As humans worldwide face catastrophic events and their consequences daily, disaster management represents an urgent challenge for global health [1]. Catastrophic events could be natural, such as hurricanes, earthquakes, floods, pandemics [2], or man-made disasters, like war, terrorist attacks or radiation emergencies [3]. Following a crisis or a calamity, changes in health services utilisation patterns are commonly observed, [4, 5] also due to access restrictions to healthcare facilities [6]. Moreover, an event may directly affect the population's health, and its consequences may also be reflected by short- and long-term effects on the mental health of individuals, with potential repercussions on admission patterns to psychiatric wards [7, 8, 9]. An example of such a phenomenon was reported by Beaglehole and colleagues, who described a decrease in admission rates in the acute psychiatric wards over the 18 months following the Christchurch earthquakes in New Zealand [10]. Comparable observations were made several decades ago following the bombing that destroyed the city of London in 1940 [11]. However, the reduction in admission rates following a natural disaster may last only for the first period after the traumatic event, and the utilisation of health services may significantly increase again after a few months or years [12]. Conversely, Sakuma et al. (2018), who analysed the admission rates in two different psychiatric hospitals following the 2011 Great East Japan earthquake, highlighted an initial increase in admissions in the four weeks following the event [13]. Such results were also observed by Aoki and colleagues (2012), who reported an increase in compulsory treatment hospitalisations after the Great East Japan earthquake, particularly of patients diagnosed with schizophrenia [14].
At 3:32 am, on the 6th of April 2009, a 6.3 Mw earthquake devastated the city of L’Aquila and its surroundings, killing 309 people and injuring more than 1600. Several studies have been conducted on the earthquake's acute, medium, and long-term mental health effects [15, 16, 17, 18, 19]. However, only a few studies observed admissions to the L’Aquila psychiatric unit, and they mainly focused on the first months post-earthquake [20, 21]. Specifically, Pollice et al. (2010) observed that among admitted patients diagnosed with schizophrenia, nine patients (15%) met the criteria for Post-traumatic stress disorder and showed more severe positive symptoms and impairment in working memory [21]. However, this study does not provide data regarding specific admissions patterns over time.
Recently, the COVID-19 pandemic represented another catastrophic event that significantly impacted the population's mental health, primarily because of the adopted restrictive measures to contrast the virus spread [22, 23, 24]. In Italy, such measures included a national lockdown, the first and longest occurring from March 11th 2020, to May 4th, 2020 [25], followed by other and shorter lockdowns, preventive measures and curfews that lasted until the end of 2021.
Several studies investigated how this event influenced psychiatric hospital admissions and service utilisation [26, 27, 28, 29, 30, 31]. Bonello et al. (2021), in a study carried out at the Malta Psychiatric Hospital, observed a decrease in inward admissions, specifically for depressive or anxiety disorders, a marked decrease in substance abuse admissions, but an increase in compulsory treatments [27]. In Italy, a study that analysed data on admissions in psychiatric wards in 12 different Italian regions compared data from the pre-lockdown period (i.e. 2018 and 2019), the lockdown (i.e. March 1st -April 30th, 2020) and post-lockdown (i.e. May 1st -June 30th, 2020), and reported a drastic decline in psychiatric admissions during the lockdown [28]. Such a trend was particularly noticeable in the over-65s in all periods considered in 2020 [28].
Another study by Dionisie et al. (2022) focused on the effect of the COVID-19 pandemic on hospital admissions in psychiatric departments according to diagnosis [32]. The study describes decreasing trends of hospitalisation for schizophrenia, acute psychotic disorder, depressive, and bipolar disorders during the imposition of lockdown measures, followed by an increase in admissions for psychotic and mood disorders occurring after the dissolution of the lockdown measures, although never exceeding pre-lockdown levels [32].
Despite the significant number of studies conducted on the effects of the L'Aquila earthquake on mental health, no study has analysed how it influenced patterns of admissions in the psychiatric unit over a prolonged period. To the best of our knowledge, no Italian research has compared the impact of different catastrophic events on psychiatric unit admissions. Noteworthy, only the study by Vukojević and colleagues (2021) compared two catastrophic events regarding admissions to psychiatric wards in Zagreb: the Spanish flu pandemic and the COVID-19 pandemic [33]. Authors found a slight dip in acute psychiatric admissions when compared to a three-year period average before for both pandemics. The currently available literature provides conflicting results, and the potential impact of different traumatic events on hospitalisation rates, specifically in a psychiatric unit, has not been completely elucidated.
In such context, this study aims to analyse the trend of hospitalisations in the psychiatric ward (SPUDC – Servizio Psichiatrico Universitario di Diagnosi e Cura) of the “San Salvatore” Hospital of L'Aquila during the four-year period 2008–2011 and 2019–2022, with a focus on the second quarter of 2009 (L'Aquila earthquake) and 2020 (COVID-19 lockdown/first wave). Temporal patterns of discharge diagnosis, sociodemographic data, and the total number of patients admitted have been analysed to understand whether and how the two traumatic events influenced the trend of hospitalisations.