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The impact of the COVID-19 pandemic on presentations of self-harm over an 18-month period to a tertiary hospital

Published online by Cambridge University Press:  16 February 2023

A. O’Malley*
Affiliation:
School of Medicine, University of Galway, Galway, Ireland
A. McIntyre
Affiliation:
School of Medicine, University of Galway, Galway, Ireland
A. McGilloway
Affiliation:
School of Medicine, University of Galway, Galway, Ireland
A. Doherty
Affiliation:
Department of Psychiatry, University College Dublin, Dublin, Ireland Department of Psychiatry, Mater Hospital, Dublin, Ireland
B. Hallahan
Affiliation:
School of Medicine, University of Galway, Galway, Ireland Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
*
Author for correspondence: Dr Andrew O’Malley, School of Medicine, Department of Psychiatry, University of Galway, Galway, Ireland. Phone: 0861209473. (E-mail: andrew.omalley@hse.ie)

Abstract

Objectives:

To examine and compare rates and methods of self-harm presenting to a tertiary referral hospital during an 18-month period since the onset of the COVID-19 pandemic with a similar period immediately prior to the pandemic onset.

Methods:

Data from an anonymized database compared rates of self-harm presentations and methods employed between 1st March 2020 and 31st August 2021 to a similar time-frame prior to the onset of the COVID-19 pandemic.

Results:

A 9.1% increase in presentations with self-harm was noted since the onset of the COVID-19 pandemic. Periods of more stringent restrictions were associated with higher levels of self-harm (daily rate of 2.10 v 0.77). A higher lethality of attempt was demonstrated post-COVID-19 onset (χ2 = 15.38, p < 0.001). Fewer individuals presenting with self-harm were diagnosed with an adjustment disorder since the onset of the COVID-19 pandemic (n = 84, 11.1%, v. n = 112, 16.2%, χ2 = 7.898, p = 0.005), with no other differences pertaining to psychiatric diagnosis noted. More patients actively engaged with mental health services (MHS) presented with self-harm (n = 239 (31.7%) v. n = 137, (19.8%), χ2 = 40.798, p ≤ 0.001) since the onset of the COVID-19 pandemic.

Conclusions:

Despite an initial reduction, an increase in rates of self-harm has occurred since the onset of the COVID-19 pandemic with higher rates evident during periods of higher government mandated restrictions. An increase in active patients of MHS presenting with self-harm potentially relates to reduced availability of supports and particularly group activities. The recommencement of group therapeutic interventions for individuals attending MHS in particular is warranted.

Type
Original Research
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

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References

Alcoholics Anonymous Ireland (2020). Coronavirus (Covid-19) brings challenging times to our Fellowship. News Sheet, Issue Apr/May 2020 (https://www.alcoholicsanonymous.ie/wp-content/uploads/2022/01/Apr-May-2020-News-Sheet.pdf). Accessed 3 January 2023.Google Scholar
Bostwick, JM, Pabbati, C, Geske, JR, McKean, AJ (2016). Suicide attempt as a risk factor for completed suicide: even more Lethal than we knew. The American Journal of Psychiatry 173, 10941100. doi: 10.1176/appi.ajp.2016.15070854.CrossRefGoogle ScholarPubMed
Carroll, R, Metcalfe, C, Gunnell, D, Carroll, R, Metcalfe, C, Gunnell, D (2014). Hospital presenting self-harm and risk of fatal and non-fatal repetition: systematic review and meta-analysis PLoS ONE 9, 2014. doi: 10.1371/journal.pone.0089944.CrossRefGoogle ScholarPubMed
College of Psychiatrists of Ireland (2020). Covid-19 impact on secondary mental healthcare services in Ireland (https://www.irishpsychiatry.ie/wp-content/uploads/2020/06/Full-Report-of-Survey-to-Consultant-Psychiatrists-on-COVID19-impact-on-MHS-17.06.20.pdf). Accessed 25 February 2022.Google Scholar
Deisenhammer, EA, Kemmler, G (2021). Decreased suicide numbers during the first 6 months of the COVID-19 pandemic. Psychiatry Research 295, 113623. doi: 10.1016/j.psychres.2020.113623.CrossRefGoogle ScholarPubMed
DelPozo-Banos, M, Lee, SC, Friedmann, Y, Akbari, A, Torabi, F, Lloyd, K, Lyons, RA, John, A (2022). Healthcare contacts with self-harm during COVID-19: an e-cohort whole-population-based study using individual-level linked routine electronic health records in Wales, UK, 2016–March 2021. PLoS ONE 17, e0266967.doi: 10.1371/journal.pone.0266967.CrossRefGoogle ScholarPubMed
Fahy, Y, Dineen, B, McDonald, C, Hallahan, B (2021). The impact of COVID-19 on a cohort of patients treated with clozapine. Irish Journal of Psychological Medicine 38, 249257. doi: 10.1017/ipm.2021.30.CrossRefGoogle ScholarPubMed
Farooq, S, Tunmore, J, Wajid Ali, M, Ayub, M (2021). Suicide, self-harm and suicidal ideation during COVID-19: a systematic review. Psychiatry Research 306, 114228. doi: 10.1016/j.psychres.2021.114228.CrossRefGoogle ScholarPubMed
Government of Ireland (2020). Resilience and recovery 2020–2021 plan for living with COVID-19. Published 2 September 2020 (https://www.citizensinformation.ie/en/health/covid19/public_health_measures_for_covid19.html). Accessed 3 January 2023.Google Scholar
Gunnell, D, Appleby, L, Arensman, E, Hawton, K, John, A, Kapur, N, Khan, M, O’Connor, RC, Pirkis, J (2020). Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry 7, 468471. doi: 10.1016/S2215-0366(20)30171-1.CrossRefGoogle ScholarPubMed
Hennigan, K, McGovern, M, Plunkett, R, Costello, S, McDonald, C, Hallahan, B (2021). A longitudinal evaluation of the impact of the COVID-19 pandemic on patients with pre-existing anxiety disorders. Irish Journal of Psychological Medicine 38, 258265. doi: 10.1017/ipm.2021.32.CrossRefGoogle ScholarPubMed
Hyland, P, Shevlin, M, McBride, O, Murphy, J, Karatzias, T, Bentall, RP, Martinez, A, Vallières, F (2020). Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. Acta Psychiatrica Scandinavica 142, 249256. doi: 10.1111/acps.13219.CrossRefGoogle ScholarPubMed
Hoey, A (2020). HR circular 017/2020: update re social distancing in the health sector. Health Service Executive (https://www.hse.ie/eng/staff/resources/hr-circulars/hr-circular-017-2020-update-social-distancing-in-the-health-sector.pdf). Accessed 29 December 2022.Google Scholar
Jollant, F, Roussot, A, Corruble, E, Chauvet-Gelinier, J-C, Falissard, B, Mikaeloff, Y, Quantin, C (2021). Hospitalization for self-harm during the early months of the COVID-19 pandemic in France: a nationwide retrospective observational cohort study. Lancet Regional Health Europe 6, 100102. doi: 10.1016/j.lanepe.2021.100102.CrossRefGoogle Scholar
Kar, SS, Menon, V, Yasir Arafat, SM, Rai, S, Kaliamoorthy, C, Akter, H, Shukla, S, Sharma, N, Roy, D, Sridhar, VK (2021). Impact of COVID-19 pandemic related lockdown on suicide: analysis of newspaper reports during pre-lockdown and lockdown period in Bangladesh and India. Asian Journal of Psychiatry 60, 102649.CrossRefGoogle ScholarPubMed
Kopelovich, SL, Monroe-DeVita, M, Buck, BE, Brenner, C, Moser, L, Jarskog, LF, Harker, S, Chwastiak, LA (2021). Community mental health care delivery during the COVID-19 pandemic: practical strategies for improving care for people with serious mental illness. Community Mental. Health Journal 57, 405415. doi: 10.1007/s10597-020-00662-z.CrossRefGoogle ScholarPubMed
Kristoffersen, ES, Jahr, SH, Thommessen, B, Rønning, OM (2020). Effect of COVID-19 pandemic on stroke admission rates in a Norwegian population. Acta Neurologica Scandinavica 142, 632636. doi: 10.1111/ane.13307.CrossRefGoogle Scholar
Kuzman, MR, Vahip, S, Fiorillo, A, Beezhold, J, Costa, MP, da Skugarevsky, O, Dom, G, Pajevic, I, Peles, AM, Mohr, P, Kleinberg, A, Chkonia, E, Balazs, J, Flannery, W, Mazaliauskiene, R, Chihai, J, Samochowiec, J, Cozman, D, Mihajlovic, G, Izakova, L, Arango, C, Goorwod, P (2021). Mental health services during the first wave of the COVID-19 pandemic in Europe: results from the EPA Ambassadors Survey and implications for clinical practice. European Psychiatry 64. doi: 10.1192/j.eurpsy.2021.2215.Google Scholar
Leaune, E, Samuel, M, Oh, H, Poulet, E, Brunelin, J (2020). Suicidal behaviors and ideation during emerging viral disease outbreaks before the COVID-19 pandemic: a systematic rapid review. Preventive Medicine: An International Journal Devoted to Practice and Theory 141. doi: 10.1016/j.ypmed.2020.106264.CrossRefGoogle ScholarPubMed
Li, H, Glecia, A, Kent-Wilkinson, A, Leidl, D, Kleib, M, Risling, T (2021). Transition of Mental health service delivery to Telepsychiatry in response to COVID-19: a literature review. Psychiatric Quarterly 117. doi: 10.1007/s11126-021-09926-7.Google ScholarPubMed
Mafham, MM, Spata, E, Goldacre, R, Gair, D, Curnow, P, Bray, M, Hollings, S, Roebuck, C, Gale, CP, Mamas, MA, Deanfield, JE, de Belder, MA, Luescher, TF, Denwood, T, Landray, MJ, Emberson, JR, Collins, R, Morris, EJA, Casadei, B, Baigent, C (2020). COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet 396, 381389. doi: 10.1016/S0140-6736(20)31356-8.CrossRefGoogle Scholar
McIntyre, A, Tong, K, McMahon, E, Doherty, AM (2021). COVID-19 and its effect on emergency presentations to a tertiary hospital with self-harm in Ireland. Irish Journal of Psychological Medicine 38, 116122. doi: 10.1017/ipm.2020.116.CrossRefGoogle ScholarPubMed
McLoughlin, J, O’Grady, MM, Hallahan, B (2021). Impact of the covid-19 pandemic on patients with pre-existing mood disorders. Irish Journal of Psychological Medicine doi: 10.1017/ipm.2021.38.Google ScholarPubMed
Pirkis, J, John, A, Shin, S, DelPozo-Banos, M, Arya, V, Analuisa-Aguilar, P, et al. (2021). Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries. Lancet Psychiatry 8, 579588. doi: 10.1016/S2215-0366(21)00091-2.CrossRefGoogle ScholarPubMed
Plunkett, R, Costello, S, McGovern, M, McDonald, C, Hallahan, B (2021). Impact of the COVID-19 pandemic on patients with pre-existing anxiety disorders attending secondary care. Irish Journal of Psychological Medicine 38, 123131. doi: 10.1017/ipm.2020.75.CrossRefGoogle Scholar
Rainford, A, Moran, S, McMahon, E, Fahy, YP, McDonald, C, Hallahan, B (2022). A longitudinal evaluation of the impact of the COVID-19 pandemic on a cohort of patients treated with clozapine. Irish Journal of Psychological Medicine 16. doi: 10.1017/ipm.2021.84.Google ScholarPubMed
Reger, MA, Stanley, IH, Joiner, TE (2020). Suicide mortality and Coronavirus disease 2019—a perfect storm? JAMA Psychiatry 77, 10931094. doi: 10.1001/jamapsychiatry.2020.1060.CrossRefGoogle ScholarPubMed
Rojnic-Kuzman, M, Vahip, S, Fiorillo, A, Beezhold, J, Pinto da Costa, M, Skugarevsky, O, et al. (2021). Mental health services during the first wave of the COVID-19 pandemic in Europe: results from the EPA Ambassadors Survey and implications for clinical practice. European Psychiatry 64, e41.doi: 10.1192/j.eurpsy.2021.2215.CrossRefGoogle ScholarPubMed
Steeg, S, John, A, Gunnell, DJ, Kapur, N, Dekel, D, Schmidt, L, Knipe, D, Arensman, E, Hawton, K, Higgins, JPT, Eyles, E, Macleod-Hall, C, McGuiness, LA, Webb, RT (2022). The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review. British Journal of Psychiatry 110. doi: 10.1192/bjp.2022.79.Google ScholarPubMed
Tong, K, Crudden, G, Tang, WX, McGuinness, D, O’Grady, M, Doherty, AM (2021). New ways of working: COVID-19 as a catalyst for change in acute mental health service. British Medical Journal Leader. doi: 10.1136/leader-2020-000366 CrossRefGoogle Scholar
Wang, C, Pan, R, Wan, X, Tan, Y, Xu, L, Ho, CS, Ho, RC (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health 17, 1729.CrossRefGoogle ScholarPubMed
World Health Organisation (2022). WHO Coronavirus (COVID-19) Dashboard (https://covid19.who.int). Accessed 9 August 2022.Google Scholar