Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: Time series analysis of electronic healthcare records for 2.8 million patients in the Greater Manchester Care Record.

Sarah Steeg,Darren M Ashcroft,Roger T Webb,David A Jenkins,Niels Peek,Matthew J Carr,Lana Bojanić,George Tilston,Richard Williams,Jennifer Voorhees,Nav Kapur

doi:10.1016/j.eclinm.2021.101175

Abstract

SummaryBackgroundSurveillance of temporal trends in clinically treated self-harm is an important component of suicide prevention in the dynamic context of COVID-19. There is little evidence beyond the initial months following the onset of the pandemic, despite national and regional restrictions persisting to mid-2021.MethodsDescriptive time series analysis utilizing de-identified, primary care health records of 2.8 million patients from the Greater Manchester Care Record. Frequencies of self-harm episodes between 1st January 2019 and 31st May 2021 were examined, including stratification by sex, age group, ethnicity, and index of multiple deprivation quintile.FindingsThere were 33,444 episodes of self-harm by 13,148 individuals recorded during the study period. Frequency ratios of incident and all episodes of self-harm were 0.59 (95% CI 0.51 to 0.69) and 0.69 (CI 0.63 to 0.75) respectively in April 2020 compared to February 2020. Between August 2020 and May 2021 frequency ratios were 0.92 (CI 0.88 to 0.96) for incident episodes and 0.86 (CI 0.84 to 0.88) for all episodes compared to the same months in 2019. Reductions were largest among men and people living in the most deprived neighbourhoods, while an increase in all-episode self-harm was observed for adolescents aged 10–17.InterpretationReductions in primary care-recorded self-harm persisted to May 2021, though they were less marked than in April 2020 during the first national lockdown. The observed reductions could represent longer term reluctance to seek help from health services. Our findings have implications for the ability for services to offer recommended care for patients who have harmed themselves.

Highlights

Surveillance of temporal trends in the frequency of clinically treated self-harm episodes has been identified as www.thelancet.com Vol xx Month xx, 2021Research in contextEvidence before the studyA living systematic review examining the impact of COVID-19 on rates of self-harm and suicidality, was used to identify evidence up to 31st May 2021 using the following sources: World Health Organization, PubMed, medRxiv, Elsevier, Scopus, Psy- and SocArXiv, bioRxiv, PMC, CZI and ArXiv The majority of studies reported reductions in the numbers of people seeking help for self-harm in the months following the start of the COVID-19 pandemic in March 2020, with some studies suggesting rates had returned to expected levels by July 2020
Frequency ratios of incident and all episodes of self-harm were 0.59 and 0.69 (CI 0.63 to 0.75) respectively in April 2020 compared to February 2020
We examined differences in temporal trends according to sex, age group, ethnicity and Index of Multiple Deprivation (IMD) quintile

Summary

Introduction

Surveillance of temporal trends in the frequency of clinically treated self-harm episodes has been identified as www.thelancet.com Vol xx Month xx, 2021Research in contextEvidence before the studyA living systematic review examining the impact of COVID-19 on rates of self-harm and suicidality, was used to identify evidence up to 31st May 2021 using the following sources: World Health Organization, PubMed, medRxiv, Elsevier, Scopus, Psy- and SocArXiv, bioRxiv, PMC, CZI and ArXiv (full list of search terms used in the living systematic review can be found in the registered protocol.) The majority of studies reported reductions in the numbers of people seeking help for self-harm in the months following the start of the COVID-19 pandemic in March 2020, with some studies suggesting rates had returned to expected levels by July 2020. Surveillance of temporal trends in the frequency of clinically treated self-harm episodes has been identified as www.thelancet.com Vol xx Month xx, 2021. There is little evidence regarding clinical presentations for self-harm beyond mid-2020 and into 2021, despite further waves of COVID-19 and ongoing national and regional restrictions. This study uses near real-time data from a population of 2.8 million residents in Greater Manchester, UK to examine frequencies of monthly primary care recorded selfharm from March 2020 to May 2021 compared to the same months in 2019. We observed larger reductions in men and people living in more deprived neighbourhoods and an increase in recorded self-harm among young people aged 10 −17 years.

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