COVID-19 and its effect on emergency presentations to a tertiary hospital with self-harm in Ireland

Abstract

Objectives This study aimed to assess the impact of COVID-19 on presentations to an acute hospital with self-harm. Methods All presentations to University Hospital Galway with self-harm were assessed during the peak period of the coronavirus crisis in Ireland, over the three months from 1st March to 31st May 2020. These data were compared with presentations in the same months in the three years preceding (2017-2019). Data were obtained from the anonymised service database. Results This study found that in 2020, the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May. When trends over a four-year period were examined, there was a significantly higher lethality of attempt (p<0.001), and significant differences in diagnosis (p=0.031) in 2020 in comparison with the three previous years. The increased lethality of presentations remained significant after age and gender were controlled for (p=0.036). There were also significant differences in the underlying psychiatric diagnoses(p=0.018), notably with a significant increase in substance misuse disorders presenting during the 2020 study period. Conclusions COVID-19 showed a reduction in self-harm presentations initially, followed by a sharp increase in May 2020. If a period of economic instability follows as predicted, it is likely that this will further impact the mental health of the population, along with rates of self-harm and suicidal behaviours. There is a need for research into the longer-term effect of the restrictions and changes due to Covid-19, especially with respect to self-harm.

Referral patterns for specialist child and adolescent mental health services in the Republic of Ireland during the COVID-19 pandemic compared with 2019 and 2018

“…Presentations with self-harm dropped by 35% from March to April but rose by 104% for adults from April to May. 10 Rates of children attending emergency departments for either medical or mental health presentations also fell during this initial 3-month period (March-May). 11 Reasons for reduced referrals during phase 1 and phase 2 (March-August 2020) There are a number of possible explanations for reduced referrals to CAMHS in early 2020.…”

Hospitalization for self-harm during the early months of the Covid-19 pandemic in France: a nationwide study

“…Data on self-harm are still limited. In one University hospital in Ireland, presentation for self-harm dropped in March-April before rising in April-May 21 . In a trauma center in the UK, an increase in self-harm presentation was observed 22 .…”

“…, Japan (early period) 21 . In a trauma center in the UK, an increase in self-harm presentation was observed 22 .…”

Viewpoint: Investing in strategies to support mental health recovery from the COVID-19 pandemic

“…Demand for mental health services is likely to have been suppressed, partially due to lockdown restrictions, as well as the understandable fear of contracting COVID in healthcare settings. In Ireland, for example, there is evidence that hospital presenting self-harm rates rose markedly after the initial fall at the beginning of the pandemic [6].Much more will be learnt as longer-term data on mental health become available, including for individuals who have been bereaved or are living with long-COVID. However, policy makers and service planners cannot wait for long term impacts to become apparent, they need to formulate policy now to deal with the ongoing impacts of the pandemic and its aftermath over the next few years.…”

“…Demand for mental health services is likely to have been suppressed, partially due to lockdown restrictions, as well as the understandable fear of contracting COVID in healthcare settings. In Ireland, for example, there is evidence that hospital presenting self-harm rates rose markedly after the initial fall at the beginning of the pandemic [6].…”