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. 2021 Nov:41:101175.
doi: 10.1016/j.eclinm.2021.101175. Epub 2021 Nov 1.

Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: Time series analysis of electronic healthcare records for 2.8 million patients in the Greater Manchester Care Record

Sarah Steeg  1   2 , Lana Bojanić  1   2 , George Tilston  3   4 , Richard Williams  2   3   5 , David A Jenkins  2   3   5 , Matthew J Carr  2   5   6 , Niels Peek  3   4   5 , Darren M Ashcroft  2   5   6   7 , Nav Kapur  1   2   5   8 , Jennifer Voorhees  7 , Roger T Webb  1   2   5
Affiliations

Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: Time series analysis of electronic healthcare records for 2.8 million patients in the Greater Manchester Care Record

Sarah Steeg et al. EClinicalMedicine. 2021 Nov.

Abstract

Background: Surveillance of temporal trends in clinically treated self-harm is an important component of suicide prevention in the dynamic context of COVID-19. There is little evidence beyond the initial months following the onset of the pandemic, despite national and regional restrictions persisting to mid-2021.

Methods: Descriptive time series analysis utilizing de-identified, primary care health records of 2.8 million patients from the Greater Manchester Care Record. Frequencies of self-harm episodes between 1st January 2019 and 31st May 2021 were examined, including stratification by sex, age group, ethnicity, and index of multiple deprivation quintile.

Findings: There were 33,444 episodes of self-harm by 13,148 individuals recorded during the study period. Frequency ratios of incident and all episodes of self-harm were 0.59 (95% CI 0.51 to 0.69) and 0.69 (CI 0.63 to 0.75) respectively in April 2020 compared to February 2020. Between August 2020 and May 2021 frequency ratios were 0.92 (CI 0.88 to 0.96) for incident episodes and 0.86 (CI 0.84 to 0.88) for all episodes compared to the same months in 2019. Reductions were largest among men and people living in the most deprived neighbourhoods, while an increase in all-episode self-harm was observed for adolescents aged 10-17.

Interpretation: Reductions in primary care-recorded self-harm persisted to May 2021, though they were less marked than in April 2020 during the first national lockdown. The observed reductions could represent longer term reluctance to seek help from health services. Our findings have implications for the ability for services to offer recommended care for patients who have harmed themselves.

Keywords: Covid-19; Primary care; Self-harm; Suicide attempt.

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Conflict of interest statement

NK reports grants and personal fees from the UK Department of Health and Social Care, the National Institute of Health Research (NIHR), the National Institute for Health and Care Excellence (NICE), and the Healthcare Quality and Improvement Partnership, outside the submitted work; works with NHS England on national quality improvement initiatives for suicide and self-harm; is a member of the advisory group for the National Suicide Prevention Strategy of the Department of Health and Social Care; has chaired NICE guideline committees for Self-harm and Depression; and is currently the Topic Advisor for the new NICE Guidelines for self-harm. All other authors report no conflicts of interest.

Figures

Fig. 1
Figure 1
Temporal trends in monthly incident and all-episode numbers of self-harm episodes in relation to key national and regional COVID-19 restrictions, 1st Jan. 2019–31st May 2021 6: Tier 2 restrictions in GM equivalent to previous GM Tier 3.
Fig. 2
Figure 2
a and b: Sex-specific temporal trends in monthly incident and all-episode numbers of self-harm episodes with key national and regional COVID-19 restrictions, 1st January 2019–31st May 2021.
Fig. 3
Figure 3
a and b: Age-specific temporal trends in monthly incident and all-episode numbers of self-harm episodes with key national and regional COVID-19 restrictions, 1st January 2019–31st May 2021.
Fig. 4
Figure 4
a and b: Deprivation quintile-specific temporal trends in monthly incident and all-episode numbers of self-harm episodes with key national and regional COVID-19 restrictions, 1st January 2019–31st May 2021.
Fig. 5
Figure 5
a and b: Ethnic group-specific temporal trends in monthly incident and all-episodes with key national and regional COVID-19 restrictions, 1st January 2019–31st May 2021.
See this image and copyright information in PMC

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