A Systematic Review on the Impact of Seasonality on Severe Mental Illness Admissions: Does Seasonal Variation Affect Coercion?

Coercion in psychiatry is associated mainly with involuntary admissions. The purpose of this study was to investigate the associations between hospital admissions of patients suffering from affective and schizophrenic disorders and seasonality. A systematic literature search using PubMed, Scopus and Google Scholar was conducted, including studies with affective and schizophrenia disorder admissions, published from October 1992 to August 2020. A total of 31 studies were included in the review. Four broad severe mental illness admission categories were identified regarding seasonality: affective disorders, schizophrenia disorders, involuntary admission affective disorders and involuntary admission schizophrenia disorders. There was clear and strong evidence for spring and summer peaks for severe mental illness admissions; data provided for age, gender and involuntary admissions was limited. Seasonality may have a significant effect on the onset and exacerbation of psychopathology of severe mental illness and should be considered as a risk factor in psychiatric admissions, violence and the risk of mental health coercion. A better understanding of the impact of seasonality on severe mental illness will help professionals to provide the best practices in mental health services in order to reduce and prevent psychiatric hospitalizations (especially involuntary admissions) resulting in further coercive measures.

The impact of meteorological factors on involuntary admission in Attica, Greece.

Few studies in the literature have examined the effect of meteorological factors, especially temperature, on psychiatric hospitalization and even less on their association with involuntary admission. This study aimed to investigate the potential association of meteorological factors with the involuntary psychiatric hospitalization in the region of Attica, Greece. The research was conducted at the Psychiatric Hospital of Attica "Dafni". This was a retrospective time series study of 8 consecutive years of data (2010 to 2017) and included 6887 involuntarily hospitalized patients. Data on daily meteorological parameters were provided from the National Observatory of Athens. Statistical analysis was based on Poisson or negative binomial regression models with adjusted standard errors. Analyses were initially based on univariable models for each meteorological factor separately. All meteorological factors were taken into account through factor analysis and then, through cluster analysis, an objective grouping of days with similar weather type was performed. The resulting types of days were examined for their effect on the daily number of involuntary hospitalizations. Increases in maximum temperature, in average wind speed and in minimum atmospheric pressure values were associated with an increase in the average number of involuntary hospitalizations per day. Increase of the maximum temperature above 23 °C at lag 6 days before admission did not affect significantly the frequency of involuntary hospitalizations. Low temperature and average relative humidity above 60% levels had a protective effect. The predominant day type at lag 1 to 5 days before admission showed the strongest correlation with the daily number of involuntary hospitalizations. The cold season day type, with lower temperatures and a small diurnal temperature range, northerly winds of moderate speed, high atmospheric pressure and almost no precipitation, was associated with the lowest frequency of involuntary hospitalizations, whereas the warm season day type, with low daily temperature and small daily temperature range during the warm season, high values of relative humidity and daily precipitation, moderate wind speed/gust and atmospheric pressure, was associated with the highest. As climate change increases the frequency of extreme weather events, it is necessary to develop a different organizational and administrative culture of mental health services.

Multi-sectoral impact assessment of an extreme African dust episode in the Eastern Mediterranean in March 2018.

In late March 2018, a large part of the Eastern Mediterranean experienced an extraordinary episode of African dust, one of the most intense in recent years, here referred to as the "Minoan Red" event. The episode mainly affected the Greek island of Crete, where the highest aerosol concentrations over the past 15 yeas were recorded, although impacts were also felt well beyond this core area. Our study fills a gap in dust research by assessing the multi-sectoral impacts of sand and dust storms and their socioeconomic implications. Specifically, we provide a multi-sectoral impact assessment of Crete during the occurrence of this exceptional African dust event. During the day of the occurrence of the maximum dust concentration in Crete, i.e. March 22nd, 2018, we identified impacts on meteorological conditions, agriculture, transport, energy, society (including closing of schools and cancellation of social events), and emergency response systems. As a result, the event led to a 3-fold increase in daily emergency responses compare to previous days associated with urban emergencies and wildfires, a 3.5-fold increase in hospital visits and admissions for Chronic Obstructive Pulmonary Disease (COPD) exacerbations and dyspnoea, a reduction of visibility causing aircraft traffic disruptions (eleven cancellations and seven delays), and a reduction of solar energy production. We estimate the cost of direct and indirect effects of the dust episode, considering the most affected socio-economic sectors (e.g. civil protection, aviation, health and solar energy production), to be between 3.4 and 3.8 million EUR for Crete. Since such desert dust transport episodes are natural, meteorology-driven and thus to a large extent unavoidable, we argue that the efficiency of actions to mitigate dust impacts depends on the accuracy of operational dust forecasting and the implementation of relevant early warning systems for social awareness.