COVID-19 and lockdown: effects on coercion and length of stay for patients with personality disorders

The outbreak of COVID-19 in 2020 presented a major challenge to mental health care. Due to the risk of infection and the restrictions during the lockdown, outpatient treatment services were scaled down. This may have been particularly challenging for patients with Personality Disorders (PD), for which a stable outpatient treatment setting is especially important. The aim of the study was to investigate if PD patients have experienced longer inpatient stays and more coercive measures during the COVID-19 pandemic.

In this multi-year, hospital-wide, longitudinal observational study, we compared the period before the outbreak of COVID-19 (until December 2019) and the period after (from January 2020) by means of an interrupted time series analysis including all adult inpatient cases with PD (N = 1170) admitted to the Adult Psychiatry, UPK, Basel, Switzerland, between October 2016 and December 2021 (for the median length of stay) and between January 2012 and December 2021 (for coercive measures). Outcome variables were the occurrence rate of coercive measures and the median length of stay.

Both the occurrence rate of coercive measures (OR = 15.32, p = >.001) and the median length of stay (E = 244.016, p = .028) increased in PD patients after the COVID-19 outbreak.

Our findings suggest that PD patients are specifically vulnerable to a changing and stressful psychosocial context such as that of a pandemic. Strategies to maintain outpatient care services and opportunities for short-term crisis intervention are essential for this group, especially to prevent a rise in coercive measures and unnecessarily prolonged inpatient treatment.