COVID-19 collateral: Indirect acute effects of the pandemic on physical and mental health in the UK

Abstract

Background: Concerns have been raised that the response to the UK COVID-19 pandemic may have worsened physical and mental health, and reduced use of health services. However, the scale of the problem is unquantified, impeding development of effective mitigations. We asked what has happened to general practice contacts for acute physical and mental health outcomes during the pandemic? Methods: Using electronic health records from the Clinical Research Practice Datalink (CPRD) Aurum (2017-2020), we calculated weekly primary care contacts for selected acute physical and mental health conditions (including: anxiety, depression, acute alcohol-related events, asthma and chronic obstructive pulmonary disease [COPD] exacerbations, cardiovascular and diabetic emergencies). We used interrupted time series (ITS) analysis to formally quantify changes in conditions after the introduction of population-wide restrictions ('lockdown') compared to the period prior to their introduction in March 2020. Findings: The overall population included 9,863,903 individuals on 1st January 2017. Primary care contacts for all conditions dropped dramatically after introduction of population-wide restrictions. By July 2020, except for unstable angina and acute alcohol-related events, contacts for all conditions had not recovered to pre-lockdown levels. The largest reductions were for contacts for: diabetic emergencies (OR: 0.35, 95% CI: 0.25-0.50), depression (OR: 0.53, 95% CI: 0.52-0.53), and self-harm (OR: 0.56, 95% CI: 0.54-0.58). Interpretation: There were substantial reductions in primary care contacts for acute physical and mental conditions with restrictions, with limited recovery by July 2020. It is likely that much of the deficit in care represents unmet need, with implications for subsequent morbidity and premature mortality. The conditions we studied are sufficiently severe that any unmet need will have substantial ramifications for the people experiencing the conditions and healthcare provision. Maintaining access must be a key priority in future public health planning (including further restrictions). Funding: Wellcome Trust Senior Fellowship (SML), Health Data Research UK.

COVID-19 and eating disorders in young people

“…Whereas referrals for eating disorders increased during lockdown, they increased even more as lockdown measures were relaxed. This pattern might reflect greater help seeking, which had declined during lockdown, 7 and the indispensable role that schools have in identifying mental health problems in young people; or it might be that returning to school, with all the social and academic pressures that it presents, might also constitute a period of heightened anxiety that could exacerbate the risk of eating disorders.…”

Biopsychosocial exposure to the COVID-19 pandemic and the relative risk of schizophrenia: Interrupted time-series analysis of a nationally representative sample

“…Clinical observations [15][16][17][18], theories [19,20], and research [21][22][23] imply that the multiple biopsychosocial Covid-19 pandemic adversities may increase the risk of schizophrenia. However, the available data are contradictory, indicating both Covid-19 related reductions [24,25] and increases [26] in the rate of incident schizophrenia compared to the pre-exposure periods.…”

“…In the Rhineland region of Germany, based on inpatient service utilization for a 4 range of psychiatric disorders during the first three months of the pandemic, results suggested reduced service utilization across all disorders, which was less pronounced for schizophrenia but increased in presentations with atypical psychotic features [25]. Similarly, based on electronic medical records during the first home-confinement period in the UK, a significant reduction in all mental health-related primary and secondary care contacts, including psychosis, was observed [24]. In a survey of three European countries during confinement, daily fluctuations of brief psychotic-like experiences increased with associated country-specific COVID-19 deaths [23].…”

OpenSAFELY NHS Service Restoration Observatory 1: describing trends and variation in primary care clinical activity for 23.3 million patients in England during the first wave of COVID-19

“…The WHO also found significant disruption to countries’ healthcare capacity for NCDs in May [5] and highlighted the importance that countries “build back better ” healthcare services for people with NCD, partially as they are more likely to suffer adverse outcomes from COVID-19 [7]. A recent study, not yet peer reviewed, was conducted in the UK Clinical Practice Research Datalink (CPRD) which covers 13% of the UK population: it assessed primary care contacts for specific clinical conditions such as depression, self harm, diabetic emergencies and COPD/asthma exacerbations [12] and found substantial reductions in primary care contacts for acute physical and mental conditions with “limited recovery” by July 2020; similarly we found recovery had occurred in a broad range of coded activity by September. In a separate analysis we found there to be no drop off in INR activity once adjusted for the amount of people on warfarin, the medicine which requires routine INR monitoring [13].…”