Published online: December 10, 2020
Nav Kapur, Caroline Clements, Louis Appleby, Keith Hawton, Sarah Steeg, Keith Waters, Roger Webb
The Lancet Psychiatry
There has been extensive discussion, some of it data-based1 but much of it speculative, on the effect of the COVID-19 pandemic on suicide. Since death by suicide requires thorough investigation by professionals, such as coroners, collecting timely data on these deaths is challenging. Self-harm, an important public health concern in its own right, often precedes suicide, and can be used as a proxy outcome to identify how the pandemic has affected population mental health.
People who have self-harmed might present to different parts of the health-care service. Presentation to the emergency department is common, but comprehensive UK-wide data on self-harm in this setting are scarce. However, local analyses of hospital activity can be informative. An examination of clinical records in one large provider of mental health services in England, UK, showed a 40% decrease in self-harm referrals to liaison psychiatry in the 6 weeks after the lockdown, followed by an increase in referrals to previous levels.2 This reduction is consistent with data from our own long-established self-harm monitoring systems.3 Individuals might also present to primary care with self-harm. A study of 1500 general practices in the UK using the Clinical Practice Research Datalink found that the recorded incidence of self-harm was 38% lower in April, 2020, than the rate expected on the basis of previous years.4 This decrease was particularly marked in women, people younger than 45 years, and those from the most deprived quintile of practices.
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