COMPARISON OF REFERRALS TO A UNIVERSITY CHILD AND ADOLESCENT PSYCHIATRY OUT-PATIENT UNIT BEFORE AND DURING THE COVID-19 PANDEMIC

Öz

OBJECTIVE: It’s essential to carefully assess and define the effects of illness conception and precautions related to COVID-19 pandemic, in addition to it’s physical effects, on children followed-up in psychiatry clinics. We aimed to define the effects of pandemic on patient profile and clinical practice by comparing child psychiatry out-patient unit referrals before and during the pandemic.
MATERIAL AND METHODS: All child psychiatry out-patient referrals during 14-months periods before (before pandemic [BP]) and after (during pandemic [DP]) the official announce of first COVID-19 case in Turkey on 11 March 2020 were retrospectively examined. First (PFP) and second (PSP) 7-months periods of DP were additionally explored. Age, gender and psychiatric problems of all referrals were recorded and compared.
RESULTS: Total referrals decreased by 45.9% in DP compared to BP and increased by 82.5% in PSP compared to PFP. For the diagnoses, rates of attention deficit-hyperactivity disorder and depressive disorders significantly decreased; whereas obsessive-compulsive disorder, anxiety disorders, learning disorders and personality disorders significantly increased in DP compared to BP (p<0.001 for each). Rates of personality disorders significantly increased; whereas conduct disorders, obsessive-compulsive disorders and anxiety disorders significantly decreased in PSP compared to PFP (p<0.001 for each).
CONCLUSIONS: Despite the psychological stressors came along with COVID-19 pandemic, dropping rates of referrals in DP shows these individuals cannot access psychiatric support even if they need it. Sharp increase in referral rates in PSP might implicate growing demand for psychiatric support in the long run. Further studies with larger samples and longitudinal design are needed in order to fully define how and to what extend psychiatric problems are effected by COVID-19 pandemic.

Anahtar Kelimeler

• COVID-19
• Psychopathology
• Child and adolescent

BİR ÜNİVERSİTE ÇOCUK VE ERGEN RUH SAĞLIĞI VE HASTALIKLARI POLİKLİNİĞİNE COVID-19 PANDEMİSİ ÖNCESİ VE SIRASINDAKİ BAŞVURULARIN KARŞILAŞTIRILMASI

Öz

AMAÇ: COVID-19 salgınının fiziksel etkilerinin yanında; hem hastalık kavramının hem de alınan tedbirlerin ruh sağlığı kliniklerinde takip edilen çocuklar üzerindeki etkilerinin dikkatle izlenmesi ve ortaya konması çok önemlidir. Çalışmamızda, pandemi öncesi ve pandemi sırası dönemlerdeki çocuk psikiyatrisi poliklinik başvurularının karşılaştırılarak pandeminin hasta profili ve poliklinik pratiğine etkilerinin ortaya konması amaçlanmıştır.
GEREÇ VE YÖNTEM: Türkiye’de ilk COVID-19 vakasının bildirildiği 11 Mart 2020 tarihinden önceki (pandemi öncesi [PÖ]) ve sonraki 14 aylık dönem (pandemi sırası [P]) boyunca üniversitemizin çocuk psikiyatrisi polikliniğine yapılan girişlerin tamamı geriye dönük olarak incelenmiştir. P’nin ilk 7 ayı “pandeminin ilk dönemi (PİD)”, son 7 ayı ise “pandeminin son dönemi (PSD)” olarak ayrıca araştırılmıştır. Tüm hastaların yaşları, cinsiyetleri ve psikiyatrik sorunları ayrıntılı olarak kaydedilmiş ve karşılaştırılmıştır.
BULGULAR: Toplam poliklinik başvuru sayısı PÖ’ne göre P’de %45,9 azalmış; PİD’ne göre PSD’nde %82,5 artmıştır. Tanılar özelinde başvuru sayıları PÖ’ne göre P’de; dikkat eksikliği ve hiperkativite bozukluğu ve depresif bozukluklar için belirgin azalma, obsesif-kompulsif bozukluk, anksiyete bozuklukları, özgül öğrenme bozukluğu ve kişilik bozuklukları için belirgin artış göstermiştir (her biri için p<0,001). PİD’ne göre PSD’nde ise başvuru sayıları; kişilik bozuklukları için artış, davranım bozukluğu, obsesif-kompulsif bozukluk ve anksiyete bozuklukları için azalma göstermiştir (her biri için p<0,001).
SONUÇ: COVID-19 pandemisinin getirdiği psikolojik stresörlere rağmen P’de poliklinik başvurularının azalmış olması bu kişilerin ihtiyaçları olmasına rağmen psikiyatrik desteğe yeterince ulaşamadıklarını göstermektedir. PSD’nde poliklinik başvurularında oldukça keskin bir artış izlenmesi de, uzun dönemde ruh sağlığı desteğine olan talebin artabileceğini vurgulamaktadır. Psikiyatrik sorunların COVID-19 pandemisinden nasıl ve ne ölçüde etkilendiğini tam olarak ortaya koyabilecek geniş kapsamlı uzunlamasına izlem çalışmalarına ihtiyaç vardır.

Anahtar Kelimeler

• COVID-19
• Psikopatoloji
• Çocuk ve ergen

Kaynakça

1. 1. WHO Director-General’s opening remarks at the media briefing on COVID-19. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 Erişim Tarihi: 22.08.2021.
2. 2. COVID-19 Pandemic in Turkey. https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Turkey Erişim Tarihi: 22.08.2021.
3. 3. Kaya B. Pandeminin Ruh Sağlığına Etkileri. Klinik Psikiyatri Dergisi. 2020;23(2):123–4.
4. 4. Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 2020;87(34–39):34–9.
5. 5. Waite P, Pearcey S, Shum A, Raw J, Patalay P, Creswell C. How did the mental health of children and adolescents change during early lockdown during the COVID-19 pandemic in the UK? JCPP Advances. 2021;(1):e12009.
6. 6. Barendse MEA, Flannery J, Cavanagh C, et al. Longitudinal change in adolescent depression and anxiety symptoms from before to during the COVID-19 pandemic.J Res Adolesc. 2022;Epub ahead of print.
7. 7. Tanaka T, Okamoto S. Increase in suicide following an initial decline during the COVID-19 pandemic in Japan. Nat Hum Behav. 2021;5(2):229–38.
8. 8. Ford T, John A, Gunnell D. Mental health of children and young people during pandemic. 2021;372:n614.

9. 9. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912–20.
10. 10. World Health Organisation (WHO). The ICD-10 classification of mental and behavioural disorders. Geneve, Switzerland: World Health Organisation (WHO), 1993.
11. 11. World Health Organisation. The impact of COVID-19 on mental, neurological and substance use services: Results of a rapid assessment. https://www.who.int/publications/i/item/978924012455 Erişim Tarihi: 22.08.2021.
12. 12. Williams R, Jenkins D, Ashcroft D, et al. Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study. Lancet Public Heal. 2020;5(10):e543–50.
13. 13. Carr M, Steeg S, Webb R, et al. Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study. Lancet Public Heal. 2021;6(2):e124–35.
14. 14. Bozkurt A. COVID-19 Günlerinde “Hepimiz”in Ruh Sağlığı. Türkiye Psikiyatri Derneği Bülteni. 2020;23(1):31–2.
15. 15. Van Oort F, Greaves-Lord K, Verhulst F, et al. The developmental course of anxiety symptoms during adolescence: the TRAILS study. J Child Psychol Psychiatry. 2009;50(10):1209–17.
16. 16. Angold A, Rutter M. Effects of age and pubertal status on depression in a large clinical sample. Dev Psychopathol. 1992;4(1):5–28.
17. 17. Jiao W, Wang L, Liu J, et al. Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. J Pediatr. 2020;221:264-266.e1.
18. 18. Liu J, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child Adolesc Heal. 2020;4(5):347–9.
19. 19. Fegert J, Vitiello B, Plener P, Clemens V. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child Adolesc Psychiatry Ment Health. 2020;14:20.
20. 20. López-Solà C, Fontenelle L, Bui M, et al. Aetiological overlap between obsessive-compulsive related and anxiety disorder symptoms: multivariate twin study. Br J Psychiatry. 2016;208(1):26–33.
21. 21. Fontenelle L, EC M. The impact of coronavirus (COVID-19) in the diagnosis and treatment of obsessive-compulsive disorder. Depress Anxiety. 2020;37(6):510–1.
22. 22. Nissen J, Højgaard D, Thomsen P. The immediate effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder. BMC Psychiatry. 2020;20(1):511.
23. 23. Seçer İ, Ulaş S. An Investigation of the Effect of COVID-19 on OCD in Youth in the Context of Emotional Reactivity, Experiential Avoidance, Depression and Anxiety. Int J Ment Health Addict. 2020;1–14.
24. 24. Terzioğlu F. COVID-19 Sürecinde Sağlık Sistemlerinin Zorlukların Üstesinden Gelebilme Kapasitesinin Geliştirilmesi ve Hemşireler ile Diğer Sağlık Profesyonellerinin Güç lendirilmesi. Türkiye Çocuk Hastalıkları Dergisi. 2020;(14):76–83.
25. 25. Otte C, Gold SM, Penninx BW, et al. Major depressive disorder. Nat Rev Dis Prim. 2016;2:16065.
26. 26. Preti E, Di Pierro R, Fanti E, Madeddu F, Calati R. Personality Disorders in Time of Pandemic. Curr Psychiatry Rep. 2020;22(12):80.
27. 27. Azim D, Kumar S, Nasim S, et al. COVID-19 as a psychological contagion: A new Pandora’s box to close? Infect Control Hosp Epidemiol. 2020;41(8):989–90.
28. 28. Colle L, Pellecchia G, Moroni F, et al. Levels of social sharing and clinical implications for severe social withdrawal in patients with personality disorders. Front Psychiatry. 2017;8:263.
29. 29. Somma A, Gialdi G, Krueger RF, et al. Dysfunctional personality features, non-scientifically supported causal beliefs, and emotional problems during the first month of the COVID-19 pandemic in Italy. Pers Individ Dif. 2020;165:110139.
30. 30. Mazza C, Ricci E, Biondi S, et al. A nationwide survey of psychological distress among italian people during the covid-19 pandemic: Immediate psychological responses and associated factors. Int J Environ Res Public Health. 2020;17(9):3165.
31. 31. Nonweiler J, Rattray F, Baulcomb J, Happé F, Absoud M. Prevalence and Associated Factors of Emotional and Behavioural Difficulties during COVID-19 Pandemic in Children with Neurodevelopmental Disorders. Children. 2020;7(9):128.
32. 32. Bobo E, Lin L, Acquaviva E, et al. How do children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) experience lockdown during the COVID-19 outbreak? Encephale. 2020;46(3):85–92.
33. 33. Lee J. Mental health effects of school closures during COVID-19. Lancet Child Adolesc Heal. 2020;4(6):421.
34. 34. Wang J, Wang H, Lin H, et al. Study problems and depressive symptoms in adolescents during the COVID-19 outbreak: poor parent-child relationship as a vulnerability. Global Health. 2021;17(1):1–9.
35. 35. Öğütlü H. Turkey’s response to COVID-19 in terms of mental health. Ir J Psychol Med. 2020;37(3):222–5.