Frontiers in public health · 2026
Lockdown COVID‑19: a stress test revealing more about the mental health system than psychopathology-A comparative analysis between Austria, Germany, and Italy.
СтатьяСравнительное исследованиеНаблюдательное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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de Bertoldi Francesco, Finos Livio, Roux Pascale, Gaspari Davide, Di Pauli Jan, Ullrich Heiko, Benedetti Nicolas, Bizzarri Jacopo, Neugebauer Johanna, Peter Plum P, Nitti Mariateresa, Conca Andreas
Аннотация
BACKGROUND: This study examined whether the COVID-19 pandemic produced diagnosis-specific and cross-nationally reproducible alterations in psychiatric admissions, or whether observed variations primarily reflected organizational responses. We compared psychiatric inpatient services from Austria and Germany-two hospital-centered systems with similar pre-pandemic structures-and used Italy as a contrasting community-based model.
METHODS: We conducted a retrospective multicenter observational study including all psychiatric hospitalizations between 2017 and 2020. Temporal admission trends were analyzed bi-weekly for each ICD-10 diagnostic group. Generalized Linear Models (Poisson family) were used to model the effects of Diagnosis, Year (2020 vs. pre-2020), Week, and Country, and their interactions. Diagnostic categories were grouped following ICD-10, with F10 (alcohol-related disorders) analyzed separately from other substance-use disorders to capture differences between planned and emergency admissions.
RESULTS: Across Austria and Germany, 2020 was associated with a marked temporal distortion in admission patterns compared with previous years (Week × Year interaction, p < 0.05), consistent across diagnoses except for F10. Alcohol-related disorders showed country-specific trajectories, reflecting service reorganization-bed closures in Austria versus stable capacity in Germany. No other diagnosis exhibited reproducible temporal deviations across countries, indicating that the pandemic affected admission organization rather than disorder-specific psychopathology. A supplementary comparison including Italy showed that, while Austria and Germany experienced a decline in total hospitalizations (-16 and -10%, respectively), Italy remained stable (+12%), suggesting greater resilience of its community-based system.
CONCLUSION: The pandemic did not induce diagnosis-specific increases in acute psychiatric admissions but substantially altered their temporal organization. Differences across countries highlight how healthcare structure-particularly the integration of territorial and inpatient services-modulates system resilience under crisis conditions.
METHODS: We conducted a retrospective multicenter observational study including all psychiatric hospitalizations between 2017 and 2020. Temporal admission trends were analyzed bi-weekly for each ICD-10 diagnostic group. Generalized Linear Models (Poisson family) were used to model the effects of Diagnosis, Year (2020 vs. pre-2020), Week, and Country, and their interactions. Diagnostic categories were grouped following ICD-10, with F10 (alcohol-related disorders) analyzed separately from other substance-use disorders to capture differences between planned and emergency admissions.
RESULTS: Across Austria and Germany, 2020 was associated with a marked temporal distortion in admission patterns compared with previous years (Week × Year interaction, p < 0.05), consistent across diagnoses except for F10. Alcohol-related disorders showed country-specific trajectories, reflecting service reorganization-bed closures in Austria versus stable capacity in Germany. No other diagnosis exhibited reproducible temporal deviations across countries, indicating that the pandemic affected admission organization rather than disorder-specific psychopathology. A supplementary comparison including Italy showed that, while Austria and Germany experienced a decline in total hospitalizations (-16 and -10%, respectively), Italy remained stable (+12%), suggesting greater resilience of its community-based system.
CONCLUSION: The pandemic did not induce diagnosis-specific increases in acute psychiatric admissions but substantially altered their temporal organization. Differences across countries highlight how healthcare structure-particularly the integration of territorial and inpatient services-modulates system resilience under crisis conditions.