The effect of COVID-19 lockdown on the incidence of deliberate self-harm injuries presenting to the emergency room

Abstract

Objective The World Health Organization declared COVID-19 a pandemic on 11th March 2020. The UK government introduced strict social distancing measures on 23rd March 2020, with the country put into a full lockdown to further halt the spread of the virus. The aims of this article are to ascertain whether there was a rise in the incidence of deliberate self-harm (DSH) presentations to the emergency department at a level one trauma center associated with the introduction of lockdown measures. Method An observational study from a level one trauma center was carried out. Retrospective data from 23rd March 2020 to 1st May 2020 was collected and compared to the same time period in 2019. Data was collected from coded electronic patient records. Results Total attendances to the Emergency Department (ED) reduced from 2019 to 2020 (5198 and 3059 respectively). There was a significant increase in the total number of self-harm presentations between 2019 and 2020 (103 vs 113, p-value <0.001) as well as paracetamol, NSAID and opiate overdoses, with more cases requiring hospital admission in 2020 vs 2019. Conclusions Societal lockdown measures secondary to the COVID-19 pandemic have had a significant effect on the mental health of patients. One way this can be detected is through an increased incidence and severity of deliberate self-harm injuries presenting to the ED. These findings, in conjunction with the available, literature provide valuable implications for community and emergency physicians and psychiatrists for any future wave of disease or pandemic.

Covid-19, Lockdown and Self-Isolation: Evaluation of Deliberate Self-Harm Admissions

“…A similar study conducted in Birmingham UK demonstrated an absolute increase in the presentations of deliberate self-harm to the emergency department. This study noted a rise in the percentage of these presentations from 1.98% to 3.69% (p < 0.001) when comparing 2019 to 2020 (21). These results may suggest a substantive negative impact of lockdown on mental health.…”

Injury patterns of patients with upper limb and hand trauma sustained during the COVID-19 pandemic lockdown in the UK: a retrospective cohort study

“…Road traffic collision injuries still occurred with a similar proportionate incidence to the pre-lockdown period, as was also demonstrated in France [8] . The finding that deliberate self-harm injuries to the hand and upper limb did not increase, must be interpreted alongside recent data from the same hospital, that deliberate drug overdoses did increase during the same period [11] . This is suggestive of a broader increase in psychiatric morbidity that took place during lockdown, but that did not manifest as an increase in hand and upper limb injury.…”

Hospitalization for self-harm during the early months of the COVID-19 pandemic in France: A nationwide retrospective observational cohort study

“…In one university hospital in Ireland, emergency presentations for self-harm decreased in March-April 2020 before increasing in April-May 2020 [19] . In a trauma center in the UK, an increase in self-harm emergency presentations was observed [20] . Of note, an increase in more violent suicidal acts (penetrative lesions) has also been observed in a local hospital, UK [21] , which provides motivation to analyze the change in occurrence of self-harm as a function of the suicidal means and lethality of the act.…”