Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study

Abstract

Summary Background The COVID-19 pandemic has adversely affected population mental health. We aimed to assess temporal trends in primary care-recorded common mental illness, episodes of self-harm, psychotropic medication prescribing, and general practitioner (GP) referrals to mental health services during the COVID-19 emergency in the UK. Methods We did a population-based cohort study using primary care electronic health records from general practices registered on the UK Clinical Practice Research Datalink (CPRD). We included patient records from Jan 1, 2010, to Sept 10, 2020, to establish long-term trends and patterns of seasonality, but focused primarily on the period January, 2019–September, 2020. We extracted data on clinical codes entered into patient records to estimate the incidence of depression and anxiety disorders, self-harm, prescriptions for antidepressants and benzodiazepines, and GP referrals to mental health services, and assessed event rates of all psychotropic prescriptions and self-harm. We used mean-dispersion negative binomial regression models to predict expected monthly incidence and overall event rates, which were then compared with observed rates to assess the percentage reduction in incidence and event rates after March, 2020. We also stratified analyses by sex, age group, and practice-level Index of Multiple Deprivation quintiles. Findings We identified 14 210 507 patients from 1697 UK general practices registered in the CPRD databases. In April, 2020, compared with expected rates, the incidence of primary care-recorded depression had reduced by 43·0% (95% CI 38·3–47·4), anxiety disorders by 47·8% (44·3–51·2), and first antidepressant prescribing by 36·4% (33·9–38·8) in English general practices. Reductions in first diagnoses of depression and anxiety disorders were largest for adults of working age (18–44 and 45–64 years) and for patients registered at practices in more deprived areas. The incidence of self-harm was 37·6% (34·8–40·3%) lower than expected in April, 2020, and the reduction was greatest for women and individuals aged younger than 45 years. By September, 2020, rates of incident depression, anxiety disorder, and self-harm were similar to expected levels. In Northern Ireland, Scotland, and Wales, rates of incident depression and anxiety disorder remained around a third lower than expected to September, 2020. In April, 2020, the rate of referral to mental health services was less than a quarter of the expected rate for the time of year (75·3% reduction [74·0–76·4]). Interpretation Consequences of the considerable reductions in primary care-recorded mental illness and self-harm could include more patients subsequently presenting with greater severity of mental illness and increasing incidence of non-fatal self-harm and suicide. Addressing the effects of future lockdowns and longer-term impacts of economic instability on mental health should be prioritised. ...

Mental health of children and young people during pandemic

“…The incidence of self-harm recorded in primary care was substantially lower than expected for 10-17 year olds in April 2020 but returned to pre-pandemic levels by September 2020 19. Similar patterns were detected for all mental health referrals in England,20 with reductions in urgent psychiatric presentations reported across Europe,21 suggesting possible unmet need.…”

Hospitalizations for suicide attempt during the first COVID‐19 lockdown in France

“…To our knowledge, only one population-based study reported a lower incidence of self-harm in the United Kingdom in April 2020 compared with the previous years, especially in women and people younger than 45 years. 4 In France, the first national lockdown was from March, 16 to May, 11 2020 (home confinement, limited social contacts, closure of schools and of all unnecessary business activities). We used the French national hospital discharge database (Programme de Médicalisation des Systèmes d'Information, PMSI) to identify SA-related hospitalizations (ICD-10 codes X60 to X84) in Medicine/Surgery services of publicand private-sector hospitals.…”

“…Our results are consistent with the observed decrease of suicidal behaviours in many countries during the strict lockdown. 4,5 This decrease may be explained by several factors: the so-called "pulling-together effect" observed in times of national tragedies, the work adaptation (reduced working hours and work-from-home policies), the subsidies to limit financial distress, the reduced access to illegal drugs. However, the absolute number of violent or severe SA (and related deaths during hospitalization) remained relatively stable.…”

Mental health support through primary care during and after covid-19

“…Rates of self-harm and common mental health conditions were lower than expected in primary care during the early stages of the pandemic, but concern remains about a possible rebound effect causing higher rates of mental health problems, self-harm, and suicide in the coming months and years 17…”