The Medium-Term Impact of COVID-19 Lockdown on Referrals to Secondary Care Mental Health Services: A Controlled Interrupted Time Series Study

Chen, Shanquan; She, Rui; Qin, Pei; Kershenbaum, Anne; Fernández-Egea, Emilio; Nelder, Jenny R.; Ma, Chuoxin; Lewis, Jonathan; Wang, Chaoqun; Cardinal, Rudolf N.

doi:10.3389/fpsyt.2020.585915

Cited by 50 publications

(57 citation statements)

References 36 publications

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“… 22 Our finding of a smaller reduction in referrals could be because of restructuring of local psychiatric services to divert people away from A&E departments, which may be an argument for considering their use in future waves of the pandemic. Other studies also showed a recovery period after the initial lockdown, similar to our findings, 23 but neither conducted longer-term follow-up to the end of December as we did, so our finding of no increase in referrals beyond previous baseline is potentially reassuring and could indicate mental health needs being met in other services.…”

Section: Discussionsupporting

confidence: 86%

Acute mental health presentations before and during the COVID-19 pandemic

et al. 2021

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Background A number of community based surveys have identified an increase in psychological symptoms and distress but there has been no examination of symptoms at the more severe end of the mental health spectrum. Aims We aimed to analyse numbers and types of psychiatric presentations to inform planning for future demand on mental health services in light of the COVID-19 pandemic. Method We analysed electronic data between January and April 2020 for 2534 patients referred to acute psychiatric services, and tested for differences in patient demographics, symptom severity and use of the Mental Health Act 1983 (MHA), before and after lockdown. We used interrupted time-series analyses to compare trends in emergency department and psychiatric presentations until December 2020. Results There were 22% fewer psychiatric presentations the first week and 48% fewer emergency department presentations in the first month after lockdown initiated. A higher proportion of patients were detained under the MHA (22.2 v. 16.1%) and Mental Capacity Act 2005 (2.2 v. 1.1%) (χ2(2) = 16.3, P < 0.0001), and they experienced a longer duration of symptoms before seeking help from mental health services (χ2(3) = 18.6, P < 0.0001). A higher proportion of patients presented with psychotic symptoms (23.3 v. 17.0%) or delirium (7.0 v. 3.6%), and fewer had self-harm behaviour (43.8 v. 52.0%, χ2(7) = 28.7, P < 0.0001). A higher proportion were admitted to psychiatric in-patient units (22.2 v. 18.3%) (χ2(6) = 42.8, P < 0.0001) after lockdown. Conclusions UK lockdown resulted in fewer psychiatric presentations, but those who presented were more likely to have severe symptoms, be detained under the MHA and be admitted to hospital. Psychiatric services should ensure provision of care for these patients as well as planning for those affected by future COVID-19 waves.

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Section: Discussionsupporting

confidence: 86%

Acute mental health presentations before and during the COVID-19 pandemic

et al. 2021

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“… 35 In that study, there was also an excess in unexplained deaths compared with previous years, many of which were likely to involve cases awaiting inquests, although these will not necessarily result in suicide verdicts, and estimates to date (for the UK as well as a number of other nations) have not indicated increased suicide rates, at least in the early stages of the pandemic, 36 and non-fatal self-harm presentations have also been reported as relatively low during that early period. 18 37 …”

Section: Discussionmentioning

confidence: 99%

“…5 Single-site reports from UK services have highlighted falls in activity following the 23 March d national lockdown, followed by increased demand for some services, decreased activity for others, shifts from f2f to virtual consultations and a rise in mortality. [14][15][16][17][18][19] Drawing on a network of providers, we sought to determine the level and heterogeneity of such mental healthcare changes across multiple national sites using a quasi-experimental, regression discontinuity design in time.…”

Section: And Problems Inmentioning

confidence: 99%

Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in 10 UK sites: a regression discontinuity in time design

et al. 2021

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ObjectivesTo investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 ‘lockdown’ policy in Spring 2020.DesignA regression discontinuity in time (RDiT) analysis of daily service-level activity.Setting and participantsMental healthcare data were extracted from 10 UK providers.Outcome measuresDaily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 ‘lockdown’ policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites.ResultsPooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect.ConclusionsMH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences.

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“…Other studies focused on specific populations such as children and youth with inflammatory bowel syndrome (IBS), chronic respiratory conditions, and neuromuscular disorders (Alshahrani et al, 2020), and LGBTQ-identifying adolescents (Fish et al, 2020). Eight studies contained results on child and adolescent populations accessing psychiatric services during the pandemic (Bothara et al, 2021;Cheek et al, 2020;Chen, She, et al, 2020;Diaz de Neira et al, 2020;Ferrando et al, 2020;Leeb et al, 2020;Leff et al, 2021;Tromans et al, 2020).…”

Section: Study Populationsmentioning

confidence: 99%

Review: Mental health impacts of the COVID‐19 pandemic on children and youth – a systematic review

Samji

Ladak

et al. 2021

Child Adoles Ment Health

654

478

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Background: The COVID-19 pandemic has posed an unprecedented threat to global mental health. Children and adolescents may be more susceptible to mental health impacts related to their vulnerable developmental stage, fear of infection, home confinement, suspension of regular school and extracurricular activities, physical distancing mandates, and larger scale threats such as global financial recessions and associated impacts. Our objective was to review existing evidence of the COVID-19 pandemic's global impact on the mental health of children and adolescents <19 years of age and to identify personal and contextual factors that may enhance risk or confer protection in relation to mental health outcomes. Methods: We conducted a search of peerreviewed and preprint research published in English from January 1, 2020, to February 22, 2021. We included studies collecting primary data on COVID-19-related mental health impacts on children and adolescents. We graded the strength of included articles using the Oxford Centre for Evidence-Based Medicine rating scheme. Results: Our search and review yielded 116 articles presenting data on a total of 127,923 children and adolescents; 50,984 child and adolescent proxy reports (e.g., parents, healthcare practitioners); and >3,000 chart reviews. A high prevalence of COVID-19-related fear was noted among children and adolescents, as well as more depressive and anxious symptoms compared with prepandemic estimates. Older adolescents, girls, and children and adolescents living with neurodiversities and/or chronic physical conditions were more likely to experience negative mental health outcomes. Many studies reported mental health deterioration among children and adolescents due to COVID-19 pandemic control measures. Physical exercise, access to entertainment, positive familial relationships, and social support were associated with better mental health outcomes. Conclusions: This review highlights the urgent need for practitioners and policymakers to attend to and collaborate with children and adolescents, especially those in higher risk subgroups, to mitigate short-and long-term pandemic-associated mental health effects. Key Practitioner Message• Children and adolescents are at crucial phases of development, making them more susceptible to negative mental health impacts of the COVID-19 pandemic and response measures.• In this review, children and adolescents were found to experience more depressive and anxious symptoms than reported prepandemic rates, specifically with high levels of fear and concern regarding the impact of COVID-19 on their lives.• Factors associated with worse COVID-19 mental health outcomes were older adolescent age, female gender, neurodiversity, and the presence of chronic physical conditions.• While this review captures emerging data, study designs that utilize validated measures and undertake longitudinal data capture will greatly improve understanding of impacts.• Pandemic-associated negative impacts on child and adolescent mental health are clear and must be...

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The Medium-Term Impact of COVID-19 Lockdown on Referrals to Secondary Care Mental Health Services: A Controlled Interrupted Time Series Study

Cited by 50 publications

References 36 publications

Acute mental health presentations before and during the COVID-19 pandemic

Acute mental health presentations before and during the COVID-19 pandemic

Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in 10 UK sites: a regression discontinuity in time design

Review: Mental health impacts of the COVID‐19 pandemic on children and youth – a systematic review

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