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The early impact of COVID-19 on mental health and community physical health services and their patients' mortality in Cambridgeshire and Peterborough, UK.
J Psychiatr Res. 2020 12; 131:244-254.JP

Abstract

BACKGROUND

COVID-19 has affected social interaction and healthcare worldwide.

METHODS

We examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK (population ~0·86 million), plus service activity and deaths. We conducted interrupted time series analyses with respect to the time of UK "lockdown", which was shortly before the peak of COVID-19 infections in this area. We examined changes in standardized mortality ratio for those with and without severe mental illness (SMI).

RESULTS

Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking). This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for eating disorders, for which there was no evidence of change. Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality was primarily in the over-70s. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity.

CONCLUSIONS

COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. "Supply" changes may have reduced access to mental health services for some. "Demand" changes may reflect a genuine reduction of need or a lack of help-seeking with pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.

Authors+Show Affiliations

Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK. Electronic address: sc2147@medschl.cam.ac.uk.Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: pbj21@cam.ac.uk.Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: Ben.Underwood@cpft.nhs.uk.Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: am2708@medschl.cam.ac.uk.Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: etb23@cam.ac.uk.Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK. Electronic address: sb2333@medschl.cam.ac.uk.Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: efo22@cam.ac.uk.Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: Julia.Deakin@cpft.nhs.uk.Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: Catherine.Hatfield@cpft.nhs.uk.Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: Fiona.Thompson@cpft.nhs.uk.Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: Jonathon.Artingstall@cpft.nhs.uk.Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: Matthew.Slann@cpft.nhs.uk.Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: Jonathan.Lewis@cpft.nhs.uk.Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK. Electronic address: rnc1001@cam.ac.uk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33035957

Citation

Chen, Shanquan, et al. "The Early Impact of COVID-19 On Mental Health and Community Physical Health Services and Their Patients' Mortality in Cambridgeshire and Peterborough, UK." Journal of Psychiatric Research, vol. 131, 2020, pp. 244-254.
Chen S, Jones PB, Underwood BR, et al. The early impact of COVID-19 on mental health and community physical health services and their patients' mortality in Cambridgeshire and Peterborough, UK. J Psychiatr Res. 2020;131:244-254.
Chen, S., Jones, P. B., Underwood, B. R., Moore, A., Bullmore, E. T., Banerjee, S., Osimo, E. F., Deakin, J. B., Hatfield, C. F., Thompson, F. J., Artingstall, J. D., Slann, M. P., Lewis, J. R., & Cardinal, R. N. (2020). The early impact of COVID-19 on mental health and community physical health services and their patients' mortality in Cambridgeshire and Peterborough, UK. Journal of Psychiatric Research, 131, 244-254. https://doi.org/10.1016/j.jpsychires.2020.09.020
Chen S, et al. The Early Impact of COVID-19 On Mental Health and Community Physical Health Services and Their Patients' Mortality in Cambridgeshire and Peterborough, UK. J Psychiatr Res. 2020;131:244-254. PubMed PMID: 33035957.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The early impact of COVID-19 on mental health and community physical health services and their patients' mortality in Cambridgeshire and Peterborough, UK. AU - Chen,Shanquan, AU - Jones,Peter B, AU - Underwood,Benjamin R, AU - Moore,Anna, AU - Bullmore,Edward T, AU - Banerjee,Soumya, AU - Osimo,Emanuele F, AU - Deakin,Julia B, AU - Hatfield,Catherine F, AU - Thompson,Fiona J, AU - Artingstall,Jonathon D, AU - Slann,Matthew P, AU - Lewis,Jonathan R, AU - Cardinal,Rudolf N, Y1 - 2020/09/22/ PY - 2020/09/05/received PY - 2020/09/17/accepted PY - 2020/10/10/pubmed PY - 2020/12/1/medline PY - 2020/10/9/entrez KW - Alcohol and substance misuse KW - Anxiety KW - COVID-19/SARS-CoV-2 coronavirus pandemic KW - Depression KW - Mortality KW - Self-harm KW - Severe mental illness (SMI) KW - Suicidality SP - 244 EP - 254 JF - Journal of psychiatric research JO - J Psychiatr Res VL - 131 N2 - BACKGROUND: COVID-19 has affected social interaction and healthcare worldwide. METHODS: We examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK (population ~0·86 million), plus service activity and deaths. We conducted interrupted time series analyses with respect to the time of UK "lockdown", which was shortly before the peak of COVID-19 infections in this area. We examined changes in standardized mortality ratio for those with and without severe mental illness (SMI). RESULTS: Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking). This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for eating disorders, for which there was no evidence of change. Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality was primarily in the over-70s. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity. CONCLUSIONS: COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. "Supply" changes may have reduced access to mental health services for some. "Demand" changes may reflect a genuine reduction of need or a lack of help-seeking with pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic. SN - 1879-1379 UR - https://www.unboundmedicine.com/medline/citation/33035957/The_early_impact_of_COVID_19_on_mental_health_and_community_physical_health_services_and_their_patients'_mortality_in_Cambridgeshire_and_Peterborough_UK_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3956(20)30984-5 DB - PRIME DP - Unbound Medicine ER -