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Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 'lockdown' policy in 10 UK sites: a regression discontinuity in time design.
BMJ Open. 2021 05 26; 11(5):e049721.BO

Abstract

OBJECTIVES

To investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 'lockdown' policy in Spring 2020.

DESIGN

A regression discontinuity in time (RDiT) analysis of daily service-level activity.

SETTING AND PARTICIPANTS

Mental healthcare data were extracted from 10 UK providers.

OUTCOME MEASURES

Daily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 'lockdown' policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites.

RESULTS

Pooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect.

CONCLUSIONS

MH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences.

Authors+Show Affiliations

Department of Biostatistics and Health Informatics, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK.South London and Maudsley NHS Foundation Trust, London, UK r.stewart@iop.kcl.ac.uk. Department of Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK.Southern Health NHS Foundation Trust, Southampton, UK. Faculty of Medicine, University of Southampton, Southampton, UK.Lancashire and South Cumbria NHS Foundation Trust, Preston, UK.Lancashire and South Cumbria NHS Foundation Trust, Preston, UK.South London and Maudsley NHS Foundation Trust, London, UK.Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK. Liaison Psychiatry Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK.Camden and Islington NHS Foundation Trust, London, UK.Department of Psychiatry, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK. Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK.Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.Lancashire and South Cumbria NHS Foundation Trust, Preston, UK.Usher Institute of Population Health Sciences & Informatics, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK.Population Data Science, Swansea University Medical School, Swansea, UK.Department of Psychiatry, University of Oxford, Oxford, UK.Population Data Science, Swansea University Medical School, Swansea, UK.Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK.Division of Psychiatry, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK.Division of Psychiatry and Applied Psychology, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK. Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.Division of Psychiatry, University College London Faculty of Medical Sciences, London, UK.Southern Health NHS Foundation Trust, Southampton, UK.Southern Health NHS Foundation Trust, Southampton, UK.Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK.Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.Lothian Primary Care NHS Trust, Edinburgh, UK.Department of Biostatistics and Health Informatics, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK.

Pub Type(s)

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

Language

eng

PubMed ID

34039579

Citation

Bakolis, Ioannis, et al. "Changes in Daily Mental Health Service Use and Mortality at the Commencement and Lifting of COVID-19 'lockdown' Policy in 10 UK Sites: a Regression Discontinuity in Time Design." BMJ Open, vol. 11, no. 5, 2021, pp. e049721.
Bakolis I, Stewart R, Baldwin D, et al. Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 'lockdown' policy in 10 UK sites: a regression discontinuity in time design. BMJ Open. 2021;11(5):e049721.
Bakolis, I., Stewart, R., Baldwin, D., Beenstock, J., Bibby, P., Broadbent, M., Cardinal, R., Chen, S., Chinnasamy, K., Cipriani, A., Douglas, S., Horner, P., Jackson, C. A., John, A., Joyce, D. W., Lee, S. C., Lewis, J., McIntosh, A., Nixon, N., ... Landau, S. (2021). Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 'lockdown' policy in 10 UK sites: a regression discontinuity in time design. BMJ Open, 11(5), e049721. https://doi.org/10.1136/bmjopen-2021-049721
Bakolis I, et al. Changes in Daily Mental Health Service Use and Mortality at the Commencement and Lifting of COVID-19 'lockdown' Policy in 10 UK Sites: a Regression Discontinuity in Time Design. BMJ Open. 2021 05 26;11(5):e049721. PubMed PMID: 34039579.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 'lockdown' policy in 10 UK sites: a regression discontinuity in time design. AU - Bakolis,Ioannis, AU - Stewart,Robert, AU - Baldwin,David, AU - Beenstock,Jane, AU - Bibby,Paul, AU - Broadbent,Matthew, AU - Cardinal,Rudolf, AU - Chen,Shanquan, AU - Chinnasamy,Karthik, AU - Cipriani,Andrea, AU - Douglas,Simon, AU - Horner,Philip, AU - Jackson,Caroline A, AU - John,Ann, AU - Joyce,Dan W, AU - Lee,Sze Chim, AU - Lewis,Jonathan, AU - McIntosh,Andrew, AU - Nixon,Neil, AU - Osborn,David, AU - Phiri,Peter, AU - Rathod,Shanaya, AU - Smith,Tanya, AU - Sokal,Rachel, AU - Waller,Rob, AU - Landau,Sabine, Y1 - 2021/05/26/ PY - 2021/5/27/entrez PY - 2021/5/28/pubmed PY - 2021/6/1/medline KW - COVID-19 KW - adult psychiatry KW - mental health KW - old age psychiatry KW - organisation of health services SP - e049721 EP - e049721 JF - BMJ open JO - BMJ Open VL - 11 IS - 5 N2 - OBJECTIVES: To investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 'lockdown' policy in Spring 2020. DESIGN: A regression discontinuity in time (RDiT) analysis of daily service-level activity. SETTING AND PARTICIPANTS: Mental healthcare data were extracted from 10 UK providers. OUTCOME MEASURES: Daily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 'lockdown' policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites. RESULTS: Pooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect. CONCLUSIONS: MH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/34039579/Changes_in_daily_mental_health_service_use_and_mortality_at_the_commencement_and_lifting_of_COVID_19_'lockdown'_policy_in_10_UK_sites:_a_regression_discontinuity_in_time_design_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=34039579 DB - PRIME DP - Unbound Medicine ER -