Primary care clinical management following self-harm during the first wave of COVID-19 in the UK: population-based cohort study
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Abstract
A substantial reduction in self-harm recorded in primary care occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown. Our objectives were to examine the impact of COVID-19 on clinical management within 3 months of an episode of self-harm.
Design
Retrospective cohort study.
Setting
UK primary care.
Participants
4238 patients with an index episode of self-harm recorded in UK primary care during the COVID-19 first-wave period (10 March 2020–10 June 2020) compared with 48 739 patients in a prepandemic comparison period (10 March-10 June, 2010-2019).
Outcome measures
Using data from the UK Clinical Practice Research Datalink, we compared cohorts of patients with an index self-harm episode recorded during the prepandemic period versus the COVID-19 first-wave period. Patients were followed up for 3 months to capture subsequent general practitioner (GP)/practice nurse consultation, referral to mental health services and psychotropic medication prescribing. We examined differences by gender, age group and Index of Multiple Deprivation quintile.
Results
Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (4.2%) was around two-thirds of that in the prepandemic cohort (6.1%). Similar proportions were prescribed psychotropic medication within 3 months in the prepandemic (54.0%) and COVID-19 first-wave (54.9%) cohorts.
Conclusions
Despite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to prepandemic levels. We found no evidence of widening of digital exclusion in terms of access to remote consultations. However, the reduced likelihood of referral to mental health services warrants attention. Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.
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SciScore for 10.1101/2021.03.19.21253969: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IACUC: The study was approved by the Independent Scientific Advisory Committee (protocol number 20_001RA2). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources The GOLD database is extracted from the Vision® system, with most of its contributing general practices based in Northern Ireland, Scotland and Wales. GOLDsuggested: (GOLD, RRID:SCR_000188)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 …SciScore for 10.1101/2021.03.19.21253969: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IACUC: The study was approved by the Independent Scientific Advisory Committee (protocol number 20_001RA2). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources The GOLD database is extracted from the Vision® system, with most of its contributing general practices based in Northern Ireland, Scotland and Wales. GOLDsuggested: (GOLD, RRID:SCR_000188)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:Strengths and limitations: The main strength of our study is the broadly representative data source that included a large number of general practices across the UK. CPRD Aurum is broadly representative of geographical coverage, area-level deprivation, age, and sex in England 16 while CPRD GOLD dataset is broadly representative of the UK age and sex profile.17 This enables us to make inferences at national level about how the pandemic affected primary care clinical management of patients who have self-harmed. However, there are some limitations in utilising anonymised primary care records. The data are extracted from GP information systems and their accuracy is determined by the quality of the information inputted by contributing practices. Some of the self-harm episodes recorded in primary care would have been emergency department presentations that were subsequently added to the patient’s primary care record. Future research using linked Hospital Episode Statistics will enable separate examination of emergency department self-harm presentations. Finally, we were unable to examine referrals to mental health services in England due to limitations to the CPRD Aurum dataset. Comparison with existing literature: Previous research found that reductions in help-seeking were greatest among patients registered at practices located in more deprived areas.4 Our study found that patients at practices in the two most deprived quintiles who did seek help had similar rates of psychotropic ...
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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