Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysis
Objectives To quantify access to health services during the COVID-19 pandemic and measure the change in use between the prepandemic and the pandemic periods in a population with assessment of psychological distress or diagnosis of mental disorders.Data sources We developed and piloted a search synta...
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BMJ Publishing Group
2025-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/3/e091342.full |
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| author | Marianna Purgato Federico Tedeschi Corrado Barbui Emiliano Albanese Eleonora Prina Beatrice Bano Camilla Sculco Monica Bianca Bartucz |
| author_facet | Marianna Purgato Federico Tedeschi Corrado Barbui Emiliano Albanese Eleonora Prina Beatrice Bano Camilla Sculco Monica Bianca Bartucz |
| author_sort | Marianna Purgato |
| collection | DOAJ |
| description | Objectives To quantify access to health services during the COVID-19 pandemic and measure the change in use between the prepandemic and the pandemic periods in a population with assessment of psychological distress or diagnosis of mental disorders.Data sources We developed and piloted a search syntax and adapted it to enter the following databases from 1 January 2020 to 31 March 2023: PubMed/MEDLINE, PsycINFO, Web of Science, Epistemonikos and the WHO International Clinical Trials Registry Platform. We reran the searches from the end of the original search to 3 December 2024.Design We systematically screened titles, abstracts and full texts of retrieved records.Eligibility criteria We included observational studies on any populations and regions, covering health services such as doctor visits, hospital admissions, diagnostic examinations, pharmaceutical therapies and mental health (MH) services. Only studies using validated scales to assess psychological distress or mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders were included.Data extraction and synthesis We extracted data using a purposefully designed form and evaluated the studies’ quality with the Newcastle-Ottawa Scale. We measured the incidence rate (IR) of access to health services and the IR ratio (IRR) between the prepandemic and the pandemic periods. We calculated contacts days and catchment areas in the different periods. We used the random effects DerSimonian-Laird inverse-variance model and calculated heterogeneity with statistics I² and τ². We computed pooled IR and pooled IRR and tested the hypothesis of no variation (IRR=1).Results We retrieved 10 014 records and examined the full text of 580 articles. We included 136 primary studies of which 44 were meta-analysed. The IR of access to services during the pandemic was 2.59 contact months per 10 000 inhabitants (IR=2.592; 95% CI: 1.301 to 5.164). We observed a reduction of 28.5% in the use of services with negligible differences by age group and type of services (IRR=0.715; 95% CI: 0.651 to 0.785). We observed significant differences in effect sizes across studies (τ2=5.44; p<0.001 and τ2=0.090; p<0.001).Conclusion By considering MH, our study provides consolidated evidence and quantifies the reduction in the use of health services during the COVID-19 pandemic.PROSPERO registration number CRD42023403778. |
| format | Article |
| id | doaj-art-5b02a5e509ed4775bde61c42bf6930cb |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-5b02a5e509ed4775bde61c42bf6930cb2025-08-20T03:42:02ZengBMJ Publishing GroupBMJ Open2044-60552025-03-0115310.1136/bmjopen-2024-091342Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysisMarianna Purgato0Federico Tedeschi1Corrado Barbui2Emiliano Albanese3Eleonora Prina4Beatrice Bano5Camilla Sculco6Monica Bianca Bartucz7Cochrane Global Mental Health and WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, ItalyWHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, ItalyWHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy2 Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland1 WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy1 WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, ItalyInstitute of Public Health, Universita della Svizzera italiana, Lugano, Ticino, SwitzerlandDepartment of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, ItalyObjectives To quantify access to health services during the COVID-19 pandemic and measure the change in use between the prepandemic and the pandemic periods in a population with assessment of psychological distress or diagnosis of mental disorders.Data sources We developed and piloted a search syntax and adapted it to enter the following databases from 1 January 2020 to 31 March 2023: PubMed/MEDLINE, PsycINFO, Web of Science, Epistemonikos and the WHO International Clinical Trials Registry Platform. We reran the searches from the end of the original search to 3 December 2024.Design We systematically screened titles, abstracts and full texts of retrieved records.Eligibility criteria We included observational studies on any populations and regions, covering health services such as doctor visits, hospital admissions, diagnostic examinations, pharmaceutical therapies and mental health (MH) services. Only studies using validated scales to assess psychological distress or mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders were included.Data extraction and synthesis We extracted data using a purposefully designed form and evaluated the studies’ quality with the Newcastle-Ottawa Scale. We measured the incidence rate (IR) of access to health services and the IR ratio (IRR) between the prepandemic and the pandemic periods. We calculated contacts days and catchment areas in the different periods. We used the random effects DerSimonian-Laird inverse-variance model and calculated heterogeneity with statistics I² and τ². We computed pooled IR and pooled IRR and tested the hypothesis of no variation (IRR=1).Results We retrieved 10 014 records and examined the full text of 580 articles. We included 136 primary studies of which 44 were meta-analysed. The IR of access to services during the pandemic was 2.59 contact months per 10 000 inhabitants (IR=2.592; 95% CI: 1.301 to 5.164). We observed a reduction of 28.5% in the use of services with negligible differences by age group and type of services (IRR=0.715; 95% CI: 0.651 to 0.785). We observed significant differences in effect sizes across studies (τ2=5.44; p<0.001 and τ2=0.090; p<0.001).Conclusion By considering MH, our study provides consolidated evidence and quantifies the reduction in the use of health services during the COVID-19 pandemic.PROSPERO registration number CRD42023403778.https://bmjopen.bmj.com/content/15/3/e091342.full |
| spellingShingle | Marianna Purgato Federico Tedeschi Corrado Barbui Emiliano Albanese Eleonora Prina Beatrice Bano Camilla Sculco Monica Bianca Bartucz Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysis BMJ Open |
| title | Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysis |
| title_full | Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysis |
| title_fullStr | Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysis |
| title_full_unstemmed | Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysis |
| title_short | Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysis |
| title_sort | access and use of general and mental health services before and during the covid 19 pandemic a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/15/3/e091342.full |
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