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Wang J, Zhang X, Deng H, Tan Y. The Effect of the COVID-19 Pandemic Lockdown on Self-Harm: A Meta-Analysis. ALPHA PSYCHIATRY 2025; 26:39868. [PMID: 40352079 PMCID: PMC12059762 DOI: 10.31083/ap39868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 09/11/2024] [Accepted: 09/24/2024] [Indexed: 05/14/2025]
Abstract
Objective The Coronavirus disease 2019 (COVID-19) pandemic caused a range of mental health problems, particularly self-harm. Lockdowns are the usual methods of responding to these public health emergencies. However, the effect of the COVID-19 lockdown on self-harm remains poorly characterized. This study aimed to investigate the influence of the COVID-19 pandemic on the incidence of self-harm. The findings may inform future policy development and strategies for managing pandemic-related mental health challenges. Methods A meta-analysis was conducted using several database searches: APA PsycINFO, Embase, PubMed, Web of Science, CNKI, and Wan Fang. Published studies with data on the incidence of self-harm during visits to medical institutions, before and during the COVID-19 pandemic, were included. The pooled risk ratio (RR) value of self-harm incidence variation before and during the COVID-19 lockdown period, expressed as the comparison of clinical institution visits before and during the pandemic, was calculated. Results Fifteen retrospective cohort studies with observational designs involving 253,600 participants were included. The pooled RR value of self-harm incidence variation was 1.386 (95% confidence interval (CI), 1.205-1.595, I2 = 58.9%, p = 0.002). The subgroup analysis showed that "emergency department type" (p = 0.004) and "mean age of the sample" were the sources of the RR values' heterogeneity (p = 0.026). Conclusions Our findings suggest that the lockdown during the COVID-19 pandemic was a risk factor for self-harm. Therefore, special attention should be paid to individuals visiting the emergency department and the middle-aged and elderly populations. The PROSPERO Registration This study was registered in PROSPERO (CRD42023373026), https://www.crd.york.ac.uk/PROSPERO/view/CRD42023373026.
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Affiliation(s)
- Jue Wang
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, 100096 Beijing, China
| | - Xueqian Zhang
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, 100096 Beijing, China
| | - Hu Deng
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, 100096 Beijing, China
| | - Yunlong Tan
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, 100096 Beijing, China
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Sen MS, Deep R, Chawla N, Sagar R, Chadda RK. Pattern of Psychiatric Emergencies in Children and Adolescents at a Tertiary Care Centre After Onset of COVID-19 Pandemic. Indian Pediatr 2023; 60. [PMID: 36786181 PMCID: PMC10019384 DOI: 10.1007/s13312-023-2810-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVES To assess changes in profile of psychiatric emergencies in children and adolescents (aged <19 year) during the coronavirus disease 2019 (COVID-19) pandemic compared to pre-pandemic period. METHODS The psychiatric emergency records were analyzed for the period of April, 2019 - September, 2021 to assess the pattern and profile of mental health emergencies in children and adolescents in the period before and after the onset of the pandemic lockdown (i.e., 23 March, 2020). RESULTS 379 consecutive child and adolescent psychiatric emergencies were identified, of which 219 were seen after the onset of pandemic. Commonest reason for referral in the pandemic group was attempted self-harm (44.3%). The ICD-10 neurotic, stress-related and somatoform disorders constituted the commonest diagnostic category, similar to pre-pandemic period. A significantly higher proportion (44% vs 28%) of children was prescribed benzodiazepines in the pandemic period, compared to the pre-pandemic period. CONCLUSION The average monthly psychiatric emergencies in children and adolescents showed no increase during the pandemic period. Self-harm was the commonest cause of psychiatric referral in emergency services mental health crisis in the younger population.
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Affiliation(s)
- Mahadev Singh Sen
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi
| | - Raman Deep
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi
| | - Nishtha Chawla
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi
| | - Rakesh Kumar Chadda
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi. Correspondence to: Prof Rakesh Kumar Chadda, Chief, NDDTC, Professor and Head, Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029.
