The effect of COVID-19 and socioeconomic inequalities on emergency department accesses for psychiatric conditions

  1. Chiara Schepisi
  2. Martina Ventura
  3. Anteo Di Napoli
  4. Massimiliano Aragona
  5. Roberta Ciampichini
  6. Valeria Fano
  7. Christian Napoli
  8. Martina Pacifici
  9. Claudio Rosini
  10. Caterina Silvestri
  11. Fabio Voller
  12. Alberto Zucchi
  13. Alessio Petrelli
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Abstract

Background

COVID-19 produced a detrimental effect on mental health that could not be appropriately addressed due to a reduced accessibility of healthcare services, as patients with socioeconomic vulnerabilities faced the largest barriers in accessing healthcare during the pandemic. This study aimed to investigate emergency department (ED) accesses with a psychiatric diagnosis before and after COVID-19, with a specific focus on the role of socioeconomic factors.

Methods

Population-based longitudinal open cohort of residents and NHS beneficiaries aged ≥ 10, was enrolled in three large Italian areas from 1 January 2018 to 31 December 2021 (n=5,159,363). The primary outcome of interest was the first access to an ED (FMHEA); sex, age, deprivation level, citizenship and groups of diagnosis were considered as covariates. Crude incidence rates were calculated comparing the two time periods (pre- and post-COVID-19) by each covariate. In the context of interrupted time series (ITS), incidence rate ratios (IRR) of FMHEAs with 95%CI were estimated via an ITS analysis using a step-change negative binomial model. Temporal trend of FMHEAs was investigated through an ITS analysis on their monthly numbers.

Results

During follow-up, 56,762 FMHEAs were observed. The multivariate analysis showed that before COVID-19, the rate of FMHEA was higher among the highly deprived (IRR: 1.28; 95%CI:1.22.-1.35 for highest vs lowest deprivation level), females, people aged ≤24 and ≥85 and immigrants. A significant interaction between the COVID-19 period and deprivation level was found: the probability of reduced FMHEA increased with the deprivation level. The greater impact of COVID-19 was found in the central age classes resulting in a reduction in the differences in FMHEA rates by age in the post-Covid-19 period.

Conclusion

COVID-19 reduced incidence rates of ED accesses, but increased socioeconomic inequalities in the use of ED for mental health disorders.

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  1. Version published to 10.1101/2025.04.25.25326419 on medRxiv