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1.
Br J Health Psychol ; 2022 Apr 13.
Article in English | MEDLINE | ID: covidwho-1799275

ABSTRACT

OBJECTIVES: This study aimed to (1) examine barriers and enablers to General Practitioners' (GP) use of National Institute for Health and Care Excellence (NICE) guidelines for self-harm and (2) recommend potential intervention strategies to improve implementation of them in primary care. DESIGN: Qualitative interview study. METHODS: Twenty-one telephone interviews, semi-structured around the capabilities, opportunities and motivations model of behaviour change (COM-B), were conducted with GPs in the United Kingdom. The Theoretical Domains Framework was employed as an analytical framework. Using the Behaviour Change Wheel, Behaviour Change Techniques (BCTs), intervention functions and exemplar interventions were identified. RESULTS: GPs valued additional knowledge about self-harm risk assessments (knowledge), and communication skills were considered to be fundamental to high-pressure consultations (cognitive and interpersonal skills). GPs did not engage with the guidelines due to concerns that they would be a distraction from patient cues about risk during consultations (memory, attention and decision processes), and perceptions that following the guidance is difficult due to time pressures and lack of access to mental health referrals (environmental context and resources). Clinical uncertainty surrounding longer term care for people that self-harm, particularly patients that are waiting for or cannot access a referral, drives GPs to rely on their professional judgement over the guidance (beliefs about capabilities). CONCLUSIONS: Three key drivers related to information and skill needs, guideline engagement and clinical uncertainty need to be addressed to support GPs to be able to assess and manage self-harm. Five intervention functions and ten BCT groups were identified as potential avenues for intervention design.

2.
ProQuest Central;
Preprint in English | ProQuest Central | ID: ppcovidwho-328222

ABSTRACT

Background: The COVID-19 pandemic has caused considerable morbidity, mortality and disruption to people’s lives around the world. There are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review synthesises findings from emerging literature on incidence and prevalence of suicidal behaviour as well as suicide prevention efforts in relation to COVID-19, with this iteration synthesising relevant evidence up to 19 th October 2020. Method:  Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. We exclude one-off cross-sectional studies without either pre-pandemic measures or comparisons of COVID-19 positive vs. unaffected individuals. Results: Searches identified 6,226 articles. Seventy-eight articles met our inclusion criteria. We identified a further 64 relevant cross-sectional studies that did not meet our revised inclusion criteria. Thirty-four articles were not peer-reviewed (e.g. research letters, pre-prints). All articles were based on observational studies. There was no consistent evidence of a rise in suicide but many studies noted adverse economic effects were evolving. There was evidence of a rise in community distress, fall in hospital presentation for suicidal behaviour and early evidence of an increased frequency of suicidal thoughts in those who had become infected with COVID-19. Conclusions:  Research evidence of the impact of COVID-19 on suicidal behaviour is accumulating rapidly. This living review provides a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide risk as the longer term impacts of the pandemic on suicide risk are researched.

3.
EuropePMC;
Preprint in English | EuropePMC | ID: ppcovidwho-327188

ABSTRACT

Background Evidence on the impacts of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. Aims To systematically review evidence on health services utilisation for self-harm during the COVID-19 pandemic. Methods A comprehensive search of multiple databases (WHO COVID-19 database;Medline;medRxiv;Scopus;PsyRxiv;SocArXiv;bioRxiv;COVID-19 Open Research Dataset, PubMed) was conducted. Studies reporting presentation frequencies for self-harm published from 1 st Jan. 2020 to 7 th Sept. 2021 were included. Study quality was assessed using a critical appraisal tool. Results Fifty-one studies were included. 59% (30/51) were rated as ‘low’ quality, 29% (15/51) as ‘moderate’ and 12% (6/51) as ‘high-moderate’. Most evidence (84%, 43/51 studies) was from high-income countries. 47% (24/51) of studies reported reductions in presentation frequency, including all 6 rated as high-moderate quality, which reported reductions of 17- 56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the 3 higher quality studies including study observation months from 2021 reported reductions in service utilisation. Evidence from 2021 suggested increased use of health services following self-harm among adolescents, particularly girls. Conclusions Sustained reductions in service utilisation were seen into the first half of 2021. However, evidence from low- and middle-income countries is lacking. The increased use of health services among adolescents, particularly girls, into 2021 is of concern. Our findings may reflect changes in thresholds for help seeking, use of alternative sources of support and variable effects of the pandemic across different groups.

