{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T18:04:31Z","timestamp":1784657071453,"version":"3.55.0"},"reference-count":63,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>COVID-19 produced a detrimental effect on mental health that could not be appropriately addressed due to a reduced accessibility of healthcare services, as patients with socioeconomic vulnerabilities faced the largest barriers in accessing healthcare during the pandemic.<\/jats:p>\n                    <jats:p>This study aimed to investigate emergency department (ED) accesses with a psychiatric diagnosis before and after COVID-19, with a specific focus on the role of socioeconomic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a multicentre longitudinal retrospective study that involves a population-based open cohort of residents and National Health Service (NHS)beneficiaries aged\u2009\u2265\u200910, enrolled in three large Italian areas from 1 January 2018 to 31 December 2021 (n\u2009=\u20095,159,363). The primary outcome of interest was the First Mental Health Emergency Access (FMHEA); sex, age, deprivation level, citizenship and groups of diagnosis were considered as covariates. Crude incidence rates were calculated comparing the two time periods (pre- and post-COVID-19) by each covariate. In the context of interrupted time series (ITS), incidence rate ratios (IRR) of FMHEAs with 95%CI were estimated via an ITS analysis using a step-change negative binomial model. Temporal trend of FMHEAs was investigated through an ITS analysis on their monthly numbers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During follow-up, 56,762 FMHEAs were observed. The multivariate analysis showed that before COVID-19, the rate of FMHEA was higher among the highly deprived (IRR: 1.28; 95%CI:1.22.-1.35 for highest vs lowest deprivation level), females, people aged \u226424 and \u226585 and immigrants. A significant interaction between the COVID-19 period and deprivation level was found: the probability of reduced FMHEA increased with the deprivation level. The greater impact of COVID-19 was found in the central age classes resulting in a reduction in the differences in FMHEA rates by age in the post-Covid-19 period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>COVID-19 reduced incidence rates of ED accesses, but increased socioeconomic inequalities in the use of ED for mental health disorders.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0324305","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T17:28:03Z","timestamp":1784654883000},"page":"e0324305","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The effect of COVID-19 and socioeconomic inequalities on emergency department accesses for psychiatric conditions"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8354-6305","authenticated-orcid":true,"given":"Chiara","family":"Schepisi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Ventura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3207-8761","authenticated-orcid":true,"given":"Anteo","family":"Di Napoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Aragona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Ciampichini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1396-4928","authenticated-orcid":true,"given":"Valeria","family":"Fano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5775-2276","authenticated-orcid":true,"given":"Christian","family":"Napoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Pacifici","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Rosini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Silvestri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Voller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Zucchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7533-7260","authenticated-orcid":true,"given":"Alessio","family":"Petrelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"pone.0324305.ref001","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.ijsu.2020.04.018","article-title":"The socio-economic implications of the coronavirus pandemic (COVID-19): a review","volume":"78","author":"M Nicola","year":"2020","journal-title":"Int J Surg"},{"issue":"19","key":"pone.0324305.ref002","doi-asserted-by":"crossref","first-page":"4596","DOI":"10.3390\/jcm10194596","article-title":"Long-term impact of economic downturn and loneliness on psychological distress: triple crises of COVID-19 pandemic","volume":"10","author":"S Liu","year":"2021","journal-title":"J Clin Med"},{"key":"pone.0324305.ref003","volume-title":"Principali risultati della terza edizione dell\u2019indagine straordinaria sulle famiglie italiane nel 2020. 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