Using data to improve public health: COVID-19 secondment

The key aims
This project aims to understand how mental health has been affected by the pandemic. This is important because COVID-19 raised many new challenges. Daily life has been harmed by its life-threatening nature, lockdowns, shielding, changes at work, home schooling and self-isolation. People have feared for themselves and for others; many faced loneliness. Early research shows that people's mental health suffered. My own research showed that the NHS struggled to deliver usual high quality healthcare over this time. In this project, I will analyse how many people during the pandemic developed mental health problems like depression, anxiety, poor sleep, alcohol and drug abuse, self-harm and eating disorders. I will compare this to previous years to understand changes during COVID. This will help us to know the full effects of COVID and to plan how to curb mental health problems in future pandemics.

Where and how the research will be undertaken
When someone sees a health professional in a GP practice or hospital, facts are recorded about the reasons for their visit, their health problems and care given. In the past, these were written in paper files. Now these records are kept on computers. Because of this, researchers can pool the stored information in secure data banks and study them to improve healthcare. This is a key strength of my research, I will use routinely collected data and so will not burden patients or clinicians by getting new data.

The UK is world leading in building set-ups (platforms) where people's health data are kept safe yet researchers are allowed to study them. In this research I will use two high quality platforms: OpenSAFELY and NHS Digital. I will study the number of people with new mental health symptoms and diagnoses, and drugs prescribed to treat them. I will use data from before the pandemic to predict how many people with mental health problems would be expected had the pandemic not happened. I will compare this to what has actually happened. This will help us to understand the effect of the pandemic on mental health and on the services people were provided. I will also find factors that may put people at risk of mental health problems during pandemics. This is in line with this funding call and with the government's priorities. Mental Health, Healthcare Disruption and Health in the Society were stated as key areas needing study.

Who will be involved
As the leading researcher, I will plan and deliver this work. I will use the platforms stated above. I will be guided by expert scientists, patients, and doctors/nurses. My work will be powerful as it will use data from a large section of the UK population. People who do not wish their data to be shared, can have their data removed. Not many people do, knowing that their data are kept safely, used correctly and with the clear aim to help them and the NHS. Researchers cannot identify individual people. The results that we show to the government and public will be summaries. For example, in this study we will present the results as overall numbers and percentages of people who experienced mental health problems. We will give estimates on how much could be related to the pandemic. We will say what kinds of people are at more risk of mental health problems due to the pandemic and its lockdown measures. This will help the government to act better to help the needs of people.

Challenges
The plan above does have some challenges. We will need to say clearly what is/is not a new mental health diagnosis. It could be seen as when someone has a mental health diagnosis for the first time, or when they have not had it for several years. This will be decided with patients and doctors/nurses. The work will also be difficult because lockdown reduced people's contact with their GPs. We will need to look carefully at this to tell the real effect of COVID on mental health. We will need to separate this from the effect of disrupted NHS services.

This project will be delivered with colleagues from the Longitudinal Health and Wellbeing National Core Study (LHW NCS) and will focus on investigating the effect of COVID-19 on cancer and mental health of the population. It will use routine health data (electronic health records) from primary and secondary care. More specifically, the project will use platforms such as the NHS Digital Trusted Research Environment and OpenSAFELY, which link anonymised patient health records across different healthcare sectors, and make the data available for research in a way that is secure and transparent. The lead researcher on this project, Dr Lemanska from the University of Surrey, has already undertaken and published a study on the effect of the COVID-19 crisis on mental health. This research showed a dramatic drop in GP consultations for mental health during 2020, while the prescriptions system was more resilient and was not disrupted. The study discussed implications and recommendations for future pandemics in relation to switching to remote consultations and preventing backlogs in the NHS. This work led to a joint project with Public Health England (PHE) that compared the COVID-19-related disruption across healthcare systems including primary, out of hours and emergency care.
The current research will contribute to the emerging picture regarding the wider healthcare implications of the COVID-19 crisis and in turn contribute to the national efforts in the fight against the pandemic. COVID-19 and lockdowns led to a shift in healthcare needs of patients. The pandemic has also affected the availability and readiness of NHS services to deliver healthcare and highlighted how difficult it can be to deliver healthcare under such challenging conditions. This project will build on Dr Lemanska's COVID-19 health disruption work. It will use linked electronic health records from different healthcare settings in the UK to investigate the impact of the COVID-19 pandemic and lockdowns on the delivery and outcomes of cancer care. Specifically, we will investigate how cancer screening and diagnostic testing was affected. For example, we plan to investigate prostate cancer and prostate-specific antigen blood tests which are used in primary and secondary care to detect cancer. In the area of mental health, we are interested in investigating the impact of COVID-19 on mental health. For example, we will look at how many people developed new mental health symptoms, new diagnoses, or needed new prescriptions for common mental health conditions such as depression, anxiety, alcohol and drug abuse, self-harm, sleep and eating disorders.