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.
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.
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DOI：
10.1136/bmjopen-2021-049721
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发表时间：
2021-05-26
期刊：
影响因子：
2.9
通讯作者：
Landau S
中科院分区：
文献类型：
--
作者：
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 CA;John A;Joyce DW;Lee SC;Lewis J;McIntosh A;Nixon N;Osborn D;Phiri P;Rathod S;Smith T;Sokal R;Waller R;Landau S
调查2020年春季实施和解除COVID-19“封锁”政策后，日常精神卫生服务使用和死亡率的变化。每日服务水平活动的时间不连续回归分析。心理健康数据来自10个英国供应商。每天（一个地点每周）各种原因造成的死亡、转诊和出院、住院治疗（入院、出院、病例量）和社区服务（面对面(f2f)/非f2f接触、病例量）：成人、老年人和儿童/青少年心理健康；精神病早期干预；家庭治疗小组和联络/意外及紧急情况（A&E）。所有站点的数据提取时间为2019年1月1日至2020年5月31日，4个站点的数据补充至2020年7月31日。使用RDiT设计估算了COVID-19“封锁”政策开始和解除前后（分别为3月23日和5月10日）的变化，该设计采用差中差法生成发病率比（IRRs），并对各站点进行了荟萃分析。对封锁过渡的综合估计显示，与封锁前相比，每日死亡人数增加（IRR 2.31, 95% CI 1.86至2.87），转诊人数减少（IRR 0.62, 95% CI 0.55至0.70），住院人数减少（IRR 0.75, 95% CI 0.67至0.83），病例量减少（IRR 0.85, 95% CI 0.79至0.91）。所有社区服务都从f2f接触者转变为非f2f接触者，但病例量变化有所不同。与封城期间相比，解除封城与死亡人数减少（IRR 0.42, 95% CI 0.27至0.66）、转诊人数增加（IRR 1.36, 95% CI 1.15至1.60）、住院人数增加（IRR 1.21, 95% CI 1.04至1.42）和病例量增加（IRR 1.06, 95% CI 1.00至1.12）相关。解除封锁后，全站活动、住院治疗和社区服务没有恢复到封锁前的水平，而死亡人数却恢复了。站点间异质性最常表明影响的大小而不是方向上的差异。在第一次全国封锁期间，MH的服务提供发生了相当大的变化，其后果尚不清楚，也未得到评估。
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. A regression discontinuity in time (RDiT) analysis of daily service-level activity. Mental healthcare data were extracted from 10 UK providers. 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. 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. MH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences.
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DOI：
10.1016/s2215-0366(20)30434-x
发表时间：
2020-12
期刊：
The lancet. Psychiatry
影响因子：
--
作者：
Livingston G;Rostamipour H;Gallagher P;Kalafatis C;Shastri A;Huzzey L;Liu K;Sommerlad A;Marston L
通讯作者：
Marston L
DOI：
10.1136/bmj.n834
发表时间：
2021-03-29
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Appleby, Louis
通讯作者：
Appleby, Louis
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
4.8
作者：
Chen S;Jones PB;Underwood BR;Moore A;Bullmore ET;Banerjee S;Osimo EF;Deakin JB;Hatfield CF;Thompson FJ;Artingstall JD;Slann MP;Lewis JR;Cardinal RN
通讯作者：
Cardinal RN
影响因子：
64.3
作者：
Holmes, Emily A.;O'Connor, Rory C.;Bullmore, Ed
通讯作者：
Bullmore, Ed