The effect of the March 2020 COVID-19 lockdown on national psychiatric contacts in Denmark: An interrupted time series analysis

The COVID-19 pandemic resulted in national lockdowns in several countries. Previous global epidemics led to an increase in the number of psychiatric patients presenting symptoms of anxiety or depression. Knowledge about the impact of early lockdown initiatives during the COVID-19 pandemic on the number of healthcare interactions is sparse. Contacts in this study include all recorded face-to-face (FTF) and virtual treatment interactions between patients and healthcare systems. Aim: To investigate both the impact of the Danish lockdown event on psychiatric patients' contact with the healthcare system, stratified by type of contact (FTF or virtual) and ICD-10 diagnosis, and how acute contacts were impacted in the five regions in Denmark. Methods: An interrupted time series analysis was applied to determine the effect of the COVID-19 lockdown event on the number of contacts with psychiatric hospitals in Denmark, from February 25, 2019 to May 3, 2020. The analyses took a Box-Jenkins approach to fit an autoregressive integrated moving average (ARIMA) model. Results: Virtual contacts replaced most FTF contacts during the lockdown. For most patient groups, the total number of contacts did not decrease significantly. However, for adult patients diagnosed with ICD-10 F 0-10, 10-19, and 60-69 and child and adolescent patients diagnosed with F 10-19, 70-79, and 80-89, the number of contacts decreased during lockdown. The number of acute contacts with the psychiatric system decreased significantly in all regions in Denmark during lockdown. Discussion: The Danish healthcare system was forced to introduce innovative tele-psychiatry to mental health care during the lockdown. Disruption to service delivery was minimized because the resources were in place to sustain the transition from FTF to virtual contacts.