Impact of the SARS-CoV-2 pandemic on psychiatric emergencies in northern Greece: Preliminary study on a sample of the Greek population.

We write to communicate the results of our study on the impact of the SARS‐CoV‐2 pandemic on mental health, and in particular on psychiatric emergencies, in a Greek population sample. This Letter to the Editor was written on 15 May 2020, examining the lockdown period in Greece, which lasted from March to mid‐May 2020.

All data known so far regarding the conditions in everyday human life had recently been overturned worldwide by measures proposed by experts and implemented by governments in order to fight the outbreak of the novel coronavirus pandemic.

In Greece, the novel coronavirus pandemic broke out and expanded from 26 February 2020 onwards, while a reduction in the number of cases was not noticed until 30 April 2020. Following the announcement of the first three confirmed cases in Greece on 27 February, all festive religious and political activities that involved gatherings of people were canceled until further notice in order to reduce the contamination risk. In addition, hospital outpatient clinics ceased operations on 28 February. Further measures were taken on 10 March, including the suspension of operation of all educational structures at all levels, followed by the closure of public gathering places on 13 March. From 23 March, significant restrictions were imposed on public and car transportation of citizens throughout the country. On 4 May, the government decided to gradually de‐escalate emergency measures and gradually resume operations. By 15 May, the resumption had not yet been completed.

As people were forced to stay indoors and reduce social interactions to a dramatic degree, an escalation of inner tension in the population would be a reasonable hypothesis. There might have been an intensification of already existing relational issues among people living together, while individuals living alone may have faced aggravating issues of loneliness, , , especially high‐risk individuals (including those who would have experienced worsening mental disorder symptoms when deprived of care due to the predominating challenging circumstances; people experiencing difficulty in making ends meet or other financial problems created or aggravated by the lockdown; and those already with a history of major psychiatric disorders, previous suicide attempts, or other forms of expressed violence). , It is worth noting, however, that Greece has a relatively low suicide rate of five suicides per 100 000 inhabitants and 526 suicide cases per year (incidence; male : female [M : F] ratio, 4.05:1).

The authors of the present article constitute a team of mental health professionals working in the mental health department of AHEPA University General Hospital of Thessaloniki, which is the reference hospital for novel coronavirus cases in northern Greece. The purpose of the present communication was to record and detect a possible change in the profile of psychiatric emergencies during the period of implementation of restrictive measures, as well as the social and psychological impact of the pandemic.

All records of emergency cases addressed at the psychiatric emergency department of AHEPA University General Hospital of Thessaloniki were investigated during the following equal time intervals: March to mid‐May 2019, mid‐November 2019 to end of January 2020, and March to mid‐May 2020. The variables examined were raw numbers of cases attending the psychiatric emergency room (n), their M : F ratio, as well as their age range and mean age. The cases were diagnostically recorded according to the ICD‐10 and then grouped and counted based on the first digit of the ICD‐10 taxonomy. Therefore, all F1* (F10–F19) cases stood for mental and behavioral disorders due to psychoactive substance use; all F2* (F20–F29) cases stood for schizophrenia spectrum disorders; all F3* (F30–F39) cases stood for affective disorders; all F4* (F40–F49) cases stood for anxiety, dissociative, stress‐related, somatoform, and other nonpsychotic mental disorders; all F6* (F60–F69) cases stood for disorders of adult personality and behavior; all F0* (F01–F09) cases stood for mental disorders due to physiological conditions; Z04.6 stood for psychiatric examination requested by authority; and Z65.1 stood for psychiatric examination of detainees. In addition, it was recorded and counted whether the case concerned a suicide attempt. The data of the examined period of March to mid‐May 2020 were compared separately with the same period of the previous year (March to mid‐May 2019), but also with the exact previous period of the same year, mid‐November 2019 to end of January 2020.

A bivariate analysis was performed to examine relations between the examined variables. Fisher's exact test and the Mann–Whitney U‐test were used in ibm spss V21. All tests were two‐tailed and statistical significance was set at P < 0.05.

During the time of expansion of the novel coronavirus pandemic accompanied by restrictive measures in Greece, the number of emergency cases arriving at our hospital for psychiatric examination approximately decreased by half, which was a statistically significant outcome (P‐value < 0.01). The M : F ratio (males outnumbering females) did not change significantly, nor did the mean or median age of the subjects (early 40s). Despite the steep fall in the total number of cases examined, a significant increase of the psychiatric emergencies associated with relapses of schizophrenia spectrum disorders was noted (P‐value < 0.05) accompanied by an increase in prosecutorial orders for psychiatric assessment and involuntary hospitalization (P‐value < 0.05). A moderate statistically significant increase was also observed in suicide attempts (P‐value < 0.05), which, as a percentage of the total number of cases examined, increased threefold (Table S1).

The results of the present preliminary study on the implications of the SARS‐CoV‐2 pandemic on psychiatric emergencies in a sample of the Greek population reflected that schizophrenia spectrum disorders may have been much more prone to relapse compared to other mental disorders. Furthermore, patients with schizophrenia spectrum disorders may have been more indifferent to the fear of infection contamination.

An increase in prosecutorial orders for psychiatric assessment and involuntary hospitalization was noted, which indicated a potential hypervigilance on the part of the police and the judicial authorities in order to safeguard the national measures against infection spread.

A moderate statistically significant increase was also observed in suicide attempts. This finding is consistent with other studies on suicidal rates during the novel coronavirus pandemic, attributing the increase to the fear of the infection itself as well as to social stigma, isolation, depression, anxiety, emotional imbalance, economic lockdown, lack and/or distorted information, and financial and future insecurities. Furthermore, as schizophrenia spectrum disorders are in a high suicide risk category, an increase in their relapse may be associated with the number of suicide attempts.

The present letter aims to communicate preliminary results of an assessment of the SARS‐CoV‐2 pandemic's impact on psychiatric emergencies in northern Greece within the implementation period of compulsory measures against the pandemic spread by comparing the mental health emergency rates with the corresponding rates of the pre‐pandemic period. The findings so far have been indicative of an overall decrease in the total number of psychiatric emergencies, but with a significant rise in cases of schizophrenia spectrum disorders needing psychiatric assistance and prosecutorial orders for psychiatric assessment. A moderate increase in suicide attempts has been noticed as well. The impact of the SARS‐CoV‐2 pandemic should be reevaluated, however, with a comparative study for psychiatric emergency rates in the post‐pandemic period so that long‐term results can be considered.

Disclosure statement

The authors grant their permission to share this relevant submission directly with the World Health Organization. This manuscript is in accordance with the corresponding ethical standards of the study country. There are no potential conflicts of interest regarding this study. This work has not been funded by any corporation.

Table S1. Pivotal table.

Click here for additional data file.