Prevalence, Spectrum, and Outcome of Deliberate Self-harm Presenting to Emergency Department during COVID-19 Pandemic of 2020

Abstract

A bstract Background The coronavirus disease-2019 (COVID-19) pandemic, and the lockdown imposed, has had profound social and economic consequences and thereby implications on psychological health. This study aims to understand the effects of the pandemic and the lockdown on the prevalence, spectrum, and outcome of patients presenting with deliberate self-harm (DSH) to the emergency department (ED). Materials and methods This was a retrospective, observational study done in the ED of a tertiary care hospital in South India on DSH victims presenting from January to August 2020, spanning the prelockdown, lockdown, and unlock phases of the pandemic, and compared with data from a similar period in 2018. Results Our study population included 507 DSH victims (prevalence: 1.2%) from January to August 2020. The percentage of DSH cases showed a slight increase among the prelockdown (203/17,234: 1.18%), the lockdown (179/14,687: 1.22%), and the unlock phases (125/9,977: 1.25%). There was a female preponderance (286/507: 56.4%), and the mean age was 33.2 years. Of the 507 patients, 369 (72.8%) were admitted and 19 (3.7%) died. The lockdown period in 2020 showed a 40.9% absolute decrease in the number of DSH victims presenting to the ED as compared to an equivalent period in 2018. The proportion of patients taking plant poisons was significantly lower [odds ratio (OR) 0.38, 95% confidence intervals (CI) 0.18–0.81, p = 0.012] and that of corrosive ingestion was significantly higher (OR 2.94, 95% CI 1.57–5.48, p = 0.001) in the lockdown phase as compared to a lockdown-control phase of 2018. Conclusion There was a reduction in the absolute number of patients presenting with DSH to the ED during January–August 2020, and more so during the lockdown phase (March 24–June 30), as compared to a similar period in 2018. There was no significant difference in the hospital outcome of DSH patients between the two periods. How to cite this article John SM, John A, Hazra D, Murugan S, Abhilash KPP. Prevalence, Spectrum, and Outcome of Deliberate Self-harm Presenting to Emergency Department during COVID-19 Pandemic of 2020. Indian J Crit Care Med 2021;25(12):1387–1394.

Pattern of adult psychiatric emergencies at a tertiary care center before and after the onset of the COVID-19 pandemic

“…Three prior reports from India are all restricted to the first lockdown period between March 2020 and mid-2020. [ 1 2 3 ] Two of these reports focused only on self-harm and/or violence cases,[ 2 3 ] while the third study reported a profile of all emergency visits between March 2020 and June 2020, finding a reduction in the absolute number of emergency visits during this lockdown. [ 1 ] Of the two former studies, the retrospective observational study revealed an increase in the incidence of self-harm and violence among patients who presented to the emergency department between March 24, 2020, and June 30, 2020, when compared to the same period in the preceding year.…”

“…[ 2 ] Conversely, the other study reported a significant decline of 40.9% in deliberate self-harm cases during March 2020 and June 2020 as compared to the corresponding months in 2018. [ 3 ] Surprisingly, there are not much Indian data on the profile of mental and behavioral emergencies, with respect to the COVID-19 pandemic, except for these three early reports restricted to months of lockdown. In view of the gap in published data on psychiatric emergencies from India, especially beyond the initial few months of the pandemic, we aimed to assess the pattern and profile of adult psychiatric emergencies in the 18 months after the onset of the COVID-19 pandemic and compare them to the pre-pandemic period.…”

Prognostication and Prediction of Outcomes in Patients with Organophosphorus and Carbamate Poisoning: A Prospective Cohort Study

“… 4 – 6 In our institution, OP and carbamate poisoning frequently necessitate admissions to the high dependency unit (HDU) and intensive care unit (ICU), mirroring the situation in other healthcare facilities. 7 , 8 The toxicity of OP and carbamate poisoning stems from their capacity to deactivate the enzyme acetylcholinesterase, leading to the accumulation of acetylcholine and subsequent overstimulation of receptors. 9 – 11 Serious clinical manifestations of both OP and carbamate poisoning share similarities.…”