COVID-19 and its effect on emergency presentations to a tertiary hospital with self-harm in Ireland.

A Mcintyre,A M Doherty,K Tong,E Mcmahon

doi:10.1017/ipm.2020.116

A Mcintyre, A M Doherty + Show 2 more

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https://doi.org/10.1017/ipm.2020.116

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Abstract

This study aimed to assess the impact of COVID-19 on presentations to an acute hospital with self-harm. All presentations to University Hospital Galway with self-harm were assessed during the peak period of the coronavirus crisis in Ireland, over the 3 months from 1 March to 31 May 2020. These data were compared with presentations in the same months in the 3 years preceding (2017-2019). Data were obtained from the anonymised service database. This study found that in 2020, the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May. When trends over a 4-year period were examined, there was a significantly higher lethality of attempt (p < 0.001), and significant differences in diagnosis (p = 0.031) in 2020 in comparison with the three previous years. The increased lethality of presentations remained significant after age and gender were controlled for (p = 0.036). There were also significant differences in the underlying psychiatric diagnoses (p = 0.018), notably with a significant increase in substance misuse disorders presenting during the 2020 study period. COVID-19 showed a reduction in self-harm presentations initially, followed by a sharp increase in May 2020. If a period of economic instability follows as predicted, it is likely that this will further impact the mental health of the population, along with rates of self-harm and suicidal behaviours. There is a need for research into the longer-term effect of COVID-19 and lockdown restrictions, especially with respect to self-harm.

Highlights

In December 2019, the World Health Organisation (WHO) became aware of a novel coronavirus associated with atypical cases of pneumonia: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in Wuhan, China
This paper aims to assess the impact of COVID-19 and the associated social change on rates of self-harm at a tertiary university hospital in Ireland, by comparing the levels of self-harm during the periods of the pandemic with the same months and weeks in three previous years: 2017, 2018 and 2019
It is possible that people who are at risk or may have self-harmed may not have sought medical attention in the hospital setting if they perceived that the self-harm was not severe enough as to require immediate medical attention, due to the severity of the pandemic in the country at that time

Summary

Introduction

In December 2019, the World Health Organisation (WHO) became aware of a novel coronavirus associated with atypical cases of pneumonia: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in Wuhan, China. This disease, COVID-19 has since spread internationally and was declared a pandemic by the WHO on 11 March 2020. Homelessness, substance misuse and living in residential settings further increase the risk of poorer outcomes among people with SMI, in the case of exposure to COVID-19 (Thornicroft et al 2009; Green et al 2018)

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