4.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-307789

ABSTRACT

Background: The Covid-19 pandemic has adversely affected population mental health.Methods: Using electronic health records from 1714 UK general practices registered with the Clinical Practice Research Datalink we examined incidence and event rates of depression and anxiety disorders, self-harm, prescriptions for antidepressants and benzodiazepines and GP referrals to mental health services per 100,000 person-months, before, during and after the peak of the Covid-19 emergency. Analyses were stratified by gender, age group and practice-level Index of Multiple Deprivation quintile.Findings: In April 2020, primary care-recorded incident depression reduced by 43·6% (95% CI 39·0% to 47·9%), anxiety disorders by 48·2% (CI 44·6% to 51·5%) and antidepressant prescribing by 36·2% (CI 33·7% to 38·6%) compared to expected rates based on prior trends. Reductions in first diagnoses of depression and anxiety disorders were particularly stark for working-age adults and patients registered at practices in more deprived areas. Self-harm incidence was 38·5% (CI 35·7% to 41·3%) lower than expected in April 2020. Total self-harm contacts fell by 28·2% (CI 25·5% to 30·8%). Rates of both incident and any self-harm remained around thirty percent lower than expected up to June 2020. Interpretation: Our findings reveal a stark treatment gap that was greater for first diagnoses of depression and anxiety disorders in working age adults, for practice populations in deprived areas, and for self-harm. Consequences could include more patients subsequently presenting with greater acuity and severity of mental illness and rising rates of non-fatal self-harm and suicide. Funding: This work was funded by the National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, UK Research and Innovation/Medical Research Council COVID-19 Rapid Response Initiative funding and by a University of Manchester Presidential Fellowship (SS). CC-G received funding from the NIHR Applied Research Collaboration West Midlands. Declaration of Interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work;no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.Ethics Approval Statement: This study is based on data from the Clinical Practice Research Datalink obtained under license from the UK Medicines and Healthcare products Regulatory Agency. The study was approved by the Independent Scientific Advisory Committee for Clinical Practice Research Datalink research (protocol number 20_094R1).

5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-305685

ABSTRACT

Background: There are concerns that the COVID-19 pandemic may lead to an increase in suicide. The coronial system in England is not suitable for close monitoring of suicide because of the frequent gap of several months before inquests are held. Methods: We used data from established systems of "real time surveillance" (RTS) of suspected suicides, in areas covering a total population of around 13 million, to examine for any increase after the first national lockdown in England. Outcomes: The average monthly number of suicides in the months before lockdown, January-March 2020, was 125·7, compared to 121·3 in April-October 2020 (-4%;95% CI -19% to 13%, p=0·59). Incidence rate ratios did not rise significantly in individual months after lockdown began and were not raised during the 2-month lockdown period April-May 2020 or the 5-month period after the easing of lockdown, June-October 2020 (IRR: 1·00 [0·8-1·25] and 0·94 [0·81-1·08]). Comparison of the suicide rates after lockdown in 2020 for the same months in selected areas in 2019 showed no difference. Interpretation: We did not find a rise in suicide in England in the months after the first national lockdown began in 2020, despite evidence of greater distress. However, a number of caveats should be noted. These are early figures and may change. Any effect of the pandemic may vary by population group or geographical area. The use of RTS in this way is new and further development is needed before it can provide full national data. Funding: The study was carried out as part of the role of the National Confidential Inquiry into Suicide and Safety in Mental Health in supporting suicide prevention in England, funded by NHS England/NHS Improvement.Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: LA chairs the National Suicide Prevention Strategy Advisory Group (NSPSAG) at the Department of Health and Social Care in England;NK is a member of the Group, chaired the guideline development group for the 2012 National Institute for Health and Clinical Excellence (NICE) guidelines on the longer-term management of self-harm, currently chairs the guideline development group for the NICE depression in adults’ guidelines, is currently the topic advisor on the new NICE guideline on self-harm, and reports grants from the Department of Health and Social Care, National Institute of Health Research and NICE. All authors work with NHS England on the National Quality Improvement initiatives for suicide and self-harm. LA, NK, and PT report grants from the Health Quality Improvement Partnership.

