Causes of death in mental health service users during the first wave of the COVID-19 pandemic: South London and Maudsley data from March to June 2020, compared with 2015-2019
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Abstract
The COVID-19 pandemic is likely to have had a particularly high impact on the health and wellbeing of people with pre-existing mental disorders. This may include higher than expected mortality rates due to severe infections themselves, due to other comorbidities, or through increased suicide rates during lockdown. However, there has been very little published information to date on causes of death in mental health service users. Taking advantage of a large mental healthcare database linked to death registrations, we describe numbers of deaths within specific underlying-cause-of-death groups for the period from 1 st March to 30 th June in 2020 and compare these with the same four-month periods in 2015-2019. In past and current service users, there were 2561 deaths in March-June 2020, compared to an average of 1452 for the same months in 2015-19: an excess of 1109. The 708 deaths with COVID-19 as the underlying cause in 2020 accounted for 63.8% of that excess. The remaining excess was accounted for by unnatural/unexplained deaths and by deaths recorded as due to neurodegenerative conditions, with no excess in those attributed to cancer, circulatory disorders, digestive disorders, respiratory disorders, or other disease codes. Of 295 unexplained deaths in 2020 with missing data on cause, 162 (54.9%) were awaiting a formal death notice (i.e. the group that included deaths awaiting a coroner’s inquest) – an excess of 129 compared to the average of previous years, accounting for 11.6% of the excess in total deaths.
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SciScore for 10.1101/2020.10.25.20219071: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: CRIS has received approval as a data source for secondary analyses (Oxford Research Ethics Committee C, reference 18/SC/0372). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Considering limitations, it is important to bear in mind that the data are derived from a single site. …
SciScore for 10.1101/2020.10.25.20219071: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: CRIS has received approval as a data source for secondary analyses (Oxford Research Ethics Committee C, reference 18/SC/0372). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Considering limitations, it is important to bear in mind that the data are derived from a single site. Because complete data are being provided for that site with no hypothetical source population intended, calculation of confidence intervals was not felt to be appropriate for the descriptive data provided in this report; applicability to other mental healthcare providers cannot therefore be inferred and would need specific investigation. We additionally aim to provide further analysed output on mortality trends and predictors in future submissions for peer-reviewed publications. Data stratifications were relatively broad, pragmatically driven by the need for sufficiently large group sizes. For example, the conflation of ethnic groups into the categories defined here is inevitably approximate and may fail to reflect varying experiences between constituent groups. Finally, the way in which ‘active’ service users were defined for stratification might have weighted the profile of deaths in this group towards those occurring later in each March-June period, of potential relevance to 2020 mortality if this altered across the first wave of the pandemic.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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