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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

Marcos del Pozo Banos Orcid Logo, Sze Chim Lee, Yasmin Friedmann, Ashley Akbari Orcid Logo, Fatemeh Torabi, Keith Lloyd Orcid Logo, Ronan Lyons Orcid Logo, Ann John Orcid Logo

PLOS ONE, Volume: 17, Issue: 4, Start page: e0266967

Swansea University Authors: Marcos del Pozo Banos Orcid Logo, Sze Chim Lee, Yasmin Friedmann, Ashley Akbari Orcid Logo, Fatemeh Torabi, Keith Lloyd Orcid Logo, Ronan Lyons Orcid Logo, Ann John Orcid Logo

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DOI (Published version): 10.1371/journal.pone.0266967

Abstract

Reduced rates of help seeking by those who self-harmed during the COVID-19 pandemic have been reported. ObjectivesTo understand changes in healthcare service contacts for self-harm during the COVID-19 pandemic across primary, emergency and secondary care.MethodsThis retrospective cohort study used r...

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ISSN: 1932-6203
Published: Public Library of Science (PLoS) 2022
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ObjectivesTo understand changes in healthcare service contacts for self-harm during the COVID-19 pandemic across primary, emergency and secondary care.MethodsThis retrospective cohort study used routine electronic healthcare data for Wales, United Kingdom, from 2016 to March 14, 2021. Population-based data from primary care, emergency departments and hospital admissions were linked at individual-level. All Welsh residents aged ≥10 years over the study period were included in the study. Primary, emergency and secondary care contacts with self-harm at any time between 2016 and March 14, 2021 were identified. Outcomes were counts, incidence, prevalence and proportion of self-harm contacts relative to all contacts in each and all settings, as well as the proportion of people contacting one or more settings with self-harm. Weekly trends were modelled using generalised estimated equations, with differences between 2020 (to March 2021) and comparison years 2016-2018 (to March 2017-2019) quantified using difference in differences, from which mean rate of odds ratios (μROR) across years was reported.ResultsThe study included 3,552,210 individuals over the study period. Self-harm contacts reduced across services in March and December 2020 compared to previous years. Primary care contacts with self-harm reduced disproportionately compared to non-self-harm contacts (μROR=0.7, p&lt;0.05), while their proportion increased in emergency departments during April 2020 (μROR=1.3, p&lt;0.05 in 2/3 comparison years) and hospital admissions during April-May 2020 (μROR=1.2, p&lt;0.05 in 2/3 comparison years). Despite this, those who self-harmed in April 2020 were more likely to be seen in primary care than other settings compared to previous years (μROR=1.2, p&lt;0.05). A lower proportion of those with self-harm contacts in emergency departments were subsequently admitted to hospital in December 2020 compared to previous years (μROR=0.5, p&lt;0.05).ConclusionsThese findings suggest that those who self-harmed during the COVID-19 pandemic may have been less likely to seek help, and those who did so faced more stringent criteria for admission. Communications encouraging those who self-harm to seek help during pandemics may be beneficial. However, this needs to be supported by maintained provision of mental health services.</abstract><type>Journal Article</type><journal>PLOS ONE</journal><volume>17</volume><journalNumber>4</journalNumber><paginationStart>e0266967</paginationStart><paginationEnd/><publisher>Public Library of Science (PLoS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1932-6203</issnElectronic><keywords>Healthcare, COVID-19, Wales</keywords><publishedDay>27</publishedDay><publishedMonth>4</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-04-27</publishedDate><doi>10.1371/journal.pone.0266967</doi><url/><notes>This study makes use of anonymized data held in the Secure Anonymised Information Linkage (SAIL) Databank. This work uses data provided by patients and collected by the NHS as part of their care and support. We would also like to acknowledge all data providers who make anonymized data available for research. We wish to acknowledge the collaborative partnership that enabled acquisition and access to the de-identified data, which led to this output. The collaboration was led by the Swansea University Health Data Research UK team under the direction of the Welsh Government Technical Advisory Cell (TAC) and includes the following groups and organizations: the SAIL Databank, Administrative Data Research (ADR) Wales, Digital Health and Care Wales (DHCW), Public Health Wales, NHS Shared Services Partnership (NWSSP) and the Welsh Ambulance Service Trust (WAST). All research conducted has been completed under the permission and approval of the SAIL independent Information Governance Review Panel (IGRP) project number 0911.