Risk factors for excess deaths during lockdown among older users of secondary care mental health services without confirmed COVID‐19: A retrospective cohort study

Abstract

Objective To investigate factors contributing to excess deaths of older patients during the initial 2020 lockdown beyond those attributable to confirmed COVID‐19. Methods Retrospective cohort study comparing patients treated between 23 March 2020 and 14 June 2020, deemed exposed to the pandemic/lockdown, to patients treated between 18 December 2019 and 10 March 2020, deemed to be unexposed. Data came from electronic clinical records from secondary care mental health services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment area population ∼0.86 million). Eligible patients were aged 65 years or over at baseline with at least 14 days' follow‐up, excluding patients diagnosed with confirmed or suspected SARS‐CoV‐2 infection. The primary outcome was all‐cause mortality. Findings In the two cohorts, 3,073 subjects were exposed to lockdown and 4,372 subjects were unexposed; the cohorts were followed up for an average of 74 and 78 days, respectively. After controlling for confounding by sociodemographic factors, smoking status, mental comorbidities, and physical comorbidities, patients with dementia suffered an additional 53% risk of death (HR = 1.53, 95% CI = 1.02–2.31), and patients with severe mental illness suffered an additional 123% risk of death (HR = 2.23, 95% CI = 1.42–3.49). No significant additional mortality risks were identified from physical comorbidities, potentially due to low statistical power in that respect. Conclusion During lockdown people with dementia or severe mental illness had a higher risk of death without confirmed COVID‐19. These data could inform future health service responses and policymaking to help prevent avoidable excess death during future outbreaks of this or a similar infectious disease.

End-of-Life Experiences Within a Dementia Support Program During COVID-19: Context and Circumstances Surrounding Death During the Pandemic

“…These excess deaths have been attributed to both the direct and indirect (eg, lockdown) effects of the pandemic. 8 …”

A Cross-Sectional Study of Mental Health and Wellbeing on the Bearing Transition of Students' Academic-life after COVID-19 Pandemic

“…Although the government of Indonesia has issued several policies related to countering the COVID-19 outbreak by restricting people form face to face contact, The regulation also suggests that classroom interaction be delivered through online classroom applications (Putri et al, 2020;Syafrida & Hartati, 2020). The policy intention is to control the direct physical contact in the public area; indeed, the university is a crowded environment which is suggested to obey the regulations (Brondino et al, 2020;Chen et al, 2021;Joyce et al, 2021). The closure of educational institutions is an immediately disrupted phenomenon in Indonesia (Putri et al, 2020;Sukesih et al, 2020;Syafrida & Hartati, 2020).…”

“…Restricting the students from face-to-face contact, which is the foremost an interaction in teachinglearning, disrupts and isolates them from social interaction (Churiyah et al, 2020;Putri et al, 2020). Indeed, it distracts the students' normal behavior and habit (Chen et al, 2021;Churiyah et al, 2020;Kahn & Williams, 2021). The concern for students' mental health and well-being is the main objective to be preserved in the writer's home-based institution (Chaturvedi et al, 2021;Iqbal et al, 2020;Kahn & Williams, 2021;Ohliger et al, 2020).…”

“…Some of these are children who are lazy to follow scheduled school lessons, have difficulty understanding lessons, and complain about too many learning assignments, so children become burdened and tend to delay doing assignments and leads to academic stress (Ariebowo, 2021;Cira & López, 2020;Jayewardene et al, 2017). Physical distance due to the pandemic, children are very at risk of experiencing symptoms of anxiety, irritability, laziness, boredom, emotional and behavioral disorders, and academic stress (Chen et al, 2021;Churiyah et al, 2020;Syahputri et al, 2020). Though this condition has an impact in the short term, it can also have a long-term impact on the affected groups.…”

“…Though this condition has an impact in the short term, it can also have a long-term impact on the affected groups. For some students' families, the impact becomes felt when the school issues a policy related to distance learning (Chen et al, 2021;Joyce et al, 2021;Roberts et al, 2021). Many other triggering factors among parents during the pandemic became overprotective of their children, so many children became socially isolated (Abidah et al, 2020;Brondino et al, 2020;Chaturvedi et al, 2021;Vainikainen et al, 2020).…”