Self-harm rates, clinical contact and risks of suicide and early death before, during and after the COVID-19 peak: cohort study of linked health data
Lead Research Organisation:
University of Manchester
Department Name: School of Health Sciences
Abstract
The COVID-19 pandemic could have a profound impact on suicide. People who have self-harmed, for example by intentionally poisoning or injuring themselves, have particularly high risks of suicide. Therefore, it is important to understand how the pandemic has affected rates of self-harm. So far, information has come from people who have chosen to respond to surveys, rather than from the general population. We aim to find out:
- how the pandemic has affected rates of self-harm
- likelihood of being prescribed medication for mental illness and being referred for mental health treatment by GPs for patients who have self-harmed
- risks of further self-harm and suicide
The pandemic has affected people differently so we will examine differences by age group, gender, ethnic group, existing mental or physical illness and social deprivation. This research will use anonymous health records, linked to information on deaths, for around 11 million patients in England. The study will cover the periods before, during and after the peak of the pandemic, including up to August 2020.
The findings will be shared rapidly, with key messages communicated on the study's blog. The research team will also host a webinar to share and discuss findings with local and national suicide prevention team and health services.
- how the pandemic has affected rates of self-harm
- likelihood of being prescribed medication for mental illness and being referred for mental health treatment by GPs for patients who have self-harmed
- risks of further self-harm and suicide
The pandemic has affected people differently so we will examine differences by age group, gender, ethnic group, existing mental or physical illness and social deprivation. This research will use anonymous health records, linked to information on deaths, for around 11 million patients in England. The study will cover the periods before, during and after the peak of the pandemic, including up to August 2020.
The findings will be shared rapidly, with key messages communicated on the study's blog. The research team will also host a webinar to share and discuss findings with local and national suicide prevention team and health services.
Technical Summary
Incidence of self-harm and suicide could increase substantially following the COVID-19 pandemic and subsequent economic downturn. People who have intentionally poisoned or injured themselves have greatly elevated risks of suicide and other causes of premature death. Certain groups are particularly vulnerable, including people of lower socioeconomic position, those with existing health problems and young people.
This proposed research will use nationally-representative, linked, anonymised healthcare data for around 11 million current patients in England as recorded in the Clinical Practice Research Datalink (CPRD). We will examine self-harm incidence rates, subsequent contact with general practice and mental health services, and risks for self-harm repetition and death by suicide and other external causes. The study will cover the periods before, during and after the pandemic's peak, including up to August 2020. Differences by age group, gender, ethnic group, COVID-19 shielding status, mental illness and area-level social deprivation will be examined.
The findings will provide timely and essential evidence for informing suicide prevention strategies, for which people who have already harmed themselves non-fatally are a key focus. This study will provide nationally representative evidence to inform how the pandemic has affected suicidal behaviour and access to clinical services and which groups are at highest risk. The findings will be disseminated rapidly, with key messages communicated openly via the study's blog prior to full academic publication. The investigative team will also host a webinar to share and discuss salient findings with local and national suicide prevention teams, health service commissioners and clinicians.
This proposed research will use nationally-representative, linked, anonymised healthcare data for around 11 million current patients in England as recorded in the Clinical Practice Research Datalink (CPRD). We will examine self-harm incidence rates, subsequent contact with general practice and mental health services, and risks for self-harm repetition and death by suicide and other external causes. The study will cover the periods before, during and after the pandemic's peak, including up to August 2020. Differences by age group, gender, ethnic group, COVID-19 shielding status, mental illness and area-level social deprivation will be examined.
The findings will provide timely and essential evidence for informing suicide prevention strategies, for which people who have already harmed themselves non-fatally are a key focus. This study will provide nationally representative evidence to inform how the pandemic has affected suicidal behaviour and access to clinical services and which groups are at highest risk. The findings will be disseminated rapidly, with key messages communicated openly via the study's blog prior to full academic publication. The investigative team will also host a webinar to share and discuss salient findings with local and national suicide prevention teams, health service commissioners and clinicians.
Publications
Carr MJ
(2021)
Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study.
in The Lancet. Public health
| Description | We conducted a series of epidemiological studies using the nationally representative Clinical Practice Research Datalink and the regional Greater Manchester Care Record, both of which hold electronic health record for large numbers of primary care patients. We utilised these sources to examine whether, and how, the frequency of recorded non-fatal self-harm episodes changed during the COVID-19 pandemic, and we also assessed whether, and how, clinical management of these patients altered during the public health emergency's initial phase in 2020. Summary of Key Findings: In a dataset containing the electronic health records of more than 14 million patients registered at general practices across the four nations of the UK, during April 2020 we observed a large reduction in the frequency of recorded incident self-harm episodes compared with expected rates that were calculated according to what had occurred during the years before the pandemic began. The largest reductions in recorded self-harm frequency were among female patients and those aged below 45 years and in the most deprived practice populations nationally. This heightened and uneven acute unmet need could contribute to causing future increases in mental illness severity and rising rates of self-harm and suicide, thereby widening of pre-existing health inequalities (Carr & Steeg et al. The Lancet Public Health 2021; 6(2): e124-e135. In the population of Greater Manchester, a conurbation that was particularly adversely affected by the pandemic and by the infection containment measures that were implemented, reductions in recorded self-harm episodes in primary care electronic health records persisted through to May 2021, though to a less marked degree than during the first national lockdown during the spring of 2020. This evidence of enduring impact could represent longer-term reluctance to seek help from healthcare services (Steeg et al. eClinicalMedicine 2021; 41: 101175). Although general practices faced difficult and complex challenges in continuing to deliver effective healthcare during the initial phase of the pandemic during the spring of 2020, primary care management of self-harm was broadly similar to the pre-pandemic comparison period in terms of frequencies of psychotropic medication prescribing and clinician consultation observed. Rather surprisingly, and reassuringly, we found no evidence of digital exclusion due to socioeconomic influences during the early pandemic period, in terms of the likelihood of patients consulting remotely with a GP or practice nurse after a self-harm episode (Steeg et al. BMJ Open 2022;12:e052613). |
| Exploitation Route | These findings will inform current and future investigations of population health researchers in the UK and other countries who are seeking to examine the longer-term impact of the COVID-19 pandemic, as well as other subsequent societal stressors such as the 2022-2023 'cost of living crisis' on help seeking and accessibility of healthcare services among people who have harmed themselves. They could also potentially inform public health policy and the planning of effective and efficient healthcare services to ensure that the needs of the individuals, families and communities who are at greatest risk are met. |
| Sectors | Healthcare |
| Description | Our work has contributed to and has been cited in a World Health Organization Scientific Briefing (published on 2 March 2022) on the impact of the COVID-19 pandemic on mental health. |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Citation in other policy documents |
| URL | https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1 |
| Description | Our work was discussed and cited in a report to the UK Parliament in July 2021 'Mental health impacts of the COVID-19 pandemic on adults' |
| Geographic Reach | National |
| Policy Influence Type | Citation in other policy documents |
| URL | https://researchbriefings.files.parliament.uk/documents/POST-PN-0648/POST-PN-0648.pdf |
| Description | The Conversation article |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | An article published in The Conversation with the title 'Fewer people sought help for mental illness during the UK's first lockdown - new research' which had received over 4,000 readers as of 2nd March 2021. |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://theconversation.com/fewer-people-sought-help-for-mental-illness-during-the-uks-first-lockdow... |