</notes><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>WT_/Wellcome Trust/United Kingdom, MR/V028367/1/MRC_/Medical Research Council/United Kingdom, CSO_/Chief Scientist Office/United Kingdom, BHF_/British Heart Foundation/United Kingdom</funders><projectreference>This study makes use of anonymized data held in the Secure Anonymised Information Linkage (SAIL) Databank. This work uses data provided by patients and collected by the NHS as part of their care and support. We would also like to acknowledge all data providers who make anonymized data available for research. We wish to acknowledge the collaborative partnership that enabled acquisition and access to the de-identified data, which led to this output. The collaboration was led by the Swansea University Health Data Research UK team under the direction of the Welsh Government Technical Advisory Cell (TAC) and includes the following groups and organizations: the SAIL Databank, Administrative Data Research (ADR) Wales, Digital Health and Care Wales (DHCW), Public Health Wales, NHS Shared Services Partnership (NWSSP) and the Welsh Ambulance Service Trust (WAST). All research conducted has been completed under the permission and approval of the SAIL independent Information Governance Review Panel (IGRP) project number 0911.</projectreference><lastEdited>2024-07-15T12:11:09.9904864</lastEdited><Created>2022-04-12T14:32:26.7778976</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Marcos</firstname><surname>del Pozo Banos</surname><orcid>0000-0003-1502-389X</orcid><order>1</order></author><author><firstname>Sze Chim</firstname><surname>Lee</surname><order>2</order></author><author><firstname>Yasmin</firstname><surname>Friedmann</surname><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><order>5</order></author><author><firstname>Keith</firstname><surname>Lloyd</surname><orcid>0000-0002-1440-4124</orcid><order>6</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>7</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>8</order></author></authors><documents><document><filename>59804__23944__d67a8ed3a4ac4500bca7731c33e3d226.pdf</filename><originalFilename>59804.VOR.pdf</originalFilename><uploaded>2022-04-29T16:29:03.2528677</uploaded><type>Output</type><contentLength>1821048</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Distributed under the terms of a Creative Commons Attribution 4.0 licence (CC-BY).</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 59804 2022-04-12 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 f141785b1c0ab9efe45665d35c081b84 0000-0003-1502-389X Marcos del Pozo Banos Marcos del Pozo Banos true false 10628af4988d624b49c4de7bd78b4694 Sze Chim Lee Sze Chim Lee true false 94dd4462b95e78880040791727786dfc Yasmin Friedmann Yasmin Friedmann true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 82d3ece22f59fb20bd77eaf40c36e03b Fatemeh Torabi Fatemeh Torabi true false a13aaa0df9045c205e82ed3b95d18c10 0000-0002-1440-4124 Keith Lloyd Keith Lloyd true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2022-04-12 MEDS Reduced rates of help seeking by those who self-harmed during the COVID-19 pandemic have been reported. ObjectivesTo understand changes in healthcare service contacts for self-harm during the COVID-19 pandemic across primary, emergency and secondary care.MethodsThis retrospective cohort study used routine electronic healthcare data for Wales, United Kingdom, from 2016 to March 14, 2021. Population-based data from primary care, emergency departments and hospital admissions were linked at individual-level. All Welsh residents aged ≥10 years over the study period were included in the study. Primary, emergency and secondary care contacts with self-harm at any time between 2016 