The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in Italy
ObjectiveComprehensive evidence on the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on the use of mental health services is scarce. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the access to mental health services in Italy and to assess the socioeconomic...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1494284/full |
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| author | Alessio Petrelli Martina Ventura Roberta Ciampichini Anteo Di Napoli Valeria Fano Valeria Fano Christian Napoli Martina Pacifici Claudio Rosini Caterina Silvestri Fabio Voller Alberto Zucchi Massimiliano Aragona |
| author_facet | Alessio Petrelli Martina Ventura Roberta Ciampichini Anteo Di Napoli Valeria Fano Valeria Fano Christian Napoli Martina Pacifici Claudio Rosini Caterina Silvestri Fabio Voller Alberto Zucchi Massimiliano Aragona |
| author_sort | Alessio Petrelli |
| collection | DOAJ |
| description | ObjectiveComprehensive evidence on the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on the use of mental health services is scarce. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the access to mental health services in Italy and to assess the socioeconomic and citizenship inequalities for the same outcome.MethodsA population-based longitudinal open cohort of residents aged ≥ 10 years was established in three large centers covering about 6 million beneficiaries (nearly 10% of the entire population) of the Italian National Health Service (NHS) from 01 January 2018 to 31 December 2021. The primary outcome of interest was the first access to one of the following mental health care services (FAMHS): outpatient facilities, hospital discharges, psychiatric drug prescriptions, emergency room admissions, residential and day care facilities, co-pay exemptions. To evaluate the effect of the COVID-19 pandemic on FAMHS, the temporal trend of FAMHS rates was investigated through an interrupted time series (ITS) analysis of their monthly rates. Crude incidence rates per 100,000 person days with 95%CI were calculated comparing the two time periods (pre- and post-COVID-19) by sex, age group, deprivation index (as a proxy of socioeconomic status), and citizenship. Finally, adjusted rates and rates ratios with 95%CI were estimated via ITS analysis using a step-change model.ResultsITS analysis for the trend of FAMHS rates showed a significant drop at the outbreak of the pandemic in crude rates and after adjusting for age, sex, deprivation level, and citizenship (RR=0.83 p<0.001). After the outbreak of COVID-19, the trend increased, with rates returning to pre-pandemic levels. Adjusted incidence rate ratios (IRRs) showed a higher probability of having a FAMHS for females, Italians, and for residents in the most deprived areas. A gradient of higher rates with the increase in age was observed. Greater COVID-19 impact was found on the most deprived areas of residence, with a reduction in IRRs from pre- to post-COVID-19 significantly stronger.ConclusionsThe COVID-19 pandemic increased socioeconomic inequalities in mental health in Italy. Population-based cohorts are the most powerful instrument to monitor inequalities in access to mental health services and to provide timely information to drive policy. |
| format | Article |
| id | doaj-art-4337b7c6e82a471383c41a86e53b3638 |
| institution | OA Journals |
| issn | 1664-0640 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj-art-4337b7c6e82a471383c41a86e53b36382025-08-20T01:58:35ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402024-12-011510.3389/fpsyt.2024.14942841494284The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in ItalyAlessio Petrelli0Martina Ventura1Roberta Ciampichini2Anteo Di Napoli3Valeria Fano4Valeria Fano5Christian Napoli6Martina Pacifici7Claudio Rosini8Caterina Silvestri9Fabio Voller10Alberto Zucchi11Massimiliano Aragona12Epidemiology Unit, National Institute for Health, Migration and Poverty, Istituto Nazionale per la promozione della salute delle popolazioni Migranti e per il contrasto delle malattie della Povertà (INMP), Rome, ItalyEpidemiology Unit, National Institute for Health, Migration and Poverty, Istituto Nazionale per la promozione della salute delle popolazioni Migranti e per il contrasto delle malattie della Povertà (INMP), Rome, ItalyEpidemiology Unit, Health Protection Agency, Agenzia di Tutela della Salute (ATS), Bergamo, ItalyEpidemiology Unit, National Institute for Health, Migration and Poverty, Istituto Nazionale per la promozione della salute delle popolazioni Migranti e per il contrasto delle malattie della Povertà (INMP), Rome, ItalyDepartment