Healthcare contacts with self-harm during COVID-19: An e-cohort whole-population-based study using individual-level linked routine electronic health records in Wales, UK, 2016—March 2021

  1. M. DelPozo-Banos
  2. S. C. Lee
  3. Y. Friedmann
  4. A. Akbari
  5. F. Torabi
  6. K. Lloyd
  7. R. A. Lyons
  8. A. John

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Abstract

Reduced rates of help seeking by those who self-harmed during the COVID-19 pandemic have been reported.

Objectives

To understand changes in healthcare service contacts for self-harm during the COVID-19 pandemic across primary, emergency and secondary care.

Methods

This retrospective cohort study used routine electronic healthcare data for Wales, United Kingdom, from 2016 to March 14, 2021. Population-based data from primary care, emergency departments and hospital admissions were linked at individual-level. All Welsh residents aged ≥10 years over the study period were included in the study. Primary, emergency and secondary care contacts with self-harm at any time between 2016 and March 14, 2021 were identified. Outcomes were counts, incidence, prevalence and proportion of self-harm contacts relative to all contacts in each and all settings, as well as the proportion of people contacting one or more settings with self-harm. Weekly trends were modelled using generalised estimated equations, with differences between 2020 (to March 2021) and comparison years 2016–2018 (to March 2017–2019) quantified using difference in differences, from which mean rate of odds ratios (μROR) across years was reported.

Results

The study included 3,552,210 individuals over the study period. Self-harm contacts reduced across services in March and December 2020 compared to previous years. Primary care contacts with self-harm reduced disproportionately compared to non-self-harm contacts (μROR = 0.7, p<0.05), while their proportion increased in emergency departments during April 2020 (μROR = 1.3, p<0.05 in 2/3 comparison years) and hospital admissions during April-May 2020 (μROR = 1.2, p<0.05 in 2/3 comparison years). Despite this, those who self-harmed in April 2020 were more likely to be seen in primary care than other settings compared to previous years (μROR = 1.2, p<0.05). A lower proportion of those with self-harm contacts in emergency departments were subsequently admitted to hospital in December 2020 compared to previous years (μROR = 0.5, p<0.05).

Conclusions

These findings suggest that those who self-harmed during the COVID-19 pandemic may have been less likely to seek help, and those who did so faced more stringent criteria for admission. Communications encouraging those who self-harm to seek help during pandemics may be beneficial. However, this needs to be supported by maintained provision of mental health services.

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  1. Version published to 10.1371/journal.pone.0266967
  2. ScreenIT

    SciScore for 10.1101/2021.08.13.21261861: (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.
    RandomizationSelf-harm and COVID-19 infection association: To study the association between COVID-19 and self-harm, we defined an index date as the first date of COVID-19 infection or a random date between 28 February 2020 and 27 August 2020 for those not infected.
    Blindingnot detected.
    Power Analysisnot detected.
    Cell Line AuthenticationAuthentication: 20 From these, we identified self-harm contacts using validated code lists.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    , Consolidated Deaths Data Source, Wales Longitudinal General Practice (WLGP – covering 80%, i.e. 330/412, of all general practices in Wales), Emergency Department Data Set, Patient Episode Database for Wales (PEDW), Critical Care Dataset, Welsh Laboratory Information Systems (PATD) containing both COVID-19 polymerase chain reaction (PCR)/antigen tests (pillars 1 and 2) and serology/antibodies tests (pillar 3) results,14 the care homes data containing geographic information data on care homes, a list of COVID-19 shielded persons who are identified as clinically extremely vulnerable and advised to self-isolate during the pandemic,15 and the UK Census 2011 data.
    Welsh Laboratory Information Systems
    suggested: None
    We used Python (www.python.org/) to represent the results.
    Python
    suggested: (IPython, RRID:SCR_001658)
    All statistical analyses were performed using R (www.r-project.org) and Stata version 16.1 (StataCorp. 2019).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    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 10.1101/2021.08.13.21261861v1 on medRxiv