and March 14, 2021 were identified. Outcomes were counts, incidence, prevalence and proportion of self-harm contacts relative to all contacts in each and all settings, as well as the proportion of people contacting one or more settings with self-harm. Weekly trends were modelled using generalised estimated equations, with differences between 2020 (to March 2021) and comparison years 2016-2018 (to March 2017-2019) quantified using difference in differences, from which mean rate of odds ratios (μROR) across years was reported.ResultsThe study included 3,552,210 individuals over the study period. Self-harm contacts reduced across services in March and December 2020 compared to previous years. Primary care contacts with self-harm reduced disproportionately compared to non-self-harm contacts (μROR=0.7, p<0.05), while their proportion increased in emergency departments during April 2020 (μROR=1.3, p<0.05 in 2/3 comparison years) and hospital admissions during April-May 2020 (μROR=1.2, p<0.05 in 2/3 comparison years). Despite this, those who self-harmed in April 2020 were more likely to be seen in primary care than other settings compared to previous years (μROR=1.2, p<0.05). A lower proportion of those with self-harm contacts in emergency departments were subsequently admitted to hospital in December 2020 compared to previous years (μROR=0.5, p<0.05).ConclusionsThese findings suggest that those who self-harmed during the COVID-19 pandemic may have been less likely to seek help, and those who did so faced more stringent criteria for admission. Communications encouraging those who self-harm to seek help during pandemics may be beneficial. However, this needs to be supported by maintained provision of mental health services. Journal Article PLOS ONE 17 4 e0266967 Public Library of Science (PLoS) 1932-6203 Healthcare, COVID-19, Wales 27 4 2022 2022-04-27 10.1371/journal.pone.0266967 This study makes use of anonymized data held in the Secure Anonymised Information Linkage (SAIL) Databank. This work uses data provided by patients and collected by the NHS as part of their care and support. We would also like to acknowledge all data providers who make anonymized data available for research. We wish to acknowledge the collaborative partnership that enabled acquisition and access to the de-identified data, which led to this output. The collaboration was led by the Swansea University Health Data Research UK team under the direction of the Welsh Government Technical Advisory Cell (TAC) and includes the following groups and organizations: the SAIL Databank, Administrative Data Research (ADR) Wales, Digital Health and Care Wales (DHCW), Public Health Wales, NHS Shared Services Partnership (NWSSP) and the Welsh Ambulance Service Trust (WAST). All research conducted has been completed under the permission and approval of the SAIL independent Information Governance Review Panel (IGRP) project number 0911. COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) WT_/Wellcome Trust/United Kingdom, MR/V028367/1/MRC_/Medical Research Council/United Kingdom, CSO_/Chief Scientist Office/United Kingdom, BHF_/British Heart Foundation/United Kingdom This study makes use of anonymized data held in the Secure Anonymised Information Linkage (SAIL) Databank. This work uses data provided by patients and collected by the NHS as part of their care and support. We would also like to acknowledge all data providers who make anonymized data available for research. We wish to acknowledge the collaborative partnership that enabled acquisition and access to the de-identified data, which led to this output. The collaboration was led by the Swansea University Health Data Research UK team under the direction of the Welsh Government Technical Advisory Cell (TAC) and includes the following groups and organizations: the SAIL Databank, Administrative Data Research (ADR) Wales, Digital Health and Care Wales (DHCW), Public Health Wales, NHS Shared Services Partnership (NWSSP) and the Welsh Ambulance Service Trust (WAST). All research conducted has been completed under the permission and approval of the SAIL independent Information Governance Review Panel (IGRP) project number 0911. 2024-07-15T12:11:09.9904864 2022-04-12T14:32:26.7778976 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Marcos del Pozo Banos 0000-0003-1502-389X 1 Sze Chim Lee 2 Yasmin Friedmann 3 Ashley Akbari 0000-0003-0814-0801 4 Fatemeh Torabi 5 Keith Lloyd 0000-0002-1440-4124 6 Ronan Lyons 0000-0001-5225-000X 7 Ann John 0000-0002-5657-6995 8 59804__23944__d67a8ed3a4ac4500bca7731c33e3d226.pdf 59804.VOR.pdf 2022-04-29T16:29:03.2528677 Output 1821048 application/pdf Version of Record true Distributed under the terms of a Creative Commons Attribution 4.0 licence (CC-BY). true eng https://creativecommons.org/licenses/by/4.0/
