Substance use and self-harm emergency department presentations during COVID19: evidence from a National Clinical Programme for Self-Harm.

INTRODUCTION: Given the evidence that drinking patterns and self-harm hospital presentations have changed during COVID-19, this study aimed to examine any change in self-harm and suicide-related ideation presentations, together with any possible contribution made by alcohol or substance misuse, to Irish Emergency Departments in 2020, compared with 2018 and 2019. METHODS: A population-based cohort with self-harm and suicide-related ideation presenting to Irish hospitals derived from the National Clinical Programme for Self-Harm was analysed. Descriptive analyses were conducted based on sociodemographic variables and types of presentation for the period January to August 2020 and compared with the same period in 2018 and 2019. Binomial regression analyses were performed to investigate the independent effect of demographic characteristics and pre/during COVID-19 periods on the use of substances as contributory factors in the self-harm and suicide-related ideation presentations. RESULTS: 12,075 presentations due to self-harm and suicide-related ideation were recorded for the periods January-August 2018-2020 across nine emergency departments. The COVID-19 year was significantly associated with substances contributing to self-harm and suicide-related ideation ED presentations (OR = 1.183; 95% CI, 1.075-1.301, p < 0.001). No changes in the demographic characteristics were found for those with self-harm or suicide-related ideation across the years. Suicide-related ideation seemed to be increased after May 2020 compared with previous years. In terms of self-harm episodes with comorbid drug and alcohol overdose and poisoning, these were significantly increased in January-August 2020, compared with previous timepoints (χ2 = 42.424, df = 6, p < 0.001). CONCLUSION: An increase in suicide-related ideation and substance-related self-harm presentations may indicate longer term effects of the pandemic and its relevant restrictions. Future studies might explore whether those presenting with ideation will develop a risk of suicide in post-pandemic periods.

Consulting patterns of children at a general practice during the coronavirus pandemic

Aim We sought to measure the change in the use of the general practitioner (GP) service by paediatric patients of our group practice, following the introduction of pandemic restrictions in March 2020. We aimed to determine the causes for the observed reduced consulting frequency and whether telephone advice is acceptable to parents as an alternative to face-to-face consultation. Methods We interrogated the electronic medical record for a count of surgery and out of hours (OOH) contacts between January 2019 and June 2020. We interviewed 10 parents of children under six years of age as to their reasons for consulting or not at this time. This informed an on-line survey of 108 parents. Results Consulting frequency fell by three quarters from an average of 12 visits/day to 3. OOH visits also declined from an average of 3 to 1/day. Telephone contacts with the GP did not increase. Parents gave a number of reasons for not consulting: absence of illness (90%, 62/69), fear of coronavirus infection (28%,19/69), wishing to protect the front-line service (21%,14/68) availability of a parent to monitor a sick child (20%,13/66) Many parents (73%, 74/102) wished to continue to avail of telephone triage following the ending of pandemic restrictions. Conclusion Much of the consulting of children at our surgery relates to infective illness. Telephone triage for children with minor illness is welcomed by parents.