of Public Health, Local Health Unit Roma 2, Rome, ItalyEpidemiology Unit, Epidemiology and Cancer Registry Unit, Regina Elena National Cancer Institute, Rome, ItalyEpidemiology Unit, National Institute for Health, Migration and Poverty, Istituto Nazionale per la promozione della salute delle popolazioni Migranti e per il contrasto delle malattie della Povertà (INMP), Rome, ItalyTuscany Regional Health Agency, Agenzia Regionale di Sanità (ARS), Florence, ItalyDepartment of Public Health, Local Health Unit Roma 2, Rome, ItalyTuscany Regional Health Agency, Agenzia Regionale di Sanità (ARS), Florence, ItalyTuscany Regional Health Agency, Agenzia Regionale di Sanità (ARS), Florence, ItalyEpidemiology Unit, Health Protection Agency, Agenzia di Tutela della Salute (ATS), Bergamo, ItalyEpidemiology Unit, National Institute for Health, Migration and Poverty, Istituto Nazionale per la promozione della salute delle popolazioni Migranti e per il contrasto delle malattie della Povertà (INMP), Rome, ItalyObjectiveComprehensive evidence on the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on the use of mental health services is scarce. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the access to mental health services in Italy and to assess the socioeconomic and citizenship inequalities for the same outcome.MethodsA population-based longitudinal open cohort of residents aged ≥ 10 years was established in three large centers covering about 6 million beneficiaries (nearly 10% of the entire population) of the Italian National Health Service (NHS) from 01 January 2018 to 31 December 2021. The primary outcome of interest was the first access to one of the following mental health care services (FAMHS): outpatient facilities, hospital discharges, psychiatric drug prescriptions, emergency room admissions, residential and day care facilities, co-pay exemptions. To evaluate the effect of the COVID-19 pandemic on FAMHS, the temporal trend of FAMHS rates was investigated through an interrupted time series (ITS) analysis of their monthly rates. Crude incidence rates per 100,000 person days with 95%CI were calculated comparing the two time periods (pre- and post-COVID-19) by sex, age group, deprivation index (as a proxy of socioeconomic status), and citizenship. Finally, adjusted rates and rates ratios with 95%CI were estimated via ITS analysis using a step-change model.ResultsITS analysis for the trend of FAMHS rates showed a significant drop at the outbreak of the pandemic in crude rates and after adjusting for age, sex, deprivation level, and citizenship (RR=0.83 p<0.001). After the outbreak of COVID-19, the trend increased, with rates returning to pre-pandemic levels. Adjusted incidence rate ratios (IRRs) showed a higher probability of having a FAMHS for females, Italians, and for residents in the most deprived areas. A gradient of higher rates with the increase in age was observed. Greater COVID-19 impact was found on the most deprived areas of residence, with a reduction in IRRs from pre- to post-COVID-19 significantly stronger.ConclusionsThe COVID-19 pandemic increased socioeconomic inequalities in mental health in Italy. Population-based cohorts are the most powerful instrument to monitor inequalities in access to mental health services and to provide timely information to drive policy.https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1494284/fullpsychiatrymental healthmental health servicesCOVID-19socioeconomic factorsimmigrants |
| spellingShingle | Alessio Petrelli Martina Ventura Roberta Ciampichini Anteo Di Napoli Valeria Fano Valeria Fano Christian Napoli Martina Pacifici Claudio Rosini Caterina Silvestri Fabio Voller Alberto Zucchi Massimiliano Aragona The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in Italy Frontiers in Psychiatry psychiatry mental health mental health services COVID-19 socioeconomic factors immigrants |
| title | The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in Italy |
| title_full | The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in Italy |
| title_fullStr | The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in Italy |
| title_full_unstemmed | The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in Italy |
| title_short | The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in Italy |
| title_sort | impact of the covid 19 pandemic on access to mental health services and socioeconomic inequalities in italy |
| topic | psychiatry mental health mental health services COVID-19 socioeconomic factors immigrants |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1494284/full |
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