The covid-19 pandemic and hospital morbidity due to mental and behavioral disorders in Brazil: an interrupted time series analysis, from January 2008 to July 2021

Carvalho, Carolina Novaes; Fortes, Sandra; Castro, André Peres Barbosa de; Cortez-Escalante, Juan; Rocha, Thiago Augusto Hernandes

doi:10.1590/S2237-96222023000100016

Carolina Novaes Carvalho

Contributed to the study concept and design, analysis and interpretation of the results, drafting and critically reviewing the contents of the manuscript. All the authors have approved the final version of the manuscript and declare themselves to be responsible for all aspects thereof, guaranteeing its accuracy and integrity.

Organização Pan-Americana da Saúde, Unidade Técnica de Doenças Transmissíveis e Determinantes Ambientais da Saúde, Brasília, DF, Brazil

https://orcid.org/0000-0003-4172-0314

Sandra Fortes

Contributed with analysis and discussion of the textual elements and critically reviewing the text. All the authors have approved the final version of the manuscript and declare themselves to be responsible for all aspects thereof, guaranteeing its accuracy and integrity.

Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0002-9918-1555

André Peres Barbosa de Castro

Contributed with analysis and discussion of the textual elements and critically reviewing the text. All the authors have approved the final version of the manuscript and declare themselves to be responsible for all aspects thereof, guaranteeing its accuracy and integrity.

Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brazil

https://orcid.org/0000-0002-4037-6446

Juan Cortez-Escalante

Contributed with analysis and discussion of the textual elements and critically reviewing the text. All the authors have approved the final version of the manuscript and declare themselves to be responsible for all aspects thereof, guaranteeing its accuracy and integrity.

Organização Pan-Americana da Saúde, Unidade Técnica de Vigilância, Preparação e Resposta a Emergências e Desastres, Brasília, DF, Brazil

https://orcid.org/0000-0002-2382-2213

Thiago Augusto Hernandes Rocha

Contributed to the study concept and design, analysis and interpretation of the results, drafting and critically reviewing the contents of the manuscript. All the authors have approved the final version of the manuscript and declare themselves to be responsible for all aspects thereof, guaranteeing its accuracy and integrity.

Duke University, Duke Global Health Institute, Durham, North Carolina, United States of America

https://orcid.org/0000-0002-6262-3276

Correspondence:
Carolina Novaes Carvalho.
E-mail:
carvalhocn@gmail.com

AUTHOR CONTRIBUTIONS

Carvalho CN and Rocha TAH contributed to the study concept and design, analysis and interpretation of the results, drafting and critically reviewing the contents of the manuscript. Fortes S, Castro APB and Cortez-Escalante J contributed with analysis and discussion of the textual elements and critically reviewing the text. All the authors have approved the final version of the manuscript and declare themselves to be responsible for all aspects thereof, guaranteeing its accuracy and integrity.

CONFLICTS OF INTEREST

The authors declare they have no conflicts of interest.

Associate editor:

Doroteia Aparecida Hofelmann - https://orcid.org/0000-0003-1046-3319

Figures (1)
Tables (5)

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Figure 1
Mental and behavioral disorder hospitalization rate (A) and breakdown of the time series of mental and behavioral disorder hospitalization rates (B), before and after the onset of the COVID-19 pandemic, Brazil, January 2008 to July 2021

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Study contributions Main results A sharp decrease in hospitalization rates due to mental and behavioral disorders was seen in Brazil after the onset of the COVID-19 pandemic, this being evidence that the pandemic affected the mental health care network. Implications for services There is evidence that there is a delay between the appearance of the first symptoms of mental disorders and seeking specialized care, which means that the consequences of the pandemic for psychosocial care will probably be seen in the years to come. Perspectives The change in the National Mental Health Policy, in the period analyzed, may lead to a misinterpretation of the change in the pattern of hospitalizations due to the pandemic, requiring future studies in order to gain a better understanding of the phenomenon.

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Table 1
Distribution of mental and behavioral disorder hospitalizations by year and geographic region, Brazil, January 2008 to July 2021

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Table 2
Characterization of mental and behavioral disorder hospitalizations, Brazil, January 2008 to July 2021

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Table 3
Characterization of hospitalizations before and after the onset of the COVID-19 pandemic, Brazil, January 2008 to July 2021

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Table 4
Relative risk (RR) and respective 95% confidence intervals (95%IC) of mental and behavioral disorder hospitalizations in the period following the onset of the pandemic, Brazil, January 2008 to July 2021

