Inequalities in children’s mental health care: analysis of routinely collected data on prescribing and referrals to secondary care (preprint)

Introduction One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. The COVID-19 pandemic appears to have exacerbated this issue. Prevalence of poor mental health is not evenly distributed across age-groups, by sex or socioeconomic groups. Equity in access to mental health care is a policy priority but relatively under-researched. Methods We linked previously unlinked records for all mental health prescriptions and referrals to specialist mental health outpatient care between the years of 2015 and 2021 for children aged 2 to 17 years in a single NHS Scotland health board region. We analysed trends in prescribing, referrals, and acceptance to out-patient treatment over time, and measured differences in treatment and service use rates by age, sex, and area deprivation. Results We identified 18,732 children with 178,657 mental health prescriptions and 21,874 referrals to specialist outpatient care. Prescriptions increased by 59% over the study period. Boys received double the prescriptions of girls and the rate of prescribing in the most deprived areas was double that in the least deprived. Referrals increased 9% overall. Initially, boys and girls both had an annual referral rate of 2.7 per 1,000, but this fell 6% for boys and rose 25% for girls. Referral rate for the youngest decreased 67% but increased 21% for the oldest. The proportion of rejected referrals increased steeply since 2020 from 17% to 30%. The proportion of referrals accepted for girls rose to 62% and the mean age increased 1.5 years. Discussion The large increase in mental health prescribing and changes in referrals to specialist outpatient care aligns with emerging evidence of increasing poor mental health, particularly since the start of the COVID-19 pandemic. The static size of the population accepted for specialist treatment amid greater demand, and the changing demographics of those accepted, indicate clinical prioritisation and unmet need.

Public acceptability of non-pharmaceutical interventions to control a pandemic in the United Kingdom: a discrete choice experiment (preprint)

Objective To understand how individuals make trade-offs between features of lockdown interventions to control a pandemic across the four nations of the United Kingdom. Design Survey that included a Discrete Choice Experiment (DCE). The survey design was informed using policy documents, social media analysis and with input from remote think aloud interviews with members of the public (n=23). Setting Nation-wide survey across the four nations of the United Kingdom. Representative sample in terms of age and sex for each of the nations recruited using an online panel between 29th October and 12th December 2020. Participants Individuals who are over 18 years old. A total of 4120 adults completed the survey (1112 in England, 848 in Northern Ireland, 1143 in Scotland and 1098 in Wales). Primary outcome measure Adult preferences for, and trade-offs between, type of lockdown restrictions, length of lockdown, postponement of routine healthcare, excess deaths, impact on ability to buy things and unemployment. Results In all four countries, one out of five respondents were willing to reduce excess deaths at all costs. The majority of adults are willing to accept higher excess deaths if this means lockdowns that are less strict, shorter and do not postpone routine healthcare. On average, respondents in England were willing to accept a higher increase in excess deaths to have less strict lockdown restrictions introduced compared to Scotland, Northern Ireland, and Wales, respectively. Conclusions The majority of the UK population is willing to accept the increase in excess deaths associated with introducing less strict lockdown restrictions. The acceptability of different restriction scenarios varies according to the features of the lockdown and across countries. Authorities can use information about trade-off preferences to inform the introduction of different lockdown restriction levels, and design compensation policies that maximise societal welfare.

Population birth outcomes in 2020 and experiences of expectant mothers during the COVID-19 pandemic: a Born in Wales mixed methods study using routine data (preprint)

BackgroundPregnancy can be a stressful time and the COVID-19 pandemic has affected all aspects of life. This study aims to investigate the impact of the pandemic on population birth outcomes in Wales, rates of primary immunisations and examine expectant mothers experiences of pregnancy including self-reported levels of stress and anxiety. MethodsPopulation-level birth outcomes in Wales: Stillbirths, prematurity, birth weight and Caesarean section births before (2016-2019) and during (2020) the pandemic were compared using national-level routine anonymised data held in the Secure Anonymised Information Linkage (SAIL) Databank. The first three scheduled primary immunisations were compared between 2019 and 2020. Self-reported pregnancy experience: 215 expectant mothers (aged 16+) in Wales completed an online survey about their experiences of pregnancy during the pandemic. The qualitative survey data was analysed using codebook thematic analysis. FindingsThere was no significant difference between annual outcomes including gestation and birth weight, stillbirths, and Caesarean sections for infants born in 2020 compared to 2016-2019. There was an increase in late term births ([≥]42 weeks gestation) during the first lockdown (OR: 1.28, p=0.019) and a decrease in moderate to late preterm births (32-36 weeks gestation) during the second lockdown (OR: 0.74, p=0.001). Fewer babies were born in 2020 (N=29,031) compared to 2016-2019 (average N=32,582). All babies received their immunisations in 2020, but there were minor delays in the timings of vaccines. Those due at 8-weeks were 8% less likely to be on time (within 28-days) and at 16-weeks, they were 19% less likely to be on time. The pandemic had a negative impact on the mental health of 71% of survey respondents, who reported anxiety, stress and loneliness; this was associated with attending scans without their partner, giving birth alone, and minimal contact with midwives. InterpretationThe pandemic had a negative impact on mothers experiences of pregnancy; however, population-level data suggests that this did not translate to adverse birth outcomes for babies born during the pandemic.