6.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-313480

ABSTRACT

Background: The COVID-19 pandemic has caused widespread morbidity and mortality as well as disruption to people’s lives and livelihoods around the world;this has occurred as a result of both infection with the virus itself and the health protection measures taken to curb its spread. There are concerns that rates of suicide, suicidal behaviours and self-harm may rise during and in the aftermath of the pandemic. Given the likely rapidly expanding research evidence base on the pandemic’s impact on rates of suicide, suicidal behaviours and self-harm and emerging evidence about how best to mitigate such effects, it is important that the best available knowledge is made readily available to policymakers, public health specialists and clinicians as soon as is possible. To facilitate this, we plan to undertake a living systematic review focusing on suicide prevention in relation to COVID-19. Method: Regular automated searches will feed into a web-based screening system which will also host the data extraction form for included articles. Our eligibility criteria are wide and include aspects of incidence and prevalence of suicidal behaviour, effects of exposures and effects of interventions in relation to the COVID-19 pandemic, with minimal restrictions on the types of study design to be included. The outcomes assessed will be death by suicide;self-harm or attempted suicide (including hospital attendance and/or admission for these reasons);and suicidal thoughts/ideation. There will be no restriction on study type, except for single case reports. There will be no restriction on language of publication. The review will be updated at three-monthly intervals if a sufficient volume of new evidence justifies doing so. Conclusions: Our living review will provide a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide. Protocol registration: PROSPERO CRD42020183326 01/05/2020

7.
J Affect Disord Rep ; 6: 100271, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1531514

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had an impact on the mental health of healthcare and social care workers, and its potential effect on suicidal thoughts and behaviour is of particular concern. METHODS: This systematic review identified and appraised the published literature that has reported on the impact of COVID-19 on suicidal thoughts and behaviour and self-harm amongst healthcare and social care workers worldwide up to May 31, 2021. RESULTS: Out of 37 potentially relevant papers identified, ten met our eligibility criteria. Our review has highlighted that the impact of COVID-19 has varied as a function of setting, working relationships, occupational roles, and psychiatric comorbidities. LIMITATIONS: There have been no completed cohort studies comparing pre- and post-pandemic suicidal thoughts and behaviours. It is possible some papers may have been missed in the search. CONCLUSIONS: The current quality of evidence pertaining to suicidal behaviour in healthcare workers is poor, and evidence is entirely absent for those working in social care. The clinical relevance of this work is to bring attention to what evidence exists, and to encourage, in practice, proactive approaches to interventions for improving healthcare and social care worker mental health.

8.
EClinicalMedicine ; 41: 101175, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1487700

ABSTRACT

BACKGROUND: Surveillance of temporal trends in clinically treated self-harm is an important component of suicide prevention in the dynamic context of COVID-19. There is little evidence beyond the initial months following the onset of the pandemic, despite national and regional restrictions persisting to mid-2021. METHODS: Descriptive time series analysis utilizing de-identified, primary care health records of 2.8 million patients from the Greater Manchester Care Record. Frequencies of self-harm episodes between 1st January 2019 and 31st May 2021 were examined, including stratification by sex, age group, ethnicity, and index of multiple deprivation quintile. FINDINGS: There were 33,444 episodes of self-harm by 13,148 individuals recorded during the study period. Frequency ratios of incident and all episodes of self-harm were 0.59 (95% CI 0.51 to 0.69) and 0.69 (CI 0.63 to 0.75) respectively in April 2020 compared to February 2020. Between August 2020 and May 2021 frequency ratios were 0.92 (CI 0.88 to 0.96) for incident episodes and 0.86 (CI 0.84 to 0.88) for all episodes compared to the same months in 2019. Reductions were largest among men and people living in the most deprived neighbourhoods, while an increase in all-episode self-harm was observed for adolescents aged 10-17. INTERPRETATION: Reductions in primary care-recorded self-harm persisted to May 2021, though they were less marked than in April 2020 during the first national lockdown. The observed reductions could represent longer term reluctance to seek help from health services. Our findings have implications for the ability for services to offer recommended care for patients who have harmed themselves.

