COVID-19 and mental health care: an epidemiological approach to analyze the effect of the pandemic on service utilization

Background: The COVID-19 pandemic has introduced significant challenges in mental healthcare, particularly affecting community-based mental health services and psychiatric and psychological Consultation-Liaison (CL) services in general hospital settings. Living in urban areas during COVID-19 pandemic leads to increased psychiatric symptoms also due to exposure to environmental stressors such as air pollution, limited green spaces, and high level of traffic and noise. Objectives: The overall aim of the doctoral thesis is to analyze the effect of the COVID-19 pandemic on mental health service utilization in Italy employing an epidemiological approach. Methods: The doctoral thesis included three retrospective observational study undertaken in Northest Italy, using two clinical databases encompassing the period from January 2019 to June 2021. Pandemic-related restrictions were classified as ‘lockdown’, ‘intermediate restrictions’, and ‘no or reduced restrictions’ based on the COVID Stringency Index (CSI). Results: The findings reveal a significant +28% increase in the number of psychiatric and psychological consultations and a significant reduction of -33.9% in the number of patients who had mental health contacts during the year 2020. Sociodemographic and environmental factors, like living in rented apartments, lower educational levels, increased air pollution, and lower solar irradiance, were related to higher use of mental health services, but the COVID-19 pandemic attenuated these differences. Discussion: Despite the access to community mental health care during the pandemic was overall reduced, the mental health system in Italy was able to maintain support for more vulnerable and severely ill patients. Additionally, the doctoral thesis underscores the complex interplay of sociodemographic and environmental factors in influencing mental health service utilization, with the COVID-19 pandemic acting as a moderating factor. These findings can inform policies and practices at both national and international levels, to improve effective mental health care delivery during and beyond pandemics.