Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: Time series analysis of electronic healthcare records for 2.8 million patients in the Greater Manchester Care Record

Background: Surveillance of temporal trends in clinically treated self-harm is an important component of sui-cide prevention in the dynamic context of COVID-19. There is little evidence beyond the initial months fol-lowing the onset of the pandemic, despite national and regional restrictions persisting to mid-2021. Methods: Descriptive time series analysis utilizing de-identified, primary care health records of 2.8 million patients from the Greater Manchester Care Record. Frequencies of self-harm episodes between 1st January 2019 and 31st May 2021 were examined, including stratification by sex, age group, ethnicity, and index of multiple deprivation quintile. Findings: There were 33,444 episodes of self-harm by 13,148 individuals recorded during the study period. Frequency ratios of incident and all episodes of self-harm were 0.59 (95% CI 0.51 to 0.69) and 0.69 (CI 0.63 to 0.75) respectively in April 2020 compared to February 2020. Between August 2020 and May 2021 frequency ratios were 0.92 (CI 0.88 to 0.96) for incident episodes and 0.86 (CI 0.84 to 0.88) for all episodes compared to the same months in 2019. Reductions were largest among men and people living in the most deprived neigh-bourhoods, while an increase in all-episode self-harm was observed for adolescents aged 10-17. Interpretation: Reductions in primary care-recorded self-harm persisted to May 2021, though they were less marked than in April 2020 during the first national lockdown. The observed reductions could represent lon -ger term reluctance to seek help from health services. Our findings have implications for the ability for serv-ices to offer recommended care for patients who have harmed themselves. Funding: This work was funded by the UK Research and Innovation/Medical Research Council COVID-19 Rapid Response Initiative (grant reference COV0499) (RTW & SS, NK, DMA, MJC) and by a University of Man-chester Presidential Fellowship (SS). MJC, DMA, NK, NP, RW, DAJ and RTW are funded by the National Insti-tute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research center. GT and NP are funded by the National Institute for Health Research (NIHR) Manchester Biomedical Research center. (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)