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Goldschmidt T, Kippe Y, Finck A, Adam M, Hamadoun H, Winkler JG, Bermpohl F, Schouler-Ocak M, Gutwinski S. Psychiatric presentations and admissions during the first wave of Covid-19 compared to 2019 in a psychiatric emergency department in Berlin, Germany: a retrospective chart review. BMC Psychiatry 2023; 23:38. [PMID: 36639626 PMCID: PMC9839445 DOI: 10.1186/s12888-023-04537-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Most studies agree that the Covid-19 pandemic and the subsequent lockdown had a negative impact on mental health. On the other hand, international studies have shown that psychiatric emergency departments (pED) experienced a decrease in presentations and admissions. METHODS Retrospective chart review of all pED presentations and admissions during the first wave of Covid-19 pandemic in Germany (Covid-19 period: 3/2/20 to 05/24/20) in a psychiatric hospital in Berlin compared to 1 year earlier (pre-Covid-19 period). Descriptive statistics and logistic regression were performed. RESULTS We observed no statistical significant changes in overall pED presentations and overall hospital admissions during the Covid-19 period compared to the pre-Covid-19 period (813 vs. 894, - 9.1%, p = 0.064 and (363 vs. 437, - 16.9%, p = 0.080 respectively). In the subgroup analysis, less patients with depressive disorders (p = 0.035) and with personality disorders (p = 0.002) presented to the pED, a larger number of presentations with schizophrenia was observed (p = 0.020). In the Covid-19 period, less patients with substance use disorder and paranoid schizophrenia were admitted to the hospital via the pED than in the pre-Covid-19 period (p = 0.035 and p = 0.006, respectively). Bed capacity was reduced in the Covid-19 period by - 32.8% (p < 0.001). Presentations in police custody were 13.7% (p = 0.029) higher during the Covid-19 compared to pre-Covid-19 period, with higher rates in female presentations (p = 0.008) and suicide attempts (p = 0.012) and less hospital admissions (p = 0.048). Logistic regression analyses revealed that positive predictors for pED presentation during Covid-19 period were police custody (p < 0.001), being redirected from another hospital (p < 0.001), suicide attempt (p = 0.038), suicidal thoughts (p = 0.004), presentation with paranoid schizophrenia (p = 0.001) and bipolar and manic disorders (p = 0.004), negative predictors were hospital admission (p < 0.001), depressive disorders (p = 0.021) and personality disorders (p < 0.001). CONCLUSIONS A larger number of presentations in police custody during the Covid-19 period may represent untreated medical needs. This was seen predominantly in female patients, suggesting this subgroup might have suffered particularly under lockdown measures. Patients with paranoid schizophrenia were the only subgroup, which increased in absolute numbers, also suggesting a particular lockdown effect. Reduced bed capacity due to infection curbing measures is suggestive to have played an important role in augmenting the threshold for hospital admissions.
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Affiliation(s)
- T Goldschmidt
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany.
| | - Y Kippe
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - A Finck
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - M Adam
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - H Hamadoun
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - J G Winkler
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - F Bermpohl
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - M Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - S Gutwinski
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
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Warwicker S, Sant D, Richard A, Cutajar J, Bellizzi A, Micallef G, Refalo D, Camilleri L, Grech A. A Retrospective Longitudinal Analysis of Mental Health Admissions: Measuring the Fallout of the Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1194. [PMID: 36673950 PMCID: PMC9858631 DOI: 10.3390/ijerph20021194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND In this research article, we review the infrequently considered long-term impact of the pandemic on inpatient mental health, by reviewing the clinical parameters of all psychiatric admissions to Mount Carmel Hospital, our region's main psychiatric healthcare facility, from 2019-2021. METHODS 4292 patients were admitted during the research period of this retrospective longitudinal analysis. Taking 2019 as the pre-COVID reference year, we compared mean monthly admissions from 2020 and 2021, looking at patient demographics, status under the Mental Health Act, diagnosis, and self-injurious behaviour. RESULTS While the pandemic was reflected in a moderate increase in mean monthly presentations with suicidal ideation and suicidal self-injury, presentations in 2020 otherwise remained largely stable. This contrasted with a surge in presentations in 2021 with mood disorders, schizophrenia, anxiety, personality disorders, and autism spectrum disorders. Furthermore, presentations involving self-injurious behaviour continued to grow. Involuntary admissions also increased significantly in 2021. CONCLUSIONS This paper highlights the pernicious long-term impact of the pandemic on mental health presentations, demonstrated by an increase in hospital admissions and more serious presentations. These findings should be considered in the guidance for responses to any future pandemic, giving attention to the evidence of the impact of restrictive measures on mental health.
