Self-harm and the COVID-19 pandemic: a study of factors contributing to self-harm during lockdown restrictions

Abstract

IntroductionThe COVID-19 pandemic and resulting public health measures may have major impacts on mental health, including on self-harm. We have investigated what factors related to the pandemic influenced hospital presentations following self-harm during lockdown in England.MethodMental health clinicians assessing individuals aged 18 years and over presenting to hospitals in Oxford and Derby following self-harm during the period March 23rd to 17th May 2020 recorded whether the self-harm was related to the impact of COVID- 19 and, if so, what specific factors were relevant. These factors were organized into a classification scheme. Information was also collected on patients’ demographic characteristics, method of self-harm and suicide intent.ResultsOf 228 patients assessed, in 46.9% (N=107) COVID-19 and lockdown restrictions were identified as influencing self-harm. This applied more to females than males (53.5%, N=68/127 v 38.6%, N=39/101, χ2 = 5.03, p=0.025), but there were no differences in age, methods of self-harm or suicide intent between the two groups. The most frequent COVID-related factors were mental health issues, including new and worsening disorders, and cessation or reduction of services (including absence of face-to-face support), isolation and loneliness, reduced contact with key individuals, disruption to normal routine, and entrapment. Multiple, often inter- connected COVID-related factors were identified in many patients.ConclusionsCOVID-related factors were identified as influences in nearly half of individuals presenting to hospitals following self-harm in the period following introduction of lockdown restrictions. Females were particularly affected. The fact that mental health problems, including issues with delivery of care, predominated has implications for organisation of services during such periods. The contribution of isolation, loneliness and sense of entrapment highlight the need for relatives, friends and neighbours to be encouraged to reach out to others, especially those living alone. The classification of COVID-related factors can be used as an aide-memoire for clinicians.

The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review

“…In one UK study, 'stay-at-home' related issues contributed to around half of cases, more so in males than females. The most frequent COVID-related factors were mental health issues, including new and worsening disorders, cessation, reduction or transformation of services (including absence of face-to-face support), isolation and loneliness, reduced contact with key individuals, disruption to normal routine, and entrapment (Hawton et al, 2020b).…”

Self‐Injury and Domestic Violence in Young Adults During the COVID‐19 Pandemic: Trajectories, Precursors, and Correlates

“…Previous research has shown that young adults with mental health problems who still live with parents have a higher likelihood of receiving adequate mental health care compared with those who have moved out of the parental home (Copeland et al., 2015 ). These differences may be exacerbated during lockdowns when psychological services may be more difficult to access (Hawton et al., 2021 ).…”

“…For young adults living alone, lockdowns may increase social isolation and loneliness, which are risk factors for self‐injury (Hawton et al., 2021 ; Shaw et al., 2021 ). By contrast, living with (supportive) others (e.g., parents, peers, or intimate partners) during a pandemic may be protective because these relationships are typically important sources of social support, which counteracts psychological problems (Finan, Ohannessian, & Gordon, 2018 ).…”

Have news reports on suicide and attempted suicide during the COVID-19 pandemic adhered to guidance on safer reporting? A UK-wide content analysis study

“…It also appears to be failing, to varying degrees, to follow media guidelines in relation to key, evidence-informed recommendations, including, for example, the omission of details of suicide methods and sensational language, and inclusion of potential sources of help and support information for readers. Whilst overall standards of reporting have improved over recent years (Fraser et al, 2017), and many reports examined in this study included messages deemed to be positive, the scale and reach of the current crisis underscores the urgent need for further improvements and more cautious reporting (Hawton et al, 2020).…”

“…To ensure that important aspects of the pandemic and its potential influence on suicidal behaviour have been appropriately and comprehensively recorded, the coding scheme was adapted from the 'Classification of COVID-19 related factors involved in self-harm' used in an investigation of hospital attendances for self-harm in the Multicentre Study of Self-harm in England (Hawton et al, 2020). For other sections of the scheme, codes (where not binary yes/no categories) were derived inductively for content (Elo and Kyngäs, 2008) and refined through an iterative process of development and piloting (by three independent raters (MH, EHS and YL)), at different stages of the data collection process.…”