An analysis of changes in emergency department visits after a state declaration during the time of COVID-19 COVID-19 and lmental health: A review of the existing literature COVID-19 pandemic and mental health consequences: Systematic review of the current evidence The psychological impact of quarantine and how to reduce it: Rapid review of the evidence Preventing suicide in the context of the COVID-19 pandemic Seasonal variation in major depressive episode prevalence in Canada Diagnostic and Statistical Manual of Mental Disorders Urgences psychiatriques et interventions de crise La dépression insuffisamment traitée par les généralistes? La revue Française de Psychiatrie et de Psychologie Médicale Trends in outpatient emergency department visits during the COVID-19 pandemic at a large, urban, academic hospital system Underutilization of the Emergency Department During the COVID-19 Pandemic The impact of the COVID-19 pandemic and governor mandated stay at home order on emergency department super utilizers Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health The Effect of COVID-19 on Youth Mental Health Suicide Prevention in the COVID-19 Era: Transforming Threat Into Opportunity How mental health care should change as a consequence of the COVID-19 pandemic Figure A: Numbers and proportions of visits per day in the emergency department before (solid lines) and after (red dots) COVID-19 lockdown. A: All visits. B: Psychiatric emergency visits. C: Proportions of psychiatric visits among all visits