Abstract
To date, there is a paucity of information regarding the effect of COVID-19 or lockdown on mental disorders. We aimed to quantify the medium-term impact of lockdown on referrals to secondary care mental health clinical services. We conducted a controlled interrupted time series study using data from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment population ~0.86 million). The UK lockdown resulted in an instantaneous drop in mental health referrals but then a longer-term acceleration in the referral rate (by 1.21 referrals per day per day, 95% confidence interval [CI] 0.41–2.02). This acceleration was primarily for urgent or emergency referrals (acceleration 0.96, CI 0.39–1.54), including referrals to liaison psychiatry (0.68, CI 0.35–1.02) and mental health crisis teams (0.61, CI 0.20–1.02). The acceleration was significant for females (0.56, CI 0.04–1.08), males (0.64, CI 0.05–1.22), working-age adults (0.93, CI 0.42–1.43), people of White ethnicity (0.98, CI 0.32–1.65), those living alone (1.26, CI 0.52–2.00), and those who had pre-existing depression (0.78, CI 0.19–1.38), severe mental illness (0.67, CI 0.19–1.15), hypertension/cardiovascular/cerebrovascular disease (0.56, CI 0.24–0.89), personality disorders (0.32, CI 0.12–0.51), asthma/chronic obstructive pulmonary disease (0.28, CI 0.08–0.49), dyslipidemia (0.26, CI 0.04–0.47), anxiety (0.21, CI 0.08–0.34), substance misuse (0.21, CI 0.08–0.34), or reactions to severe stress (0.17, CI 0.01–0.32). No significant post-lockdown acceleration was observed for children/adolescents, older adults, people of ethnic minorities, married/cohabiting people, and those who had previous/pre-existing dementia, diabetes, cancer, eating disorder, a history of self-harm, or intellectual disability. This evidence may help service planning and policy-making, including preparation for any future lockdown in response to outbreaks.
Highlights
The 2019 novel coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020 [1]
There was an immediate decrease in the number of referrals to mental health services
After lockdown, there was a substantial drop in the referral rate and an acceleration of referrals compared to the control period
Summary
The 2019 novel coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020 [1]. Li et al [2] surveyed 5,033 individuals from the general population in China following the local onset of COVID-19 and found that 20.4% of people had anxiety or depression or both. The effects of the COVID19 pandemic and state-imposed lockdown on public mental health in a clinical setting have not been evaluated systematically, and current evidence is mainly based on online surveys. The evidence relating to long-term consequences of the COVID-19 lockdown upon mental health is sparse [6]. Such evidence is urgently needed to inform interventions and for policy makers to formulate an appropriate response
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