Preplanned Studies: Change of Disease Spectrum Characteristics of Psychiatric Inpatients Before and After Lockdown Lifted During the COVID-19 Pandemic — Wuhan City, Hubei Province, China, 2021

In recent decades, the prevalence of mental disorders has increased in China and worldwide. The coronavirus disease 2019 (COVID-19) spread worldwide in less than 2 months from late December 2019. Numerous studies have shown that COVID-19 poses a significant threat to physical and mental health among the general population (1). Factors such as chronic stress and social isolation may increase the risk of emotional deterioration for some people (2), which may increase psychosis risk and proportion of inpatients. We conducted a retrospective cohort study of analyzing and comparing the disease characteristics of psychiatric inpatients 1 year before and after Wuhan lifted lockdown during COVID-19. The data were extracted from the information management system of the mental health center of the third-level hospital in Wuhan City, Hubei Province, China, from April 8, 2019 to April 9, 2021, which included gender, age, Wuhan residential registration (hukou), and disease diagnosis. Taking the date of lifting lockdown in Wuhan (April 8, 2020) as the cut-off point, the disease characteristics of psychiatric inpatients before and after one year were compared. Results showed that nearly half of inpatients were diagnosed with bipolar disorder, and most tended to be younger and female. This study suggests that more attention should be paid to the mental health of females and adolescents, and it is necessary to conduct studies that are multicenter and have more extended observation periods.

On January 23, 2020, Wuhan was under lockdown to control the pandemic, significantly reducing access to services. Renmin Hospital of Wuhan University was appointed as a designated hospital for ordinary and severe COVID-19 patients. No new inpatients were admitted to other departments except emergency and fever clinics. With the effort of the whole society, Wuhan was lifted from lockdown on April 8, 2020 into the period of normalized epidemic prevention and control. All departments only began to receive new inpatients after strict disinfection. Therefore, in this study, April 8, 2020 was taken as the time node to compare the disease spectrum characteristics of psychiatric inpatients before and after one year and provide references for mental health assessment and prevention over the coming years.

This retrospective cohort analysis was conducted on patients with mental disorders hospitalized between April 8, 2019 and April 9, 2021 in the mental health center of the third-level hospital in Wuhan, Hubei, China. This period was divided into two phases. “Phase 1” (i.e., from April 8, 2019 to April 8, 2020) represents the period before Wuhan lifted the lockdown. “Phase 2” (i.e., from April 9, 2020 to April 9, 2021) was Wuhan’s normalized epidemic prevention and control stage. Data from the electronic medical record in the information management system were used, which contained information on demographic characteristics (gender, age, Wuhan hukou) and disease diagnosis (somatoform disorders, bipolar disorder, sleep disorders, depressive disorder, stress-related disorder, emotional and behavioral disorders in children and adolescents, anxiety disorder, schizophrenia spectrum disorder, psychoactive substances-induced mental disorders, organic mental disorder, obsessive-compulsive disorder, and other mental disorders). Qualified psychiatrists were responsible for defining and classifying the diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) (3).

Continuous data were expressed as mean and standard deviation, categorical data regarding the number of patients (percentage). Continuous data were analyzed using the two-sample t-test. Differences between categorical data were evaluated using the Fisher’s Exact test or the Pearson chi-squared test. Statistical analysis was performed using IBM SPSS Statistics for Windows (version 21.0, IBM Corp., Armonk, NY, USA). And P<0.05 was considered statistically significant.

Between April 8, 2019 and April 9, 2021, 10,863 inpatients were treated in the Department of Psychiatry at Renmin Hospital of Wuhan University. The total number of inpatients in Phase 1 and Phase 2 was 6,664 (61.3%), 4,199 (38.7%), respectively, with a 36.98% reduction in Phase 2 compared to Phase 1. Comparison of demographic characteristics between both phases: the prevalence of female inpatients in Phase 2 was higher than that in Phase 1 (61.1% vs. 55.9%; P<0.01); the average age in Phase 2 was younger than that in Phase 1 (33.52$ \pm $16.52 vs. 34.55$ \pm $16.10; P<0.01); the prevalence of inpatients with non-Wuhan hukou in Phase 2 was higher than that in Phase 1 (61.5% vs. 59.0%; P<0.05) (Supplementary Table S1).

The top 3 disease diagnoses in both phases were bipolar disorder (44.6% vs. 46.7%), schizophrenia spectrum disorder (19.7% vs. 16.9%), and depressive disorder (17.9% vs. 16.6%). The distribution of disease diagnosis among inpatients in the Phase 2 was compared with the Phase 1: the proportion of inpatients with bipolar disorder increased (46.7% vs. 44.6%, P<0.05); emotional and behavioral disorders in children and adolescents increased (3.4% vs. 1.6%; P<0.01); schizophrenia spectrum disorder decreased (16.9% vs. 19.7%; P<0.01) (Table 1). The disease diagnoses distribution by gender at different age groups in Phases 1 and 2 is shown in Figure 1. The disease distribution proportion of inpatients by gender in Phase 1 and Phase 2 are separately shown in Supplementary Figures S1–S2. A detailed comparison of the two stages of disease diagnosis distribution among demographic characteristics is presented in Supplementary Table S2.

Figure 1. 

Disease distribution of inpatients by gender and age in Phase 1 and Phase 2. (A) Male in Phase 1; (B) Female in Phase 1; (C) Male in Phase 2; (D) Female in Phase 2.