9.
Lancet Reg Health Eur ; 4: 100110, 2021 May.
Article in English | MEDLINE | ID: covidwho-1193423

ABSTRACT

BACKGROUND: There have been concerns that the COVID-19 pandemic may lead to an increase in suicide. The coronial system in England is not suitable for timely monitoring of suicide because of the delay of several months before inquests are held. METHODS: We used data from established systems of "real time surveillance" (RTS) of suspected suicides, in areas covering a total population of around 13 million, to test the hypothesis that the suicide rate rose after the first national lockdown began in England. FINDINGS: The number of suicides in April-October 2020, after the first lockdown began, was 121•3 per month, compared to 125•7 per month in January-March 2020 (-4%; 95% CI-19% to 13%, p = 0•59). Incidence rate ratios did not show a significant rise in individual months after lockdown began and were not raised during the 2-month lockdown period April-May 2020 (IRR: 1•01 [0•81-1•25]) or the 5-month period after the easing of lockdown, June-October 2020 (0•94 [0•81-1•09]). Comparison of the suicide rates after lockdown began in 2020 for the same months in selected areas in 2019 showed no difference. INTERPRETATION: We did not find a rise in suicide rates in England in the months after the first national lockdown began in 2020, despite evidence of greater distress. However, a number of caveats apply. These are early figures and may change. Any effect of the pandemic may vary by population group or geographical area. The use of RTS in this way is new and further development is needed before it can provide full national data. FUNDING: This study was funded by the Healthcare Quality Improvement Partnership (HQIP).The HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programs and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage, and develop the National Clinical Audit and Patient Outcomes Program (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The program is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations, and crown dependencies.

10.
Lancet Public Health ; 6(2): e124-e135, 2021 02.
Article in English | MEDLINE | ID: covidwho-1118741

ABSTRACT

BACKGROUND: The COVID-19 pandemic has adversely affected population mental health. We aimed to assess temporal trends in primary care-recorded common mental illness, episodes of self-harm, psychotropic medication prescribing, and general practitioner (GP) referrals to mental health services during the COVID-19 emergency in the UK. METHODS: We did a population-based cohort study using primary care electronic health records from general practices registered on the UK Clinical Practice Research Datalink (CPRD). We included patient records from Jan 1, 2010, to Sept 10, 2020, to establish long-term trends and patterns of seasonality, but focused primarily on the period January, 2019-September, 2020. We extracted data on clinical codes entered into patient records to estimate the incidence of depression and anxiety disorders, self-harm, prescriptions for antidepressants and benzodiazepines, and GP referrals to mental health services, and assessed event rates of all psychotropic prescriptions and self-harm. We used mean-dispersion negative binomial regression models to predict expected monthly incidence and overall event rates, which were then compared with observed rates to assess the percentage reduction in incidence and event rates after March, 2020. We also stratified analyses by sex, age group, and practice-level Index of Multiple Deprivation quintiles. FINDINGS: We identified 14 210 507 patients from 1697 UK general practices registered in the CPRD databases. In April, 2020, compared with expected rates, the incidence of primary care-recorded depression had reduced by 43·0% (95% CI 38·3-47·4), anxiety disorders by 47·8% (44·3-51·2), and first antidepressant prescribing by 36·4% (33·9-38·8) in English general practices. Reductions in first diagnoses of depression and anxiety disorders were largest for adults of working age (18-44 and 45-64 years) and for patients registered at practices in more deprived areas. The incidence of self-harm was 37·6% (34·8-40·3%) lower than expected in April, 2020, and the reduction was greatest for women and individuals aged younger than 45 years. By September, 2020, rates of incident depression, anxiety disorder, and self-harm were similar to expected levels. In Northern Ireland, Scotland, and Wales, rates of incident depression and anxiety disorder remained around a third lower than expected to September, 2020. In April, 2020, the rate of referral to mental health services was less than a quarter of the expected rate for the time of year (75·3% reduction [74·0-76·4]). INTERPRETATION: Consequences of the considerable reductions in primary care-recorded mental illness and self-harm could include more patients subsequently presenting with greater severity of mental illness and increasing incidence of non-fatal self-harm and suicide. Addressing the effects of future lockdowns and longer-term impacts of economic instability on mental health should be prioritised. FUNDING: National Institute for Health Research and Medical Research Council.


Subject(s)
COVID-19/psychology , Mental Disorders/therapy , Primary Health Care/statistics & numerical data , Self-Injurious Behavior/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Cohort Studies , Databases, Factual , Female , Humans , Incidence , Male , Mental Disorders/epidemiology , Middle Aged , Self-Injurious Behavior/epidemiology , United Kingdom/epidemiology , Young Adult
12.
Br J Psychiatry ; 217(6): 663-664, 2020 12.
Article in English | MEDLINE | ID: covidwho-947949

ABSTRACT

This editorial considers whether the quality of care for people who present to clinical services in the UK following self-harm has improved or stagnated. Some real progress has been made in the areas of service provision and research, and self-harm has never had a higher priority in policy terms. However, major gaps remain. We need to enhance people's experience of services and improve access to high-quality assessment and aftercare.


Subject(s)
Self-Injurious Behavior , Humans , Self-Injurious Behavior/therapy
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