Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric department: An interrupted time-series analysis

Alexandre Wullschleger; Leonel Gonçalves; Maya Royston; Othman Sentissi; Julia Ambrosetti; Stefan Kaiser; Stéphanie Baggio

doi:10.1371/journal.pone.0289310

Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric department: An interrupted time-series analysis

PLoS One. 2023 Jul 27;18(7):e0289310. doi: 10.1371/journal.pone.0289310. eCollection 2023.

Authors

Alexandre Wullschleger¹, Leonel Gonçalves², Maya Royston¹, Othman Sentissi¹, Julia Ambrosetti³, Stefan Kaiser¹, Stéphanie Baggio^{4

5}

Affiliations

¹ Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland.
² Division of Prison Health, Geneva University Hospitals & University of Geneva, Geneva, Switzerland.
³ Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁴ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁵ Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.

Abstract

Background: The CoVID pandemic and the associated lockdown had a significant impact on mental health services. Inpatient services faced the challenge of offering acute psychiatric while implementing strict infection control measures. There is, however, a lack of studies investigating the use of coercive measures during the pandemic and their relation to hospitalizations and symptom severity.

Aims: To investigate the effects of the CoVID outbreak on psychiatric admissions, use of seclusion and symptom severity.

Method: Using routine data from 2019 and 2020 gathered in the Department of Psychiatry at the Geneva University Hospitals, we performed an interrupted time series analysis. This included the number of psychiatric hospitalizations, the proportion of people who experienced seclusion and the average severity of symptoms as measured by the Health of Nations Outcome Scale (HoNOS). Dependent variables were regressed on the time variable using regression model with bootstrapped standard errors.

Results: Hospitalizations decreased over time (b = -0.57, 95% CI: -0.67; -0.48, p < .001). A structural break in the data (supremum Wald test: p < .001) was observed in the 12th week of 2020. There was an inverse relationship between the number of admissions and the proportions of people subject to seclusion (b = 0.21, 95% CI: -0.32; -0.09, p < .001). There was a statistically marginally significant inverse relationship between HoNOS scores at admission and the number of psychiatric hospitalizations (b = -1.28, 95% CI: -2.59, 0.02, p = .054).

Conclusion: Our results show that the CoVID pandemic in 2020 was associated with a significant decrease in the number of hospital admissions. This decrease was correlated with a greater use of seclusion. The higher burden of symptoms and the difficult implementation of infection control measures might explain this higher use of coercion.

Copyright: © 2023 Wullschleger et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

COVID-19* / epidemiology
Coercion
Hospitalization
Hospitals, Psychiatric
Humans
Infection Control
Inpatients / psychology
Interrupted Time Series Analysis
Mental Disorders* / epidemiology
Mental Disorders* / psychology
Mental Disorders* / therapy
Restraint, Physical
Switzerland / epidemiology

Grants and funding

AW and SK received funding from the Private Fondation of the HUG (https://www.fondationhug.org/en). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.