Characterizing Unusual Spatial Clusters of Male Mental Health Emergencies Occurring During the First National COVID-19 "Lockdown" in the East Midlands Region, UK: A Geospatial Analysis of Ambulance 999 Data

Abstract

The widespread psychological effects of contagion mitigation measures associated with the novel coronavirus disease 2019 (COVID-19) are well known. Phases of "lockdown" have increased levels of anxiety and depression globally. Most research uses methods such as self-reporting that highlight the greater impact of the pandemic on the mental health of females. Emergency medical data from ambulance services may be a better reflection of male mental health. We use ambulance data to identify unusual clusters of high rates of male mental health emergencies occurring in the East Midlands of the United Kingdom during the first national "lockdown" and to explore factors that may explain clusters. Analysis of more than 5,000 cases of male mental health emergencies revealed 19 unusual spatial clusters. Binary logistic regression analysis (χ² = 787.22, df = 20, p ≤ .001) identified 16 factors that explained clusters, including proximity to "healthy" features of the physical landscape, urban and rural dynamics, and socioeconomic condition. Our findings suggest that the factors underlying vulnerability of males to severe mental health conditions during "lockdown" vary within and between rural and urban spaces, and that the wider "hinterland" surrounding clusters influences the social and physical access of males to services that facilitate mental health support. Limitations on social engagement to mitigate effects of the pandemic are likely to continue. Our approach could inform delivery of emergency services and the development of community-level services to support vulnerable males during periods of social isolation.

Keywords: COVID-19; ambulance data; male mental health; rural health; spatial analysis.

Figure 1.

Schematic Showing the Social-Environmental Mesosphere Demonstrating the Multilevel Factors That May Be Associated With Acute Male Mental Health Emergencies. Source. Adapted from Moore, Siriwardena, et al. (2022). Note. The dotted arrow indicates the interaction between socioeconomic factors and physical landscape factors within the Mesosphere. Peripheral boxes indicate the specific measures of social and environmental factors included in the research. AHAHI = Access of Healthy Assets and Hazardous Index.

Figure 2.

Map of the United Kingdom Highlighting the East Midlands Region, Including the Locations of Prominent Towns and Cities.

Figure 3.

The Geographic Location of 19 Statistically Significant (p < .5) Clusters of COVID-19, Identified Using a Kulldorff Spatial Scan Statistic. Note. Further details of clusters are given in Table 4.

Figure 4.

Spatial Representation of Relative Risk of Male Mental Health Emergencies in the East Midlands of the United Kingdom. Note. Taller clusters and clusters closer to red on the color gradient reflect greater risk of male mental health prevalence.

Figure 5.

Map Displaying Male Mental Health Clusters Superimposed Over a Predictive Layer for Vulnerability Including Four Measures From the AHAHI: Passive Green Space, Blue Space, Pharmacies, and GPs. Note. The graduated colors of the layer represent higher risk of unusual clustering: green represents lower areas of risk, and red represents higher risk areas. The predictive layer is made up of a combination of four individual layers: passive green space, blue space, pharmacies, and GPs. The 19 clusters of male mental health cases (identified using a Kulldorff spatial scan) are superimposed as black circles and numbered consistent with Table 6. AHAHI = Access of Healthy Assets and Hazardous Index; GPs = general practitioners.

Figure 6.

Map of the RUC Distribution With Unusual Clusters of Male Mental Health Emergencies Superimposed. Note. Colors in the legend reflect each rural/urban category. The 19 clusters (identified using a Kulldorff spatial scan) are represented as black circles and numbered consistent with Table 6. RUC = Rural Urban Classification.

Figure 7.

Map of the IMD Distribution With Unusual Clusters of Male Mental Health Emergencies Superimposed. Note. The green spectrum indicates more affluent areas, whereas the red spectrum indicates more deprived areas. The 19 clusters (identified using a Kulldorff spatial scan) are represented as black circles and numbered consistent with Table 6. IMD = Index of Multiple Deprivation.

Figure 8.

Schematic Representing the Distinction Between Hinterlands, Socioeconomic Condition, and Risk Factors Related to Male Mental Health Emergencies in Clusters That Are More Rural or More Urban. Note. For risk factors, the text centered and above the quadrant indicates factors that are common to rural and urban affluent clusters. The text centered and below the quadrant indicates factors that are common to rural and urban deprived clusters.