The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review

  1. Sarah Steeg
  2. Ann John
  3. David J. Gunnell
  4. Nav Kapur
  5. Dana Dekel
  6. Lena Schmidt
  7. Duleeka Knipe
  8. Ella Arensman
  9. Keith Hawton
  10. Julian P. T. Higgins
  11. Emily Eyles
  12. Catherine Macleod-Hall
  13. Luke A. McGuiness
  14. Roger T. Webb

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Abstract

Evidence on the impact 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 presentations to health services following self-harm during the COVID-19 pandemic.

Method

A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool.

Results

Fifty-one studies were included: 57% (29/51) were rated as ‘low’ quality, 31% (16/51) as ‘moderate’ and 12% (6/51) as ‘high-moderate’. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six 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 three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls.

Conclusions

Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.

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  1. Version published to 10.1192/bjp.2022.79
  2. ScreenIT

    SciScore for 10.1101/2022.01.26.22269901: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    12 This database is updated automatically using daily electronic searches of multiple databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) (see Supplement 2 for search strategy for each database).
    PubMed
    suggested: (PubMed, RRID:SCR_004846)

    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: This systematic review is the first to examine up-to-date evidence regarding associations between the COVID-19 pandemic and frequency of health service utilisation for self-harm. An established, peer-reviewed living systematic review methodology, 11 with ongoing data extraction by a panel of suicide prevention experts, was used as the basis for this review. This approach, along with a specific focus on studies comparing frequency in utilisation of health services following self-harm in different settings during the COVID-19 pandemic versus antecedent pre-pandemic periods, enables timely synthesis of the evolving evidence base. The findings of our study should be interpreted with some important caveats in mind. We excluded 6 studies that reported self-harm and suicidal thoughts as a combined measure as it was not possible to make a like-for-like comparison with findings pertaining specifically to acts of self-harm. However, we included studies using a broad range of definitions of self- harm, including those that measured and reported on suicide attempts or self-poisoning methods only. We also did not include temporal trends in the proportion of all presentations that were for self-harm as a primary outcome, due to the limitation that this outcome would be affected by changes in the overall number of presentations for reasons other than self- harm. We conducted a comprehensive narrative synthesis of the data rather than a meta-analysis due to heterog...

    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.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2022.01.26.22269901v1 on medRxiv