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. 2020 Nov 26:11:585915.
doi: 10.3389/fpsyt.2020.585915. eCollection 2020.

The Medium-Term Impact of COVID-19 Lockdown on Referrals to Secondary Care Mental Health Services: A Controlled Interrupted Time Series Study

Shanquan Chen  1 , Rui She  2 , Pei Qin  3 , Anne Kershenbaum  1   4 , Emilio Fernandez-Egea  1   4 , Jenny R Nelder  1 , Chuoxin Ma  5 , Jonathan Lewis  4 , Chaoqun Wang  6 , Rudolf N Cardinal  1   4
Affiliations

The Medium-Term Impact of COVID-19 Lockdown on Referrals to Secondary Care Mental Health Services: A Controlled Interrupted Time Series Study

Shanquan Chen et al. Front Psychiatry. .

Abstract

To date, there is a paucity of information regarding the effect of COVID-19 or lockdown on mental disorders. We aimed to quantify the medium-term impact of lockdown on referrals to secondary care mental health clinical services. We conducted a controlled interrupted time series study using data from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment population ~0.86 million). The UK lockdown resulted in an instantaneous drop in mental health referrals but then a longer-term acceleration in the referral rate (by 1.21 referrals per day per day, 95% confidence interval [CI] 0.41-2.02). This acceleration was primarily for urgent or emergency referrals (acceleration 0.96, CI 0.39-1.54), including referrals to liaison psychiatry (0.68, CI 0.35-1.02) and mental health crisis teams (0.61, CI 0.20-1.02). The acceleration was significant for females (0.56, CI 0.04-1.08), males (0.64, CI 0.05-1.22), working-age adults (0.93, CI 0.42-1.43), people of White ethnicity (0.98, CI 0.32-1.65), those living alone (1.26, CI 0.52-2.00), and those who had pre-existing depression (0.78, CI 0.19-1.38), severe mental illness (0.67, CI 0.19-1.15), hypertension/cardiovascular/cerebrovascular disease (0.56, CI 0.24-0.89), personality disorders (0.32, CI 0.12-0.51), asthma/chronic obstructive pulmonary disease (0.28, CI 0.08-0.49), dyslipidemia (0.26, CI 0.04-0.47), anxiety (0.21, CI 0.08-0.34), substance misuse (0.21, CI 0.08-0.34), or reactions to severe stress (0.17, CI 0.01-0.32). No significant post-lockdown acceleration was observed for children/adolescents, older adults, people of ethnic minorities, married/cohabiting people, and those who had previous/pre-existing dementia, diabetes, cancer, eating disorder, a history of self-harm, or intellectual disability. This evidence may help service planning and policy-making, including preparation for any future lockdown in response to outbreaks.

Keywords: COVID-19/SARS-CoV-2 coronavirus pandemic; comorbidity; controlled interrupted time series analysis; lockdown; secondary care mental health services.

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Conflict of interest statement

RC consults for Campden Instruments Ltd and receives royalties from Cambridge University Press, Cambridge Enterprise, and Routledge. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Interrupted time series analysis of referrals to secondary care mental health services in 2020 (red) and 2019 (blue). The dashed line is the model fit. The gray area indicates the transition period from social distancing (16 March 2020) to lockdown (23 March 2020).
Figure 2
Figure 2
Short-term (β6) effects of COVID-19 lockdown on the daily number of referrals to mental health services for subgroups. Units are referrals·day−1.
Figure 3
Figure 3
Medium-term (β7) effects of COVID-19 lockdown on the time trend in referrals to mental health services for subgroups. Units are referrals·day−2.
See this image and copyright information in PMC

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