Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
Lancet Psychiatry. 2021 Oct;8(10):892-900. doi: 10.1016/S2215-0366(21)00242-X. Epub 2021 Jul 29.
There is widespread concern over the impact of public health measures, such as lockdowns, associated with COVID-19 on mental health, including suicide. High-quality evidence from low-income and middle-income countries, where the burden of suicide and self-harm is greatest, is scarce. We aimed to determine the effect of the pandemic on hospital presentations for self-poisoning.
In this interrupted time-series analysis, we established a new self-poisoning register at the tertiary care Teaching Hospital Peradeniya in Sri Lanka, a lower-middle-income country. Using a standard extraction sheet, data were gathered for all patients admitted to the Toxicology Unit with self-poisoning between Jan 1, 2019, and Aug 31, 2020. Only patients classified by the treating clinician as having intentionally self-poisoned were included. Data on date of admission, age or date of birth, sex, and poisoning method were collected. No data on ethnicity were available. We used interrupted time-series analysis to calculate weekly hospital admissions for self-poisoning before (Jan 1, 2019-March 19, 2020) and during (March 20-Aug 31, 2020) the pandemic, overall and by age (age <25 years vs ≥25 years) and sex. Individuals with missing date of admission were excluded from the main analysis.
Between Jan 1, 2019, and Aug 31, 2020, 1401 individuals (584 [41·7%] males, 761 [54·3%] females, and 56 [4·0%] of unknown sex) presented to the hospital with self-poisoning and had date of admission data. A 32% (95% CI 12-48) reduction in hospital presentations for self-poisoning in the pandemic period compared with pre-pandemic trends was observed (rate ratio 0·68, 95% CI 0·52-0·88; p=0·0032). We found no evidence that the impact of the pandemic differed by sex (rate ratio 0·64, 95% CI 0·44-0·94, for females vs 0·85, 0·57-1·26, for males; p=0·43) or age (0·64, 0·44-0·93, for patients aged <25 years vs 0·81, 0·57-1·16, for patients aged ≥25 years; p=0·077).
This is the first study from a lower-middle-income country to estimate the impact of the pandemic on self-harm (non-fatal) accounting for underlying trends. If the fall in hospital presentations during the pandemic reflects a reduction in the medical treatment of people who have self-poisoned, rather than a true fall in incidence, then public health messages should emphasise the importance of seeking help early.
Elizabeth Blackwell Institute University of Bristol, Wellcome Trust, and Centre for Pesticide Suicide Prevention.
For the Sinhalese and Tamil translations of the abstract see Supplementary Materials section.
人们普遍关注与 COVID-19 相关的公共卫生措施（如封锁）对心理健康的影响，包括自杀。在自杀和自残负担最重的中低收入国家，高质量证据稀缺。我们旨在确定大流行对医院自我中毒就诊的影响。
在这项中断时间序列分析中，我们在斯里兰卡的三级护理教学医院佩拉德尼亚建立了一个新的自我中毒登记处，这是一个中低收入国家。使用标准提取表，我们收集了 2019 年 1 月 1 日至 2020 年 8 月 31 日期间因自我中毒而入住毒理学病房的所有患者的数据。仅包括治疗医生诊断为故意自我中毒的患者。收集了入院日期、年龄或出生日期、性别和中毒方法的数据。没有种族数据。我们使用中断时间序列分析计算了大流行前（2019 年 1 月 1 日至 2020 年 3 月 19 日）和大流行期间（2020 年 3 月 20 日至 8 月 31 日）每周因自我中毒而住院的人数，包括总体情况以及按年龄（<25 岁与≥25 岁）和性别进行分组。主要分析排除了入院日期缺失的个体。
2019 年 1 月 1 日至 2020 年 8 月 31 日期间，1401 人（584 [41.7%] 男性、761 [54.3%] 女性和 56 [4.0%] 性别未知）因自我中毒到医院就诊并提供了入院日期数据。与大流行前趋势相比，大流行期间自我中毒就诊人数减少了 32%（95%CI 12-48%）（比率比 0.68，95%CI 0.52-0.88；p=0.0032）。我们没有发现大流行的影响因性别（女性 0.64，95%CI 0.44-0.94，男性 0.85，0.57-1.26；p=0.43）或年龄（<25 岁的患者 0.64，0.44-0.93，≥25 岁的患者 0.81，0.57-1.16；p=0.077）而异。
这是第一项从中等收入国家估计大流行对自我伤害（非致命）影响的研究，考虑了潜在趋势。如果大流行期间医院就诊人数下降反映了接受自我中毒治疗的人数减少，而不是发病率的真正下降，那么公共卫生信息应强调尽早寻求帮助的重要性。
布里斯托大学伊丽莎白·布莱克韦尔研究所、惠康信托基金会和农药自杀预防中心。
