The effect of the COVID-19 lockdown on mental health care use in South Africa: an interrupted time series analysis
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Abstract
Aims
In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic, entailing the suspension of all non-essential activities and a complete ban of tobacco and alcohol sales. We studied the effect of the lockdown on mental health care utilisation rates in private-sector care in South Africa.
Methods
We did an interrupted time series analysis using insurance claims from January 1, 2017, to June 1, 2020 of beneficiaries 18 years or older from a large private sector medical aid scheme. We calculated weekly outpatient consultation and hospital admission rates for organic mental disorders, substance use disorders, serious mental disorders, depression, anxiety, other mental disorders, any mental disorder, and alcohol withdrawal syndrome. We calculated adjusted odds ratios (OR) for the effect of the lockdown on weekly outpatient consultation and hospital admission rates and the weekly change in rates during the lockdown until June 1, 2020.
Results
710,367 persons were followed up for a median of 153 weeks. Hospital admission rates (OR 0.38; 95% CI 0.33–0.44) and outpatient consultation rates (OR 0.74; 95% CI 0.63–0.87) for any mental disorder decreased substantially after the lockdown and did not recover to pre-lockdown levels until June 1, 2020. Health care utilisation rates for alcohol withdrawal syndrome doubled after the introduction of the lockdown, but the statistical uncertainty around the estimates was large (OR 2.24; 95% CI 0.69-7.24).
Conclusions
Reduced mental health care contact rates during the COVID-19 lockdown likely reflect a substantial unmet need for mental health services with potential long-term consequences for mental health patients and their families. Steps to ensure access and continuity of mental health services during future lockdowns should be considered.
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SciScore for 10.1101/2022.04.07.22273561: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: We adopted the study design from a previous study evaluating the effect of COVID-19 measures on health care use in the UK.(Mansfield et al. 2021) The Human Research Ethics Committee of the University of Cape Town and the Cantonal Ethics Committee of the Canton of Bern granted permission to analyse the data. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All other analyses were done in Stata version 16 (StataCorp, College Station, TX, USA). StataCorpsuggested: (Stata, RRID:SCR_012763)Results from OddPub: Thank you for sharing your code.
Results from LimitationRecog…SciScore for 10.1101/2022.04.07.22273561: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: We adopted the study design from a previous study evaluating the effect of COVID-19 measures on health care use in the UK.(Mansfield et al. 2021) The Human Research Ethics Committee of the University of Cape Town and the Cantonal Ethics Committee of the Canton of Bern granted permission to analyse the data. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All other analyses were done in Stata version 16 (StataCorp, College Station, TX, USA). StataCorpsuggested: (Stata, RRID:SCR_012763)Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our results have to be considered in light of the following limitations. First, we could not study the recovery of service utilisation as restrictions were eased to lockdown level 3 in July 2020 because our study period ended in end-June 2020. Second, our study only included data from a private-sector medical aid scheme, and thus our findings are not necessarily applicable to the public sector. Third, we could not distinguish between in-person and virtual outpatient care consultations and therefore could not evaluate to what degree telemedicine compensated for drops in in-person outpatient care consultations. Fourth, since we used routine insurance claim data, we cannot exclude the possibility that changes to administrative procedures or reimbursement practices that may have occurred during the COVID-19 pandemic have influenced our results. Fifth, we had no information on the geographic location of health care providers or the residence of beneficiaries and could not examine regional differences in health care utilisation. Further studies are needed to examine the underlying mechanisms that limited access to mental health care during the lockdown. Such mechanisms may include changes in the care-seeking behaviour of patients, transport-related and financial barriers, decreased psychiatric bed capacity to reduce the risk of in-hospital COVID-19 transmission, and other changes in service delivery possibly due to the reallocation of health care staff to care for COVID-19 patients...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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