Primary care clinical management following self-harm during the first wave of COVID-19 in the UK: population-based cohort study

被引:4
|
作者
Steeg, Sarah [1 ,2 ,3 ]
Carr, Matthew [1 ,2 ,4 ,5 ]
Trefan, Laszlo [1 ,2 ]
Ashcroft, Darren [2 ,3 ,4 ,5 ]
Kapur, Navneet [1 ,2 ,5 ,6 ]
Nielsen, Emma [7 ]
McMillan, Brian [8 ]
Webb, Roger [1 ,2 ,5 ]
机构
[1] Univ Manchester, Ctr Mental Hlth & Safety, Manchester, Lancs, England
[2] Univ Manchester, Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England
[3] Univ Manchester, Sch Primary Care Res, Natl Inst Hlth Res, Manchester, Lancs, England
[4] Univ Manchester, Ctr Pharmacoepidemiol & Drug Safety, Manchester, Lancs, England
[5] Univ Manchester, Greater Manchester Patient Safety Translat Res Ct, Natl Inst Hlth Res, Manchester, Lancs, England
[6] Greater Manchester Mental Hlth NHS Fdn Trust, Manchester, Lancs, England
[7] Univ Nottingham, Sch Psychol, Self Harm Res Grp, Nottingham, England
[8] Univ Manchester, Ctr Primary Care & Hlth Serv Res, Manchester, Lancs, England
来源
BMJ OPEN | 2022年 / 12卷 / 02期
基金
英国科研创新办公室;
关键词
primary care; suicide & self-harm; public health; COVID-19; MENTAL-HEALTH; DIAGNOSIS;
D O I
10.1136/bmjopen-2021-052613
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives A substantial reduction in self-harm recorded in primary care occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown. Our objectives were to examine the impact of COVID-19 on clinical management within 3 months of an episode of self-harm. Design Retrospective cohort study. Setting UK primary care. Participants 4238 patients with an index episode of self-harm recorded in UK primary care during the COVID-19 first-wave period (10 March 2020-10 June 2020) compared with 48 739 patients in a prepandemic comparison period (10 March-10 June, 2010-2019). Outcome measures Using data from the UK Clinical Practice Research Datalink, we compared cohorts of patients with an index self-harm episode recorded during the prepandemic period versus the COVID-19 first-wave period. Patients were followed up for 3 months to capture subsequent general practitioner (GP)/practice nurse consultation, referral to mental health services and psychotropic medication prescribing. We examined differences by gender, age group and Index of Multiple Deprivation quintile. Results Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (4.2%) was around two-thirds of that in the prepandemic cohort (6.1%). Similar proportions were prescribed psychotropic medication within 3 months in the prepandemic (54.0%) and COVID-19 first-wave (54.9%) cohorts. Conclusions Despite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to prepandemic levels. We found no evidence of widening of digital exclusion in terms of access to remote consultations. However, the reduced likelihood of referral to mental health services warrants attention. Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.
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页数:8
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