Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Jan 25, 2022; 11(1): 73-81
Published online Jan 25, 2022. doi: 10.5501/wjv.v11.i1.73
Rethinking hospital psychiatry in Italy in light of COVID-19 experience
Marco P Piccinelli, Paola Bortolaso, Greg D Wilkinson
Marco P Piccinelli, Paola Bortolaso, Psychiatric Unit Verbano, Department of Mental Health and Substance Abuse, Cittiglio 21033, Varese, Italy
Greg D Wilkinson, Liverpool University Hospitals NHS Trust, Liverpool University, Liverpool 2170, United Kingdom
Author contributions: Marco P Piccinelli and Paola Bortolaso designed the study, performed acquisition, analysis and interpretation of the data, and drafted the initial manuscript; Greg Wilkinson revised the article critically for important intellectual content and edited the manuscript.
Institutional review board statement: The paper did not require Institutional Review Board Approval.
Institutional animal care and use committee statement: Not applicable.
Clinical trial registration statement: Not applicable.
Informed consent statement: Data included in the paper were collected as part of routine clinical practice not requiring ethical approval, with patients giving their written informed consent at data collection at the time of hospital admission.
Conflict-of-interest statement: All authors confirm that there are no financial or personal relationships with any people or organizations that could inappropriately influence the actions of any author of this manuscript.
Data sharing statement: No additional data are available.
STROBE statement: All authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco P Piccinelli, MD, MPhil, PhD, Psychiatric Unit Verbano, Department of Mental Health and Substance Abuse, Via Marconi 40, Cittiglio 21033, Varese, Italy. marcopiero.piccinelli@asst-settelaghi.it
Received: March 11, 2021
Peer-review started: March 11, 2021
First decision: July 15, 2021
Revised: August 13, 2021
Accepted: January 3, 2022
Article in press: January 6, 2022
Published online: January 25, 2022
Processing time: 309 Days and 17.1 Hours
Abstract
BACKGROUND

Italy retains a distinctive organization of mental health services according to a community-based model of care with a multidisciplinary team serving a well-defined catchment area under the coordination of the local department of mental health. The coronavirus disease 2019 (COVID-19) pandemic is forcing Italian mental health services to develop new organizational strategies at all levels of care in order to face the associated challenges.

AIM

To explore factors associated with changes in psychiatric admissions to an inpatient psychiatric unit located in Lombardia Region, Italy.

METHODS

All hospital admissions (n = 44) were recorded to an inpatient psychiatric unit during a three month national lockdown in Italy in 2020 and compared with those occurring over the same time period in 2019 (n = 71). For each admission, a 20-item checklist was completed to identify factors leading to admission. Statistical analyses were performed using Statistical Package for Social Sciences for Windows, release 11.0. Chi-square test (or Fisher’s exact test) and Mann-Whitney U-test were applied, where appropriate.

RESULTS

Hospital admissions dropped by 38% during the COVID-19 pandemic. No significant differences were found in demographics, clinical variables associated with hospital admissions and length of stay between 2019 and 2020. Compared with 2019, a significantly greater proportion of hospital admissions in 2020 were related to difficulties in organizing care programs outside the hospital (chi-square = 4.91, df 1, one-way P = 0.035) and in patients’ family contexts (chi-square = 3.71, df 1, one-way P = 0.049). On the other hand, logistic and communication difficulties pertaining to residential facilities and programs were significantly more common in 2019 than in 2020 (chi-square = 4.38, df 1, one-way P = 0.032).

CONCLUSION

Admissions to the inpatient psychiatric unit dropped significantly during the COVID-19 pandemic in 2020, with difficulties in organizing care programs outside the hospital and in patients’ family contexts occurring more frequently compared with 2019.

Keywords: Mental health services; COVID-19; Italy; Psychiatric; Pandemic

Core Tip: During the coronavirus disease 2019 pandemic mental health services in Italy developed new organizational strategies in order to face the associated challenges. Compared with 2019, hospital admissions dropped significantly and were more frequently related to restrictions posed by the pandemic, like difficulties in organizing care programs outside the hospital and in patients’ family context. On the other hand, logistic and communication difficulties pertaining to residential facilities and programs were significantly more common in 2019 than in 2020, due to the reorganization of residential facilities as close communities looking after their own patients with little reliance on hospital during the pandemic.