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COVID-19 and its effect on emergency presentations to a tertiary hospital with self-harm in Ireland
A McIntyre1, K Tong1, E McMahon1
1Department of Psychiatry, University Hospital Galway, Galway, Ireland.
Insights
The COVID-19 pandemic initially reduced hospital visits for self-harm but led to a sharp increase in May 2020. This period saw higher lethality and increased substance misuse disorders among those presenting with self-harm.
Area of Science:
- Public Health
- Psychiatry
- Epidemiology
Background:
- The COVID-19 pandemic and associated public health measures, such as lockdowns, have raised concerns about their impact on mental health.
- Self-harm is a significant public health issue, and understanding its trends during crises is crucial for timely intervention.
Purpose of the Study:
- To evaluate the effect of the COVID-19 crisis on the frequency and characteristics of self-harm presentations to an acute hospital.
- To compare self-harm presentation data during the peak COVID-19 period in Ireland with pre-pandemic data.
Main Methods:
- Retrospective analysis of anonymised self-harm presentation data from University Hospital Galway.
- Comparison of data from March-May 2020 with the same period in 2017-2019.
- Statistical analysis to identify significant differences in presentation rates, lethality, and diagnoses.
Main Results:
- Self-harm presentations decreased by 35% from March to April 2020, then increased by 104% from April to May 2020.
- Presentations in 2020 exhibited significantly higher lethality (p < 0.001) and differences in diagnoses (p = 0.031) compared to 2017-2019.
- A significant increase in substance misuse disorders was observed among individuals presenting with self-harm in 2020 (p = 0.018).
Conclusions:
- The COVID-19 pandemic initially reduced, then sharply increased, self-harm hospital presentations.
- The findings highlight a concerning rise in the lethality of self-harm acts and a shift in associated diagnoses, particularly substance misuse.
- Further research is essential to understand the long-term mental health consequences of the pandemic and lockdown measures on self-harm and suicidal behaviors.
Objectives:
This study aimed to assess the impact of COVID-19 on presentations to an acute hospital with self-harm.
Methods:
All presentations to University Hospital Galway with self-harm were assessed during the peak period of the coronavirus crisis in Ireland, over the 3 months from 1 March to 31 May 2020. These data were compared with presentations in the same months in the 3 years preceding (2017-2019). Data were obtained from the anonymised service database.
Results:
This study found that in 2020, the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May. When trends over a 4-year period were examined, there was a significantly higher lethality of attempt (p < 0.001), and significant differences in diagnosis (p = 0.031) in 2020 in comparison with the three previous years. The increased lethality of presentations remained significant after age and gender were controlled for (p = 0.036). There were also significant differences in the underlying psychiatric diagnoses (p = 0.018), notably with a significant increase in substance misuse disorders presenting during the 2020 study period.
Conclusions:
COVID-19 showed a reduction in self-harm presentations initially, followed by a sharp increase in May 2020. If a period of economic instability follows as predicted, it is likely that this will further impact the mental health of the population, along with rates of self-harm and suicidal behaviours. There is a need for research into the longer-term effect of COVID-19 and lockdown restrictions, especially with respect to self-harm.
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