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Observational Study
. 2022 Aug 3;8(8):e32347.
doi: 10.2196/32347.

Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study

Gillian E Smith  1   2 , Sally E Harcourt  1 , Uy Hoang  3 , Agnieszka Lemanska  3 , Alex J Elliot  1   2 , Roger A Morbey  1   2 , Helen E Hughes  1 , Iain Lake  2   4 , Obaghe Edeghere  1   2 , Isabel Oliver  5   6 , Julian Sherlock  3 , Richard Amlôt  2   5   7 , Simon de Lusignan  3   8   9
Affiliations
Observational Study

Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study

Gillian E Smith et al. JMIR Public Health Surveill. .

Abstract

Background: The COVID-19 pandemic has resulted in an unprecedented impact on the day-to-day lives of people, with several features potentially adversely affecting mental health. There is growing evidence of the size of the impact of COVID-19 on mental health, but much of this is from ongoing population surveys using validated mental health scores.

Objective: This study investigated the impact of the pandemic and control measures on mental health conditions presenting to a spectrum of national health care services monitored using real-time syndromic surveillance in England.

Methods: We conducted a retrospective observational descriptive study of mental health presentations (those calling the national medical helpline, National Health Service [NHS] 111; consulting general practitioners [GPs] in and out-of-hours; calling ambulance services; and attending emergency departments) from January 1, 2019, to September 30, 2020. Estimates for the impact of lockdown measures were provided using an interrupted time series analysis.

Results: Mental health presentations showed a marked decrease during the early stages of the pandemic. Postlockdown, attendances for mental health conditions reached higher than prepandemic levels across most systems-a rise of 10% compared to that expected for NHS 111 and 21% for GP out-of-hours service-while the number of consultations to GP in-hours service was 13% lower compared to the same time previous year. Increases were observed in calls to NHS 111 for sleep problems.

Conclusions: These analyses showed marked changes in the health care attendances and prescribing for common mental health conditions across a spectrum of health care provision, with some of these changes persisting. The reasons for such changes are likely to be complex and multifactorial. The impact of the pandemic on mental health may not be fully understood for some time, and therefore, these syndromic indicators should continue to be monitored.

Keywords: COVID-19; anxiety; health care; health care service; health surveillance; mental health; pandemic; public health; sleep problems; syndromic surveillance.

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Conflict of interest statement

Conflicts of Interest: SdeL has received funding through his university for vaccine-related research from AstraZeneca, GSK, Sanofi, Seqirus, and Takeda. He has also been a member of advisory boards for AstraZeneca, Sanofi, and Seqirus. All other authors have none to declare.

Figures

Figure 1
Figure 1
Calls, consultations, and attendances for mental health conditions presenting to NHS 111, GP in-hours and GP out-of-hours and EDs, and GP in-hours mental health medications in comparison to selected key dates in the pandemic. (A) NHS 111 calls for mental health problems, (B) GP in-hours consultations for mental health conditions, (C) GP in-hours prescriptions for mental health medications, (D) GP out-of-hours consultations for all mental health conditions, and (E) ED attendances for mental health conditions. Daily calls/consultations/attendances/prescriptions presented as 7dma adjusted for bank holidays (BH) and by gender. The start of lockdown (March 23, 2020) and the start of the postlockdown period (June 1, 2020) are indicated by vertical lines. 7dma: 7-day moving averages; ED: emergency department; GP: general practitioner; ISO: International Organisation for Standardisation; NHS: National Health Service.
Figure 2
Figure 2
Summary of changes in syndromic indicators for the postlockdown period across systems compared to that expected. GP: general practitioner; NHS: National Health Service.
Figure 3
Figure 3
Consultations for depression and anxiety presenting to GP in-hours and out-of-hours in comparison to selected key dates in the pandemic. (A) GP in-hours consultations for depression, (B) GP out-of-hours consultations for depression, (C) GP in-hours consultations for anxiety, and (D) GP out-of-hours consultations for anxiety. Daily consultations presented as 7dma adjusted for bank holidays (BH) and by gender. The start of the lockdown (March 23, 2020) and the start of the postlockdown period (June 1, 2020) are indicated by vertical lines. 7dma: 7-day moving averages; GP: general practitioner; ISO: International Organisation for Standardisation.
Figure 4
Figure 4
Calls to NHS 111 for sleep difficulties in comparison to selected key dates in the pandemic. Daily numbers of calls presented as bank holiday (BH)-adjusted 7dma and by gender. The start of the lockdown (March 23, 2020) and the start of the postlockdown period (June 1, 2020) are indicated by vertical lines. 7dma: 7-day moving averages; ISO: International Organisation for Standardisation; NHS: National Health Service.
Figure 5
Figure 5
Ambulance calls and ED attendances for indicators of self-harm (overdose and excess alcohol use) in comparison to selected key dates in the pandemic. (A) Ambulance calls for overdose, (B) ED attendances for overdose, and (C) ED attendances for excess alcohol use. Daily numbers of call-outs/attendances presented as bank holiday (BH)-adjusted 7dma and by gender (ED only). The start of lockdown (March 23, 2020) and the start of the postlockdown period (June 1, 2020) are indicated by vertical lines. 7dma: 7-day moving averages; ED: emergency department; ISO: International Organisation for Standardisation.
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