Clinical contact with health services for mental illness and self-harm before, during and after the COVID-19 pandemic

Date of ISAC Approval: 
02/06/2020
Lay Summary: 
The COVID-19 outbreak, beginning in early 2020, is changing the everyday lives of people globally. In the UK, a national lockdown closed schools, universities and most shops and workplaces. With the exception of essential workers, most working adults have been instructed to work from home, or to suspend work if home-working is not possible. Many of those continuing to work in the community face exposure to the virus and stressful working conditions, particularly healthcare workers. In addition, social distancing, shielding and self-isolation guidance have reduced people’s social contact significantly. A deep economic recession is predicted. The effects of these sudden changes on people’s mental health is not well understood. However, from looking at what has happened after similar disease outbreaks in other countries – and from what we understand from previous economic recessions – an increase in the numbers of people experiencing mental illness is likely. As the crisis progresses, we aim to carry out rapid examination of: - patterns of GP contact for new episodes of mental illness, self-harm, prescribing for medication for symptoms of mental illness and referrals to mental health services - numbers of contacts among people with existing mental illness or a history of self-harm. We will also examine longer term consequences of the pandemic in the general population, those with existing mental disorder and/or history of self-harm and survivors of COVID-19 infection. For this part of the study we will include data on hospital attendance for self-harm, admission for inpatient psychiatric care, and death due to alcohol-related causes and by suicide.
Technical Summary: 
We aim to: (i) examine the incidence and prevalence of primary care contact for mental illness and self-harm, and referrals to mental health services before, during and after the acute phase of the COVID-19 pandemic (Phase 1) (ii) examine longer term temporal trends in primary and secondary care contacts for mental illness, non-fatal self-harm and suicide rates, following the COVID-19 pandemic (Phase 2) (iii) follow up persons diagnosed with COVID-19 to examine likelihood of specific mental illness, fatigue syndromes and episodes of self-harm identified from primary and/or secondary care, alcohol-related hospital admission, prescriptions for psychotropic medication in primary care and death by suicide, accidental poisoning or alcohol-related causes (Phase 3). For all phases we aim to examine differences by age group, gender, ethnic group and practice-level deprivation (IMD quintiles). We will also examine trends in the modes of GP consultation over time. For Phase 1 we will use primary care electronic health records included in CPRD GOLD and CPRD Aurum. First, we will estimate incidence rates of specific mental illness diagnoses, clinically significant alcohol use, prescriptions for psychotropic medication, GP referrals to psychiatric services (such as community mental health, outpatient mental health, e.g. ‘psychiatrist’, and drug and alcohol services) and episodes of self-harm. Second, we will estimate prevalence of patient contact with general practice, prescriptions for psychotropic medication and hospital-presenting self-harm among individuals with a prior diagnosis of a mental disorder and/or history of self-harm. Primary care records will be linked to HES A&E, HES APC, HES Outpatient, patient postcode-level IMD score and ONS Death Registrations for Phase 2 and 3. Incidence rates and prevalence values will be stratified by gender, age group, ethnic group and practice-level IMD quintile. Joinpoint analysis will be used to examine significant differences in temporal trends. For Phase 3 we will use cohort study designs.
Health Outcomes to be Measured: 
Incidence of: - Mental illness diagnoses: anxiety disorder; depression; schizophrenia; bipolar disorder; psychoses; eating disorder; personality disorder; PTSD - Fatigue syndromes including chronic fatigue syndrome (CFS) and post-viral fatigue syndrome (PVFS) - Prescriptions for psychotropic medication (including benzodiazepines, antidepressants, antipsychotics and other psychotropic medicines) - Referrals to mental health services from primary care - Inpatient psychiatric care - Clinically-significant alcohol use - Non-fatal self-harm (identified from primary care records) and hospital-presenting self-harm - Alcohol-related hospital admission - Death by suicide - Death from alcohol-related causes - Death from accidental poisonings Prevalence of: - GP contact for mental illness and self-harm (including face-to-face, telephone and video consultations) - Prescriptions for psychotropic medication
Collaborators: 

Darren Ashcroft - Chief Investigator - University of Manchester
Carolyn Chew-Graham - Collaborator - Keele University
Holly Hope - Collaborator - University of Manchester
Kathryn Abel - Collaborator - University of Manchester
Matthew Carr - Collaborator - University of Manchester
Matthias Pierce - Collaborator - University of Manchester
Navneet Kapur - Collaborator - University of Manchester
Roger Webb - Collaborator - University of Manchester
Sarah Steeg - Corresponding Applicant - University of Manchester

Linkages: 
HES A&E;HES Admitted;HES Outpatient;ONS;Patient IMD;Practice IMD (Standard)