The impact of the first UK COVID‐19 lockdown on presentations with psychosis to mental health services for older adults: An electronic health records study in South London. (4th November 2022)

• Record Type: Journal Article
• Authors: Simkin, Lauren; Yung, Paul; Greig, Flora; Perera, Gayan; Tsamakis, Konstantinos; Rizos, Emmanouil; Stewart, Robert; Velayudhan, Latha; Mueller, Christoph
• Is Part Of: International journal of geriatric psychiatry. Volume 37:Number 12(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-11-04
• Subjects: COVID‐19 -- delusions -- dementia -- hallucinations -- lockdown -- non‐white ethnicity -- older adults -- psychosis; Geriatric psychiatry -- Periodicals; Geriatric Psychiatry -- Periodicals; 618.97689
• DOI: 10.1002/gps.5834
• Languages: English
• ISSNs: 0885-6230

Abstract

Abstract: Objectives: Social distancing restrictions in the COVID‐19 pandemic may have had adverse effects on older adults' mental health. Whereby the impact on mood is well‐described, less is known about psychotic symptoms. The aim of this study was to compare characteristics associated with psychotic symptoms during the first UK lockdown and a pre‐pandemic comparison period. Methods: In this retrospective observational study we analysed anonymised records from patients referred to mental health services for older adults in South London in the 16‐week period of the UK lockdown starting in March 2020, and in the comparable pre‐pandemic period in 2019. We used logistic regression models to compare the associations of different patient characteristics with increased odds of presenting with any psychotic symptom (defined as hallucinations and/or delusion), hallucinations, or delusions, during lockdown and the corresponding pre‐pandemic period. Results: 1991 referrals were identified. There were fewer referrals during lockdown but a higher proportion of presentations with any psychotic symptom (48.7% vs. 42.8%, p = 0.018), particularly hallucinations (41.0% vs. 27.8%, p < 0.001). Patients of non‐White ethnicity (adjusted odds ratio (OR): 1.83; 95% confidence interval (CI): 1.13–2.99) and patients with dementia (adjusted OR: 3.09; 95% CI: 1.91–4.99) were more likely to be referred with psychotic symptoms during lockdown. While a weaker association between dementia and psychotic symptoms was found in the pre‐COVID period (adjusted OR: 1.55; 95% CI: 1.19–2.03), interaction terms indicated higher odds of patients of non‐White ethnicity or dementia to present with psychosis during the lockdown period. Conclusions: During lockdown, referrals to mental health services for adults decreased, but contained a higher proportion with psychotic symptoms. The stronger association with psychotic symptoms in non‐White ethnic groups and patients with dementia during lockdown suggests that barriers in accessing care might have increased during the COVID‐19 pandemic. Key points: Referrals to mental health of older adult services during lockdown were a third of the pre‐pandemic period, but the proportion with any psychotic symptom was higher. Non‐White ethnicity was associated with any psychotic symptom during the lockdown, but not in the pre‐COVID comparison period. A referral with a diagnosis of dementia was more likely to be associated with any psychotic symptom, predominantly hallucinations, during the lockdown period. Inequalities in access to care, already present before the pandemic, may have been exacerbated during lockdown, leading to fewer referrals and more severe presentations with psychosis.