Journal
BRITISH JOURNAL OF PSYCHIATRY
Volume 221, Issue 4, Pages 603-612Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1192/bjp.2022.79
Keywords
Epidemiology; self-harm; primary care; suicide; COVID-19
Categories
Funding
- University of Manchester Presidential Fellowship
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) at the Northern Care Alliance NHS Foundation Trust and the University of Manchester [PSTRC-2016-003]
- NIHR [NF-SI-0617-10145, NIHR203807]
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust
- University of Bristol [BRC-1215-20011, NIHR200181]
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust
- Wellcome Trust [204813/Z/16/Z]
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Evidence suggests sustained reductions in self-harm presentations during the COVID-19 pandemic, especially in the first half of 2021. However, there is a lack of evidence from low- and middle-income countries. It is concerning that there has been an increase in self-harm presentations among adolescents, particularly girls, in 2021. Findings may reflect changes in help-seeking behaviors, utilization of alternative sources of support, and varying effects of the pandemic across different groups.
Background Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. Aims To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic. Method A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool. Results Fifty-one studies were included: 57% (29/51) were rated as 'low' quality, 31% (16/51) as 'moderate' and 12% (6/51) as 'high-moderate'. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17-56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls. Conclusions Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.
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