key: cord-0710990-7k2fpxsr
authors: Pignon, Baptiste; Gourevitch, Raphaël; Tebeka, Sarah; Dubertret, Caroline; Cardot, Hélène; Masson, Valérie Dauriac‐Le; Trebalag, Anne‐Kristelle; Barruel, David; Yon, Liova; Hemery, François; Loric, Marie; Rabu, Corentin; Pelissolo, Antoine; Leboyer, Marion; Schürhoff, Franck; Pham‐Scottez, Alexandra
title: Dramatic reduction of psychiatric emergency consultations during lockdown linked to COVID‐19 in Paris and suburbs
date: 2020-07-01
journal: Psychiatry Clin Neurosci
DOI: 10.1111/pcn.13104
sha: e3ec4d3439b4a0c1fec96d08ea9838a9855d80f4
doc_id: 710990
cord_uid: 7k2fpxsr

nan

On March 17 th , 2020 a national lockdown began in France in response to the COVID-19 pandemic. Loneliness and social isolation caused by social distancing are long-established major risk factors for a number of psychiatric disorders 1, 2 . Quarantine and lockdown have other psychological consequences, such as boredom, irritability, and sleep dysregulation, which are associated with first episode emergence of psychiatric disorders as well as the exacerbation of pre-existing psychiatric conditions 3, 4 . Contamination fear has additional stress associations, e.g., anxious and obsessional symptoms, or delusional symptoms 5 .

In addition, psychiatric services have had to be reorganized 5, 6 , to reduce contacts among patients, and between patients and professionals, as restricting consultations to severe cases and re-organization of health care via teleconsultation, early hospital release and restrictions on new hospitalizations, or closure of daily care facilities. Consequently, patients may experience difficulties in accessing psychiatric services, or worry about being fined for non-compliance of lockdown rules. Overall, such factors may create a treatment gap and/or lead to break in follow-up and ongoing treatment, thereby increasing emergency consultations during lockdown 7 .

This study aimed to compare the number and characteristics of emergency psychiatric consultations during the four first weeks of the lockdown in three psychiatric emergency services from Paris and its suburbs, and to compare them to the same period in 2019.

Three psychiatric emergency centers took part in the study: one in Paris, and two in adjacent suburban cities, Colombes and Créteil. More details are available in Table 1 .

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Given the multi-faceted stressors associated with lockdown, the above results show a surprising 54.8% drop in the number of psychiatric emergency consultations, during the first 4 weeks of the COVID-19 pandemic. This decrease is evident in the 3 considered emergency departments, and across all psychiatric diagnosis categories, and concerns also suicide attempts.

This decrease is not specific to psychiatry: a greater than 50% decrease in daily total consultations was reported in the West China Hospital emergency 8 , and similarly in England 9 .

Clearly, a fear of contamination in emergency departments has contributed to this. Moreover, unnecessary hospital emergency departments visits may have decreased. In France, and elsewhere, recent decades have seen a significant increase in the number of emergency department consultations 10 . This increase is contributed to by multiple complex factors, including a deterioration in accessibility of primary care services, leading to unnecessary visits. The treatment gap in psychiatry, the gap between experiencing a psychiatric disorder and using treatment services for this disorder, has already been described 7 . Our results seem in line with this, given the significant increase of the proportion of consultations for psychotic disorders, and of hospitalizations without consent, coupled to the significant decrease in primary psychiatric consultations. For the most severe psychiatric disorders, the emergency consultations are more necessary, and the decrease is less important.

The development of telemedicine would also seem to have contributed to our results.

This viability and feasibility of telemedicine consultations are likely to emerge subsequent to the COVID-19 triggered lockdown, possibly indicating a role for their sustained implementation. Finally, as some people may find new strengths and coping strategies during 

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Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions