Epidemiological-Ecological Approach to Analyze the Effect of the pandemic on mental health services

Introduction: The COVID-19 pandemic has introduced significant challenges in mental healthcare and has raised concerns about the impact of urban living, environmental stressors, and socioeconomic disparities on mental health. Our aim was to describe the effect of COVID-19-related restrictions alongside social and environmental factors on community mental health services’ utilization



Methods: From January 2019 to June 2021, data on 13,475 patients and 294,801 contacts were obtained from an electronic clinical database. Solar radiation, PM2.5 and NO2 concentrations, % of trees, share of green areas, presence of water-courses and large public green areas were obtained for each census block. Contacts were categorized into outpatient care, social interventions, rehabilitations, multi-professional assessments, and daycare. Global and separate regressions for each type of service were performed and Incidence Rate Ratios (IRRs) were calculated for the number of contacts, while spatial and temporal analyses were employed for contact rate.



Results: In 2020, a significant reduction in the number of patients, except for young, foreign-born, and with schizophrenia. In 2020, contacts had a reduction of 33.9% with respect to 2019, notably affecting rehabilitations and day care. Additionally, regressions displayed a statistically significant effect of lockdown (IRR 0.673; p-value <0.001), but not of restrictions, in terms of reduction in the number of contacts expected for social interventions. Living in rented apartments, lower educational levels, higher tree cover, increased air pollution, and lower solar irradiance in the previous week were related to higher use of mental health services, but the COVID-19 attenuated these differences.



Discussion: Despite the access to mental health services during the pandemic was overall reduced, the mental health system was able to maintain support for more vulnerable patients. These findings can inform policies and practices at both national and international levels, to improve effective mental health care delivery during and beyond pandemics.