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Affiliation(s)
| | | | | | | | | | | | - Daniel Refalo
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
| | - Liberato Camilleri
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
| | - Anton Grech
- Mount Carmel Hospital, ATD 9033 H’Attard, Malta
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
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McLoughlin A, Abdalla A, Gonzalez J, Freyne A, Asghar M, Ferguson Y. Locked in and locked out: sequelae of a pandemic for distressed and vulnerable teenagers in Ireland : Post-COVID rise in psychiatry assessments of teenagers presenting to the emergency department out-of-hours at an adult Irish tertiary hospital. Ir J Med Sci 2022:10.1007/s11845-022-03080-0. [PMID: 35739358 PMCID: PMC9225813 DOI: 10.1007/s11845-022-03080-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/05/2022] [Indexed: 11/20/2022]
Abstract
Objective The aim of this study is to investigate the impact of the coronavirus pandemic on teenage psychiatry referrals following crisis presentation to the adult emergency department (ED) of an Irish tertiary hospital. In doing so, this study will specifically examine the effect of COVID-19 on self-injurious behaviour, suicidality and substance use among older adolescents (age 16/17 years). Methods This is a retrospective descriptive analysis of acute adolescent psychiatry referrals assessed out-of-hours via the adult ED psychiatry service across three consecutive time points (during the months of March, April and May) from pre-pandemic, 2019 (T1); initial pandemic, 2020 (T2); and peak pandemic, 2021 (T3). Data were obtained via the hospital’s ED-specific electronic database, review of original assessment notes and cross-referenced by manually extracting data logged in the on-call register. Results Crisis psychiatry assessments of teenagers during on-call hours trebled during the period of this study (p < 0.001). Although ED/crisis referrals initially decreased overall at the start of the pandemic, the rate of teenage referrals remained constant, before increasing as restrictions tightened in lockdown. The negative impact of COVID-19 on teenagers’ ability to cope was found to be statistically significant (p = 0.001). Changes in rates of self-harming and/or suicidal behaviours were not statistically significant between 2019, 2020 and 2021 (p = 0.082). Alcohol misuse occurred in up to one-third of cases across each timeframe and remained virtually constant throughout the pandemic. Drug misuse decreased from onset of COVID-19 (p = 0.01). Conclusions To our knowledge, this is the first study to specifically examine the impact of COVID-19 on suicidality, self-harming behaviours, substance misuse and on-call ED presentations of teenagers in Ireland. This study demonstrates that coronavirus-related stress is associated with negative mental health sequelae for vulnerable at-risk older adolescents, as evidenced by a rise in ED presentations and on-call referrals since the onset of the pandemic. Presentation of increased numbers of under-18’s for psychiatry assessment at the adult ED/general hospital indicates a deepening chasm between available and aspirational emergency (adolescent-specific) psychiatric care in the community. Mobilising resilience factors and maximising coping skills for at-risk youth will inform tailored intervention and support strategies along with adequate resourcing of services for vulnerable adolescents in the community.
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Affiliation(s)
| | - Ahad Abdalla
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - Jade Gonzalez
- Crumlin Sector, Tallaght University Hospital, Dublin 24, Ireland
| | - Aoife Freyne
- Clondalkin Sector, Tallaght University Hospital, Dublin 24, Ireland
| | - Muhammad Asghar
- National Drug Treatment Centre, Pearse Street, Dublin 2, Ireland
| | - Yolande Ferguson
- Dublin South Central Mental Health Service & Psychiatry Department, Tallaght University Hospital, Tallaght University Hospital, Dublin 24, Ireland
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