The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review

Sarah Steeg¹, Ann John², David J Gunnell³, Nav Kapur⁴, Dana Dekel⁵, Lena Schmidt⁶, Duleeka Knipe⁷, Ella Arensman⁸, Keith Hawton⁹, Julian P T Higgins¹⁰, Emily Eyles¹¹, Catherine Macleod-Hall⁷, Luke A McGuiness⁷, Roger T Webb¹²

Affiliations

¹ Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, UK; and Manchester Academic Health Science Centre, UK.
² Medical School, Swansea University, UK; and Public Health Wales NHS Trust, UK.
³ Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK.
⁴ Division of Psychology and Mental Health, University of Manchester, UK;NIHR Greater Manchester Patient Safety Translational Research Centre, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK.
⁵ Department of Population Psychiatry, Suicide and Informatics, Swansea University, UK.
⁶ Sciome LLC, North Carolina, USA; Population Health Sciences, Bristol Medical School, University of Bristol, UK.
⁷ Population Health Sciences, Bristol Medical School, University of Bristol, UK.
⁸ School of Public Health and National Suicide Research Foundation, University College Cork, Ireland; and Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia.
⁹ Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK; and Warneford Hospital, Oxford Health NHS Foundation Trust, UK.
¹⁰ National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK; National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK.
¹¹ National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK.
¹² Division of Psychology and Mental Health, University of Manchester, UK; and NIHR Greater Manchester Patient Safety Translational Research Centre, UK.

PMID: 35816104
DOI: 10.1192/bjp.2022.79

The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review

Sarah Steeg et al. Br J Psychiatry. 2022 Oct.

. 2022 Oct;221(4):603-612.

doi: 10.1192/bjp.2022.79.

Authors

Affiliations

¹ Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, UK; and Manchester Academic Health Science Centre, UK.
² Medical School, Swansea University, UK; and Public Health Wales NHS Trust, UK.
³ Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK.
⁴ Division of Psychology and Mental Health, University of Manchester, UK;NIHR Greater Manchester Patient Safety Translational Research Centre, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK.
⁵ Department of Population Psychiatry, Suicide and Informatics, Swansea University, UK.
⁶ Sciome LLC, North Carolina, USA; Population Health Sciences, Bristol Medical School, University of Bristol, UK.
⁷ Population Health Sciences, Bristol Medical School, University of Bristol, UK.
⁸ School of Public Health and National Suicide Research Foundation, University College Cork, Ireland; and Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia.
⁹ Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK; and Warneford Hospital, Oxford Health NHS Foundation Trust, UK.
¹⁰ National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK; National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK.
¹¹ National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK.
¹² Division of Psychology and Mental Health, University of Manchester, UK; and NIHR Greater Manchester Patient Safety Translational Research Centre, UK.

PMID: 35816104
DOI: 10.1192/bjp.2022.79

Abstract

Background: Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020.

Aims: To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic.

Method: A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool.

Results: Fifty-one studies were included: 57% (29/51) were rated as 'low' quality, 31% (16/51) as 'moderate' and 12% (6/51) as 'high-moderate'. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17-56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls.

Conclusions: Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.

Keywords: COVID-19; Epidemiology; primary care; self-harm; suicide.

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The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review

Affiliations

The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review

Authors

Affiliations

Abstract

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical