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

Sarah Steeg; Ann John; David J Gunnell; Nav Kapur; Dana Dekel; Lena Schmidt; Duleeka  Knipe; Ella Arensman; Keith Hawton; Julian P T Higgins; Emily Eyles; Catherine I A Macleod-Hall; Luke McGuinness; Roger T. Webb

doi:10.1101/2022.01.26.22269901

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

Sarah Steeg^*, Ann John, David J Gunnell, Nav Kapur, Dana Dekel, Lena Schmidt, Duleeka Knipe, Ella Arensman, Keith Hawton, Julian P T Higgins, Emily Eyles, Catherine I A Macleod-Hall, Luke McGuinness, Roger T. Webb

^*Corresponding author for this work

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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.

Original language	English
Pages (from-to)	603-612
Number of pages	10
Journal	BJPsych Open
Volume	221
Issue number	4
Early online date	11 Jul 2022
DOIs	https://doi.org/10.1101/2022.01.26.22269901 https://doi.org/10.1192/bjp.2022.79
Publication status	E-pub ahead of print - 11 Jul 2022

Bibliographical note

Funding Information:
S.S. is funded by a University of Manchester Presidential Fellowship. N.K. and R.T.W. are funded by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) at the Northern Care Alliance NHS Foundation Trust and the University of Manchester (grant no. PSTRC-2016-003). J.P.T.H. is an NIHR Senior Investigator (grant nos., until March 2022: NF-SI-0617-10145; from April 2022: NIHR203807). D.J.G. and J.P.T.H. are both are supported by the NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (grant no. BRC-1215-20011). J.P.T.H. and E.E. are supported by the NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (grant no. NIHR200181). D.K. was supported by the Wellcome Trust through an Institutional Strategic Support Fund Award to the Elizabeth Blackwell Institute for Health Research, University of Bristol (grant no. 204813/Z/16/Z).

Publisher Copyright:
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

Structured keywords

SASH

Keywords

Epidemiology
self-harm
primary care
suicide
COVID-19

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The impact of COVID-19 on self-harm and suicidal behaviour: a living systematic review
Gunnell, D. J., Higgins, J. P. T., John, A., Knipe, D., Webb, R., Moran, P. A., Schmidt, L., Eyles, E. C. & McGuinness, L.
1/05/20 → 1/12/22
Project: Research

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Steeg, S., John, A., Gunnell, D. J., Kapur, N., Dekel, D., Schmidt, L., Knipe, D., Arensman, E., Hawton, K., Higgins, J. P. T., Eyles, E., Macleod-Hall, C. I. A., McGuinness, L., & Webb, R. T. (2022). The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review. BJPsych Open, 221(4), 603-612. https://doi.org/10.1101/2022.01.26.22269901, https://doi.org/10.1192/bjp.2022.79

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

abstract = "BackgroundEvidence 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.AimsTo systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic.MethodA 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.ResultsFifty-one studies were included: 57% (29/51) were rated as {\textquoteleft}low{\textquoteright} quality, 31% (16/51) as {\textquoteleft}moderate{\textquoteright} and 12% (6/51) as {\textquoteleft}high-moderate{\textquoteright}. 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.ConclusionsSustained 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 = "Epidemiology, self-harm, primary care, suicide, COVID-19",

author = "Sarah Steeg and Ann John and Gunnell, {David J} and Nav Kapur and Dana Dekel and Lena Schmidt and Duleeka Knipe and Ella Arensman and Keith Hawton and Higgins, {Julian P T} and Emily Eyles and Macleod-Hall, {Catherine I A} and Luke McGuinness and Webb, {Roger T.}",

note = "Funding Information: S.S. is funded by a University of Manchester Presidential Fellowship. N.K. and R.T.W. are funded by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) at the Northern Care Alliance NHS Foundation Trust and the University of Manchester (grant no. PSTRC-2016-003). J.P.T.H. is an NIHR Senior Investigator (grant nos., until March 2022: NF-SI-0617-10145; from April 2022: NIHR203807). D.J.G. and J.P.T.H. are both are supported by the NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (grant no. BRC-1215-20011). J.P.T.H. and E.E. are supported by the NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (grant no. NIHR200181). D.K. was supported by the Wellcome Trust through an Institutional Strategic Support Fund Award to the Elizabeth Blackwell Institute for Health Research, University of Bristol (grant no. 204813/Z/16/Z). Publisher Copyright: Copyright {\textcopyright} The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.",

year = "2022",

month = jul,

day = "11",

doi = "10.1101/2022.01.26.22269901",

language = "English",

volume = "221",

pages = "603--612",

journal = "BJPsych Open",

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publisher = "Royal College of Psychiatrists",

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Steeg, S, John, A, Gunnell, DJ, Kapur, N, Dekel, D, Schmidt, L, Knipe, D, Arensman, E, Hawton, K, Higgins, JPT , Eyles, E, Macleod-Hall, CIA, McGuinness, L & Webb, RT 2022, 'The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review', BJPsych Open, vol. 221, no. 4, pp. 603-612. https://doi.org/10.1101/2022.01.26.22269901, https://doi.org/10.1192/bjp.2022.79

TY - JOUR

T1 - The impact of the COVID-19 pandemic on presentations to health services following self-harm

T2 - systematic review

AU - Steeg, Sarah

AU - John, Ann

AU - Gunnell, David J

AU - Kapur, Nav

AU - Dekel, Dana

AU - Schmidt, Lena

AU - Knipe, Duleeka

AU - Arensman, Ella

AU - Hawton, Keith

AU - Higgins, Julian P T

AU - Eyles, Emily

AU - Macleod-Hall, Catherine I A

AU - McGuinness, Luke

AU - Webb, Roger T.

N1 - Funding Information: S.S. is funded by a University of Manchester Presidential Fellowship. N.K. and R.T.W. are funded by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) at the Northern Care Alliance NHS Foundation Trust and the University of Manchester (grant no. PSTRC-2016-003). J.P.T.H. is an NIHR Senior Investigator (grant nos., until March 2022: NF-SI-0617-10145; from April 2022: NIHR203807). D.J.G. and J.P.T.H. are both are supported by the NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (grant no. BRC-1215-20011). J.P.T.H. and E.E. are supported by the NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (grant no. NIHR200181). D.K. was supported by the Wellcome Trust through an Institutional Strategic Support Fund Award to the Elizabeth Blackwell Institute for Health Research, University of Bristol (grant no. 204813/Z/16/Z). Publisher Copyright: Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

PY - 2022/7/11

Y1 - 2022/7/11

N2 - BackgroundEvidence 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.AimsTo systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic.MethodA 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.ResultsFifty-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.ConclusionsSustained 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.

AB - BackgroundEvidence 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.AimsTo systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic.MethodA 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.ResultsFifty-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.ConclusionsSustained 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.

KW - Epidemiology

KW - self-harm

KW - primary care

KW - suicide

KW - COVID-19

U2 - 10.1101/2022.01.26.22269901

DO - 10.1101/2022.01.26.22269901

M3 - Article (Academic Journal)

C2 - 35816104

VL - 221

SP - 603

EP - 612

JO - BJPsych Open

JF - BJPsych Open

SN - 2056-4724

IS - 4

ER -

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

Abstract

Bibliographical note

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Keywords

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The impact of COVID-19 on self-harm and suicidal behaviour: a living systematic review

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