Swansea University Medical School, Wales, United Kingdom.
Population Data Science, Swansea University Medical School, Wales, United Kingdom.
PLoS One. 2022 Apr 27;17(4):e0266967. doi: 10.1371/journal.pone.0266967. eCollection 2022.
Reduced rates of help seeking by those who self-harmed during the COVID-19 pandemic have been reported.
To understand changes in healthcare service contacts for self-harm during the COVID-19 pandemic across primary, emergency and secondary care.
This retrospective cohort study used routine electronic healthcare data for Wales, United Kingdom, from 2016 to March 14, 2021. Population-based data from primary care, emergency departments and hospital admissions were linked at individual-level. All Welsh residents aged ≥10 years over the study period were included in the study. Primary, emergency and secondary care contacts with self-harm at any time between 2016 and March 14, 2021 were identified. Outcomes were counts, incidence, prevalence and proportion of self-harm contacts relative to all contacts in each and all settings, as well as the proportion of people contacting one or more settings with self-harm. Weekly trends were modelled using generalised estimated equations, with differences between 2020 (to March 2021) and comparison years 2016-2018 (to March 2017-2019) quantified using difference in differences, from which mean rate of odds ratios (μROR) across years was reported.
The study included 3,552,210 individuals over the study period. Self-harm contacts reduced across services in March and December 2020 compared to previous years. Primary care contacts with self-harm reduced disproportionately compared to non-self-harm contacts (μROR = 0.7, p<0.05), while their proportion increased in emergency departments during April 2020 (μROR = 1.3, p<0.05 in 2/3 comparison years) and hospital admissions during April-May 2020 (μROR = 1.2, p<0.05 in 2/3 comparison years). Despite this, those who self-harmed in April 2020 were more likely to be seen in primary care than other settings compared to previous years (μROR = 1.2, p<0.05). A lower proportion of those with self-harm contacts in emergency departments were subsequently admitted to hospital in December 2020 compared to previous years (μROR = 0.5, p<0.05).
These findings suggest that those who self-harmed during the COVID-19 pandemic may have been less likely to seek help, and those who did so faced more stringent criteria for admission. Communications encouraging those who self-harm to seek help during pandemics may be beneficial. However, this needs to be supported by maintained provision of mental health services.
据报道，在 COVID-19 大流行期间，那些自残的人寻求帮助的比例有所下降。
了解 COVID-19 大流行期间初级、急诊和二级保健机构中自残的医疗服务接触情况的变化。
本回顾性队列研究使用了英国威尔士的常规电子医疗保健数据，时间范围为 2016 年至 2021 年 3 月 14 日。通过个体层面将初级保健、急诊科和住院的数据进行了关联。在研究期间，所有年龄≥10 岁的威尔士居民均被纳入研究。在 2016 年至 2021 年 3 月 14 日期间，确定了任何时候在初级保健、急诊和二级保健机构与自残相关的接触情况。结果为每个和所有环境中与所有接触相比，自残接触的数量、发生率、患病率和比例，以及与一个或多个环境中与自残相关的接触的人数比例。使用广义估计方程对每周趋势进行建模，并通过差异分析来量化 2020 年（至 2021 年 3 月）与比较年份 2016-2018 年（至 2017-2019 年 3 月）之间的差异，从中报告了各年的平均率比值比（μROR）。
研究期间共纳入了 3552210 人。与前几年相比，2020 年 3 月和 12 月自残接触减少。与非自残接触相比，初级保健机构中的自残接触不成比例地减少（μROR=0.7，p<0.05），而在 2020 年 4 月，其在急诊科的比例增加（μROR=1.3，在 2/3 个比较年份中 p<0.05），在 2020 年 4 月至 5 月期间在住院部的比例增加（μROR=1.2，在 2/3 个比较年份中 p<0.05）。尽管如此，与前几年相比，2020 年 4 月自残的人更有可能在初级保健机构而不是其他机构就诊（μROR=1.2，p<0.05）。与前几年相比，2020 年 12 月在急诊科接受治疗的自残患者随后住院的比例较低（μROR=0.5，p<0.05）。
这些发现表明，在 COVID-19 大流行期间自残的人可能不太愿意寻求帮助，而那些寻求帮助的人则面临更严格的入院标准。在大流行期间鼓励那些自残的人寻求帮助的信息可能是有益的。然而，这需要以维持精神卫生服务的提供为支撑。
