The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review. (October 2022)

• Record Type: Journal Article
• Authors: Steeg, Sarah; John, Ann; Gunnell, David J.; Kapur, Nav; Dekel, Dana; Schmidt, Lena; Knipe, Duleeka; Arensman, Ella; Hawton, Keith; Higgins, Julian P. T.; Eyles, Emily; Macleod-Hall, Catherine; McGuiness, Luke A.; Webb, Roger T.
• Is Part Of: British journal of psychiatry. Volume 221:Number 4(2022)
• Page Start: 603
• Page End: 612
• Publication Date: 2022-10
• Subjects: Epidemiology -- self-harm -- primary care -- suicide -- COVID-19; Psychiatry -- Periodicals; Psychology, Pathological -- Periodicals; 616.89005
• DOI: 10.1192/bjp.2022.79
• Languages: English
• ISSNs: 0007-1250

Abstract

Abstract : Background: Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. Aims: To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic. Method: A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool. Results: Fifty-one studies were included: 57% (29/51) were rated as 'low' quality, 31% (16/51) as 'moderate' and 12% (6/51) as 'high-moderate'. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17–56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls. Conclusions: Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.