title 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
spellingShingle 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
Marcos del Pozo Banos
Sze Chim Lee
Yasmin Friedmann
Ashley Akbari
Fatemeh Torabi
Keith Lloyd
Ronan Lyons
Ann John
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv f141785b1c0ab9efe45665d35c081b84
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a13aaa0df9045c205e82ed3b95d18c10
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author_id_fullname_str_mv f141785b1c0ab9efe45665d35c081b84_***_Marcos del Pozo Banos
10628af4988d624b49c4de7bd78b4694_***_Sze Chim Lee
94dd4462b95e78880040791727786dfc_***_Yasmin Friedmann
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
82d3ece22f59fb20bd77eaf40c36e03b_***_Fatemeh Torabi
a13aaa0df9045c205e82ed3b95d18c10_***_Keith Lloyd
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Marcos del Pozo Banos
Sze Chim Lee
Yasmin Friedmann
Ashley Akbari
Fatemeh Torabi
Keith Lloyd
Ronan Lyons
Ann John
author2 Marcos del Pozo Banos
Sze Chim Lee
Yasmin Friedmann
Ashley Akbari
Fatemeh Torabi
Keith Lloyd
Ronan Lyons
Ann John
format Journal article
container_title PLOS ONE
container_volume 17
container_issue 4
container_start_page e0266967
publishDate 2022
institution Swansea University
issn 1932-6203
doi_str_mv 10.1371/journal.pone.0266967
publisher Public Library of Science (PLoS)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description Reduced rates of help seeking by those who self-harmed during the COVID-19 pandemic have been reported. ObjectivesTo understand changes in healthcare service contacts for self-harm during the COVID-19 pandemic across primary, emergency and secondary care.MethodsThis retrospective cohort study used routine electronic healthcare data for Wales, United Kingdom, from 2016 to March 14, 2021. Population-based data from primary care, emergency departments and hospital admissions were linked at individual-level. All Welsh residents aged ≥10 years over the study period were included in the study. Primary, emergency and secondary care contacts with self-harm at any time between 2016 and March 14, 2021 were identified. Outcomes were counts, incidence, prevalence and proportion of self-harm contacts relative to all contacts in each and all settings, as well as the proportion of people contacting one or more settings with self-harm. Weekly trends were modelled using generalised estimated equations, with differences between 2020 (to March 2021) and comparison years 2016-2018 (to March 2017-2019) quantified using difference in differences, from which mean rate of odds ratios (μROR) across years was reported.ResultsThe study included 3,552,210 individuals over the study period. Self-harm contacts reduced across services in March and December 2020 compared to previous years. Primary care contacts with self-harm reduced disproportionately compared to non-self-harm contacts (μROR=0.7, p<0.05), while their proportion increased in emergency departments during April 2020 (μROR=1.3, p<0.05 in 2/3 comparison years) and hospital admissions during April-May 2020 (μROR=1.2, p<0.05 in 2/3 comparison years). Despite this, those who self-harmed in April 2020 were more likely to be seen in primary care than other settings compared to previous years (μROR=1.2, p<0.05). A lower proportion of those with self-harm contacts in emergency departments were subsequently admitted to hospital in December 2020 compared to previous years (μROR=0.5, p<0.05).ConclusionsThese findings suggest that those who self-harmed during the COVID-19 pandemic may have been less likely to seek help, and those who did so faced more stringent criteria for admission. Communications encouraging those who self-harm to seek help during pandemics may be beneficial. However, this needs to be supported by maintained provision of mental health services.
published_date 2022-04-27T12:11:08Z
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