Altogether 40 % fewer patients sought help from the Psychiatric Casualty Clinic in Oslo from and including 13 March 2020 up to and including 1 April 2020 as compared with the same period in 2019. The number of consultations for substance abuse and personality disorders was mostly unchanged, while crisis and depression-related consultations declined significantly. The number of involuntary psychiatric admissions remained stable, while voluntary admissions decreased from nine in 2019 to one in 2020. We believe this could be related to the decline in consultations for life crises and depression.
In China, researchers have investigated psychological reactions during the initial phase of the COVID-19 outbreak. The study found that more than half of the respondents to a questionnaire had moderate to severe mental disorders, the most common one being anxiety (1). We cannot make a direct comparison between the conditions in Norway and China, but 7 of 14 patients with COVID-19-related disorders in our study were also assessed as having anxiety.
The accident and emergency department at St. Olavs Hospital reported a 39 % decline in the flow of patients in week 12 as compared with the corresponding week in the preceding year (2). It is interesting that their numbers and ours are so similar. The general public most likely believes that health facilities pose a high risk of infection, and they take the advice on social distancing seriously. The sight of health personnel in personal protective equipment collecting test samples from patients outside the hospital or in a tent contributes to this impression. People may have thought that the health services were overburdened and for this reason chose not to visit the clinic. We do not have data to support this view, and the reasons for changes in help-seeking behaviours during a pandemic should be studied further. Nor can we rule out that the decline in the number of voluntary admissions may have been impacted by a higher threshold for patient admissions during the initial phase of the pandemic.
A literature review shows that quarantine in the short term can lead to depression, anxiety, anger and worry (3). These are normal reactions to quarantine. It is therefore important that the general public is informed about normal psychological crisis reactions during times of hardship, and this may prevent such reactions from being interpreted as mental illness. Providing sound information is a strategy that can also protect against long-term emotional distress and malaise (4).
In the book Psychology of Pandemics (5), Taylor writes that the extent of the psychological impact of a pandemic on the population is underestimated. Crisis reactions and depression in connection with bereavement, loss of employment and income, family conflicts, isolation and relocation are all to be expected, not only during the pandemic, but also in its aftermath.
The strength of this study is that the numbers stem from a randomly selected accident and emergency department setting that serves a relatively large population, which increases the study's validity. The weakness is that the amount of data is small, making it difficult to perform reliable statistical analyses.