Year of hospitalization	Regions of residence
	Midwest	Northeast	North	Southeast	South	Not informed	Total
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n
2008	33,553 (5.5)	132,381 (22.0)	7,567 (1.2)	331,153 (55.0)	99,824 (16.0)	884 (0.1)	605,362
2009	34,272 (5.8)	129,571 (22.0)	7,966 (1.4)	311,595 (53.0)	103,360 (18.0)	736 (0.1)	587,500
2010	34,700 (6.0)	125,247 (22.0)	8,929 (1.5)	302,688 (52.0)	109,164 (19.0)	1,278 (0.2)	582,006
2011	34,439 (6.0)	116,187 (20.0)	9,131 (1.6)	302,721 (52.0)	111,723 (19.0)	2,956 (0.5)	577,157
2012	34,449 (6.3)	107,321 (20.0)	8,757 (1.6)	285,330 (52.0)	108,998 (20.0)	3,338 (0.6)	548,193
2013	31,081 (6.2)	96,496 (19.0)	7,764 (1.5)	261,447 (52.0)	103,917 (21.0)	2,942 (0.6)	503,647
2014	26,123 (5.6)	87,466 (19.0)	8,254 (1.8)	241,232 (52.0)	101,075 (22.0)	3,024 (0.6)	467,174
2015	25,643 (6.1)	80,170 (19.0)	7,722 (1.8)	209,517 (50.0)	96,244 (23.0)	3,542 (0.8)	422,838
2016	21,586 (5.7)	74,337 (20.0)	7,770 (2.0)	179,561 (47.0)	92,666 (24.0)	3,291 (0.9)	379,211
2017	20,070 (5.6)	70,535 (20.0)	7,715 (2.2)	160,001 (45.0)	95,733 (27.0)	3,548 (1.0)	357,602
2018	24,299 (6.9)	70,110 (20.0)	8,291 (2.4)	150,400 (43.0)	98,558 (28.0)	-	351,658
2019	25,934 (7.3)	70,720 (20.0)	7,568 (2.1)	152,513 (43.0)	97,156 (27.0)	-	353,891
2020	23,683 (7.8)	62,192 (21.0)	7,660 (2.5)	126,606 (42.0)	81,662 (27.0)	-	301,803
2021	23,127 (7.9)	62,795 (22.0)	8,160 (2.8)	116,155 (40.0)	80,809 (28.0)	-	291,046
Total	392,959 (6.2)	1,285,528 (20.0)	113,254 (1.8)	3,130,919 (49.0)	1,380,889 (22.0)	25,539 (0.4)	6,329,088

Variable	n (%)
Sex
Male	4,051,133 (64.0)
Female	2,277,955 (36.0)
Race/skin color
White	1,939,843 (30.6)
Black	357,621 (5.7)
Mixed race	1,284,649 (20.3)
Yellow	17,892 (0.3)
Indigenous	3,045 (< 0.1)
Unknown	1,446,687(22.9)
Not informed	1,279,351 (20.21)
Nature of hospitalization
Elective	1,278,903 (20.2)
Urgency	3,393,570 (53.6)
Other types of transport accident	569 (< 0.1)
Other types of injury and poisoning due to chemical or physical agents	46 (< 0.1)
Not informed	1,656,000 (26.2)
Reason for charging
Discharge	3,051,625 (48.2)
Inpatient stay	3,008,571 (47.5)
Transfer to another establishment	164,794 (2.6)
Death	16,270 (0.3)
Administrative case closure	87,712 (1.4)
Not informed	116 (< 0.1)
Death during hospitalization
No	6,312,818 (99.7)
Yes	16,270 (0.3)
Primary diagnosis associated with hospitalization, according to ICD-10a group and subgroup^a
Mental and behavioral disorders (F00-F99)	6,325,995 (99.1)
Dementia (F00-F03)	113,964 (1.8)
Mental and behavioral disorders due to use of alcohol (F10)	882,628 (14.0)
Mental and behavioral disorders due to use of other psychoactive substances (F11-F19)	811,596 (13.0)
Schizophrenia, schizotypal and delusional disorders (F20-F29)	2,722,422 (43.0)
Mood (affective) disorders (F30-F39)	910,998 (14.0)
Mental retardation (F70-F79)	335,135 (5.3)
Other mental and behavioral disorders (F04-F09, F50-F69, F80-F99)	507,687 (8.0)
Symptoms and signs involving emotional state (R45)	2,037 (< 0.1)
Intentional self-harm (X60-X84)	1,056 (< 0.1)

Period	Variable	N	Mean hospitalizations	Standard deviation	Median	IQR^a	Min.	Max.
Pre-pandemic^b	Hospitalization	148	39,487.6	8,364.2	39,653.5	17,717.2	24,261.0	52,052.0
Pre-pandemic^b	Rate	148	19.8	4.7	19.7	9.8	11.5	27.2
Post-onset of pandemic^c	Hospitalization	16	24,059.2	1,500.2	23,822.0	1,522.5	22,282.0	28,237.0
Post-onset of pandemic^c	Rate	16	11.3	0.7	11.2	0.7	10.5	13.3

Characteristic	RR^a	95%CI^b	p-value
Pandemic	0.92	0.91;0.92	< 0.001
Time	0.99	0.99;0.99	< 0.001
Harmonic analysis (by month, with two sine and cosine pairs for the 12-month period)
Harmonics 1	0.99	0.99;0.99	< 0.001
Harmonics 2	0.99	0.99;0.99	< 0.001
Harmonics 3	0.99	0.99;0.99	< 0.001
Harmonics 4	0.99	0.99;0.99	< 0.001

[1] Correspondence:
Carolina Novaes Carvalho.
E-mail:
carvalhocn@gmail.com

Brasil

Brasil

The covid-19 pandemic and hospital morbidity due to mental and behavioral disorders in Brazil: an interrupted time series analysis, from January 2008 to July 2021

La pandemia de covid-19 y la morbilidad hospitalaria por trastornos mentales y del comportamiento en Brasil: un análisis de series temporales interrompidas, de enero de 2008 a julio de 2021

Abstract

Objective:

Methods:

Results:

Conclusion: