The impact of the UK’s first COVID-19 lockdown on rates of violence and aggression on psychiatric inpatient wards
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Abstract
Aims
Inpatient life in UK mental health hospitals was profoundly altered during the first wave of the COVID-19 pandemic. We analysed whether these changes impacted the rate of violent and aggressive incidents across acute adult wards and psychiatric intensive care units in a South London NHS Mental Health Trust during the first UK lockdown.
Methods
We used an interrupted time series analysis to assess whether the rate of violent and aggressive incidents changed during the lockdown period from 23rd March 2020 to 15th June 2020. We used a quasi-poisson general additive model to model the weekly rate of violent incidents as a function of a seasonal trend, time trend, and impact of lockdown, using data from 1 st January 2017 to 27 th September 2020.
Results
There was a 35% increase in the rate of incidents of violence and aggression [IR = 1.35, 95% CI: 1.15 – 1.58, p < 0.001] between March 23rd 2020 and June 15th 2020. In addition, there was strong evidence of temporal (p < 0.001) and seasonal trends (p < 0.001).
Conclusions
Our results suggest that restrictions to life increased the rate of violent incidents on the mental health wards studied here.
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SciScore for 10.1101/2021.03.10.21253244: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. 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:Our study has a number of limitations. First of all, there were myriad changes to inpatient life in addition to a likely increase in levels of anxiety due to the threat and uncertainty of the pandemic. There were also likely …
SciScore for 10.1101/2021.03.10.21253244: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. 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:Our study has a number of limitations. First of all, there were myriad changes to inpatient life in addition to a likely increase in levels of anxiety due to the threat and uncertainty of the pandemic. There were also likely differences in how strongly the guidelines were applied, given the realities of managing a ward. Our study does not tease these complexities apart to show which factors, if any, increased the rate of violence. Secondly, while we adjusted for seasonal and temporal trends, we did not control for factors pertaining to the composition of the inpatient population that could be associated with the increased rate of violence. A systematic review and meta-analysis found that factors such as a diagnosis of schzophrenia, involuntary admission, a history of alcohol abuse, and a history of violence are associated with higher levels of violence (Lozzino et al., 2015). In response to the pandemic, there was a rapid discharge of psychiatric inpatients, with 2241 more psychiatric inpatients being discharged in March 2020 as compared to February 2020 (Mind, 2020). If inpatients with the lowest levels of risk were discharged during this process, the composition of inpatients would shift towards one exhibiting a higher prevalence of risk factors. This could mean it was not necessarily changes to the ward environment that increased the rate of violence, but rather the fact that more of the remaining inpatients were higher risk and thus the number of incidents relative to occ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
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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