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

Abstract

Introduction The 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. Method Mental 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 May 17, 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. Results Of 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, χ 2 = 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. Conclusions COVID-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.

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

“…The findings are consistent with the notion that living arrangements are an important identifier of the differential risk of self-injury and domestic violence during a pandemic. Young adults living alone had an increased risk of self-injury; this is consistent with prior research on during-pandemic hospitalized individuals with self-injury who reported reduced opportunities for face-to-face contact with family members, friends, or partners, and a lack of social support (Hawton et al, 2021). Although we cannot tell from our data whether individuals who reported self-injury during the pandemic already felt isolated before the pandemic, our findings identify young people who live alone as an important target population for interventions during a pandemic and perhaps also in postpandemic times.…”

Feelings of Entrapment during the COVID-19 Pandemic Based on ACE Star Model: A Concept Analysis

“…Most studies about entrapment and COVID-19 have dealt with suicides during COVID-19 [9,14], depression and anxiety [15], self-harm [16], and primarily report negative studies. However, Tesimann and Brailovkaia (2020) note said that suicide ideation is not an inevitable consequence of feelings of entrapment [17].…”

“…Lockdown system or situation during the COVID-19 [3,6,18,26,29,[35][36][37][38][39][40][41], impairment to social and occupational functioning [9] Restricted situation Social consequences of COVID-19 [3], restrictions [35], physical distancing and self-isolation [36], isolation [29,42], reduced social opportunities [42], social restriction [38], isolation and loneliness/reduced contact with key individuals/ living alone/cessation or reduction of service (including absence of face to face support) [16], limited/restricted [43], social distancing [6,18,29,40,43], losing direct social and physical contact [9], restricted in a situation [44] Uncertain future…”

“…Increased suicide Suicide ideation [3,6], self-harm [15,16], risk factors of suicide [9,14,15,18], suicide [6,29,35,37,42,44], suicidal intent and behavior [47], suicidality [46], suicidal actions and ambivalent to living or dying [6] Decreased mental health Decreased mental health problem [3,16,29,44], feeling isolated and the specific mirroring of abuse [38], foster neglect and abuse [40] Decreased well-being Decreased well-being [3,29], negative wellbeing [36], affect their care and wellbeing [40] (1) Out of control The situation during the COVID-19 pandemic is out of control; an individual's ability to control impulses and modify inappropriate emotions and thoughts [48,49] and the world is desperately exhausted [48]. Out of control is.…”

Self-Harm in Aviation Medicine—A Complex Challenge During a Pandemic

“…It is evident that emotional distress increases during pandemics ( 15 ). Furthermore, those being treated for existing mental health disorders may experience a worsening of their condition during pandemics ( 16 ). Additionally, undiagnosed mental health conditions could worsen during a pandemic and therefore become clinically relevant.…”