Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study

Abstract

Summary Background There are concerns that the response to the COVID-19 pandemic in the UK might 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 aimed to ascertain what has happened to general practice contacts for acute physical and mental health outcomes during the pandemic. Methods Using de-identified electronic health records from the Clinical Research Practice Datalink (CPRD) Aurum (covering 13% of the UK population), between 2017 and 2020, we calculated weekly primary care contacts for selected acute physical and mental health conditions: anxiety, depression, self-harm (fatal and non-fatal), severe mental illness, eating disorder, obsessive-compulsive disorder, acute alcohol-related events, asthma exacerbation, chronic obstructive pulmonary disease exacerbation, acute cardiovascular events (cerebrovascular accident, heart failure, myocardial infarction, transient ischaemic attacks, unstable angina, and venous thromboembolism), and diabetic emergency. Primary care contacts included remote and face-to-face consultations, diagnoses from hospital discharge letters, and secondary care referrals, and conditions were identified through primary care records for diagnoses, symptoms, and prescribing. Our overall study population included individuals aged 11 years or older who had at least 1 year of registration with practices contributing to CPRD Aurum in the specified period, but denominator populations varied depending on the condition being analysed. We used an interrupted time-series analysis to formally quantify changes in conditions after the introduction of population-wide restrictions (defined as March 29, 2020) compared with the period before their introduction (defined as Jan 1, 2017 to March 7, 2020), with data excluded for an adjustment-to-restrictions period (March 8–28). Findings The overall population included 9 863 903 individuals on Jan 1, 2017, and increased to 10 226 939 by Jan 1, 2020. Primary care contacts for almost all conditions dropped considerably after the introduction of population-wide restrictions. The largest reductions were observed for contacts for diabetic emergencies (odds ratio 0·35 [95% CI 0·25–0·50]), depression (0·53 [0·52–0·53]), and self-harm (0·56 [0·54–0·58]). In the interrupted time-series analysis, with the exception of acute alcohol-related events (0·98 [0·89–1·10]), there was evidence of a reduction in contacts for all conditions (anxiety 0·67 [0·66–0·67], eating disorders 0·62 [0·59–0·66], obsessive-compulsive disorder [0·69 [0·64–0·74]], self-harm 0·56 [0·54–0·58], severe mental illness 0·80 [0·78–0·83], stroke 0·59 [0·56–0·62], transient ischaemic attack 0·63 [0·58–0·67], heart failure 0·62 [0·60–0·64], myocardial infarction 0·72 [0·68–0·77], unstable angina 0·72 [0·60–0·87], venous thromboembolism 0·94 [0·90–0·99], and asthma exacerbation 0·88 [0·86–0·...

Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries

“…1 3-8 Therefore, assessment of the full impact of the pandemic on mortality should include both the doi: 10.1136/bmj.n1137 | BMJ 2021;373:n1137 | the bmj direct effect of the pandemic on deaths from covid-19 and the indirect effect of the pandemic on deaths from other causes, as might be expected from the disruption to health services or from wider economic and social changes. [9][10][11][12][13][14][15][16][17] Assessing the overall impact of the pandemic on mortality requires measurement of "excess deaths," calculated as the difference between the number of deaths from all causes that occurred during the course of the pandemic and the expected number of deaths based on a historical baseline from recent years. [18][19][20][21] Mortality below the expected levels is called "avoided mortality" or "mortality deficit," whereas "mortality displacement" (or "harvesting") is characterised by a period of excess deaths followed by a period of mortality deficit (see glossary in supplementary materials for more information).…”

“…Measures taken to handle the covid-19 pandemic have also varied substantially across countries 1345678. Therefore, assessment of the full impact of the pandemic on mortality should include both the direct effect of the pandemic on deaths from covid-19 and the indirect effect of the pandemic on deaths from other causes, as might be expected from the disruption to health services or from wider economic and social changes 91011121314151617…”

Precautionary Behavior Practices and Psychological Characteristics of COVID-19 Patients and Quarantined Persons

“…A pandemic affects the public’s physical and mental health; these health effects were also identified during the 2019 coronavirus outbreak [ 9 , 10 , 11 , 12 ]. In the early stage of a pandemic, people feel fear, anxiousness, and helplessness due to the lack of information and uncertainty about the new risks (as well as fear of death) [ 13 , 14 ].…”

Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review

“…This systematic review has shown that there are a number of studies relating to interventions that reduce unscheduled hospital care for hypoglycaemic events for adults with diabetes. This is currently particularly important as adults with diabetes have been reluctant to go to hospital during the COVID-19 pandemic, fearful of contracting the virus and consequently missing treatment [38]. The interventions were categorised as telemedicine, education, integrated care pathways, enhanced primary care and care management teams and had varying levels of effectiveness as outlined below.…”