Since December 2019, an outbreak of a new coronavirus disease (COVID-19) has spread from Wuhan, China,  which subsequently became pandemic with extension to all continents . Italy was the first country to be affected in Europe, with the first person-to-person transmission diagnosed on February 20, 2020. The national response to contain the pandemic began on February 23, 2020, with severe social containment measures in 11 municipalities in northern Italy, continued with social distancing and school closures on March 4, 2020. More restrictive decrees followed gradually until 9 March, when the lockdown was extended to the entire Italian territory and culminated in an announced national lockdown on 11 March 2020, lasted until 4 May 2020 .
The COVID-19 outbreak resulted in more than 239 millions confirmed cases worldwide with more than 4.87 millions deaths .
COVID-19 has a major impact on the lives of millions of people around the world not only because of its rapid spread and significant mortality, but also due to the changes in people’s daily lives, the devastating impact on economy and the profound reformulation of social structures and health systems . In fact, national governments adopted an emergency protocol that imposed restrictions never experienced and social distancing with significant impact on the emotional and social sphere of children. During this period, many non-emergency outpatient activities and home therapy services were suspended, even in the context of neuropsychiatric diseases in patients in developmental age. The limitation of freedom, home confinement, reduced social interaction and poor access to therapeutic pathways have generated states of anxiety, discomfort, loss of references, increased social pressure and tensions in the general population, and even more in pediatric patients and fragile subjects and in their family context. Summer and holiday periods schools’ closure was linked with a reduction in physical activities, an increase in the use of smartphones and other media devices, dysregulation of the sleep-wake rhythm, alterations in diet and weight gain [6–8].
The COVID-19 pandemic is having a psychological impact on all individuals, particularly the most fragile groups. For adolescents with psychiatric disorders, lockdown can result in sudden interruption of care or delayed care delivery. Recent findings, based on the current pandemic, indicated that experiencing extreme fear is the most significant predictor for both depression and post-traumatic stress disorder, followed by short sleep duration and living in the most affected areas . In a survey of Chinese adolescents aged 12-18 years, a high prevalence of symptoms of depression (43%), anxiety (37%), and in combined form (31%) was found during the COVID-19 outbreak, and the female gender was the greatest risk factor .
A survey of adolescents in the United Kingdom found that 83% of them agreed that the pandemic had worsened their mental health and 26% said they were unable to access mental health support.
Adolescents are therefore more vulnerable and require careful consideration by health care providers and health system adaptations for mental health support during lock-down.
Adolescents are experiencing a period of insecurity resulting from concerns about the health and work of their relatives, the theme of death replayed daily, separation from friends, and the lock-down of school; for some of them this is an unbearable experience [11–13].
In addition, it should be considered how the COVID-19 pandemic has been changing the use of tools such as social media, the Internet, and access to information that have never been more developed, easy, and immediate. Social media could play an important role during the confinement as it could allow for more socialization, learning opportunities, even for adolescents' access to information about their health. Thus, the use of social media could be a positive factor in helping adolescents maintain social interaction during lockdown; however, social media is also associated with negative phenomena. According to a recent systematic review of the literature, time spent and investment in social media is correlated with levels of depression, anxiety, and psychological distress and be associated with insomnia .
Understanding the extent and type of issues related to psychiatric patients' access to emergency departments is of utmost importance, as the pandemic is still ongoing, and issues related to lockdown and possible lack of access to mainstream care may recur [9, 15]. Furthermore, during and after the COVID-19 outbreak, we may see an increase in suicidal ideation and behaviour among at-risk populations. According to the WHO, each suicide in a population is accompanied by more than 20 suicide attempts, and a recent model based on global public data from 63 countries predicted a 20-30% increase in suicide rates due to the COVID-19 pandemic [16, 17]. In fact, Hill et al. (2021) recently reported that rates of suicide ideation and attempts were higher during COVID-19 period but were not universally higher across this period. Months with significantly higher rates of suicide-related behaviours appear to correspond to times whenCOVID-19–related stressors and community responses were heightened, indicating that youth experienced elevated distress during these periods. Emergency Departments (ED) play a pivotal role in the identification, treatment, and coordination of care for children with mental health disorders, often serve as a safety net for children with mental health disorders seeking care [18, 19], and may be essential to identify populations at risk for delayed presentations of undiagnosed, untreated, or complicated mental health conditions. Timely recognition of at-risk children may help improve children’s and adolescents’ health and well-being as well as develop long-term capacities for mental health services .
Therefore, it is very important to know the impact of pandemic COVID-19 and lock-down on adolescent psychiatric disorders, considering that this situation could increase the risk of developing or worsening these disorders. However, no study has evaluated changes in ED visits for mental health conditions during a large 1-year COVID-19 pandemic period.
This study aims to define whether in the population of patients referred to our ED there was a change in the presentation of neuropsychiatric disorders in COVID-19 period compared to the previous year (pre COVID-19 year), analysing ED admissions of the pediatric population with neuropsychiatric disorders and evaluating a possible difference in both quantity and quality in the accesses of both periods.