Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study.
Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study.
复制标题
DOI：
10.1016/s2468-2667(20)30288-7
复制
发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Ashcroft DM
中科院分区：
文献类型：
--
作者：
Carr MJ;Steeg S;Webb RT;Kapur N;Chew-Graham CA;Abel KM;Hope H;Pierce M;Ashcroft DM
COVID-19大流行对人口心理健康造成不利影响。我们旨在评估英国COVID-19紧急情况期间初级保健记录的常见精神疾病、自我伤害事件、精神药物处方和全科医生（GP）转介精神卫生服务的时间趋势。我们使用英国临床实践研究数据链（CPRD）注册的全科医疗的初级保健电子健康记录进行了一项基于人群的队列研究。我们纳入了2010年1月1日至2020年9月10日的患者记录，以建立长期趋势和季节性模式，但主要集中在2019年1月至2020年9月期间。我们提取了输入患者记录的临床代码数据，以估计抑郁症和焦虑症、自残、抗抑郁药和苯二氮卓类药物处方以及全科医生转介到心理健康服务的发生率，并评估了所有精神科药物处方和自残的事件发生率。我们使用平均离差负二项回归模型来预测预期的每月发病率和总体事件发生率，然后将其与观察到的发生率进行比较，以评估2020年3月之后发病率和事件发生率的下降百分比。我们还按性别、年龄组和实践水平多重残疾五分位数指数进行了分层分析。我们从CPRD数据库中注册的1697家英国全科诊所中确定了14210 507名患者。 2020年4月，与预期发生率相比，英国全科医疗中初级保健记录的抑郁症发生率降低了43.0%（95%CI 38.3 - 47.4），焦虑症降低了47.8%（44.3 - 51.2），首次开抗抑郁药的发生率降低了36.4%（33.9 - 38.8）。在工作年龄的成年人（18-44岁和45-64岁）和在较贫困地区的诊所登记的病人中，抑郁症和焦虑症的首次诊断减少最多。自残的发生率比2020年4月的预期低37.6%（34.8%-40.3%），女性和45岁以下的个人减少最多。到2020年9月，抑郁症、焦虑症和自我伤害的发生率与预期水平相似。在北方爱尔兰、苏格兰和威尔士，到2020年9月，抑郁症和焦虑症的发病率仍比预期低三分之一左右。2020年4月，转介到精神卫生服务的比率不到一年中预期比率的四分之一（下降75.3%[74.0 - 76.4]）。初级保健记录的精神疾病和自我伤害的显著减少的后果可能包括更多的患者随后表现出更严重的精神疾病和非致命性自我伤害和自杀的发生率增加。应对未来封锁的影响和经济不稳定对心理健康的长期影响应成为优先事项。国家健康研究所和医学研究理事会。
The COVID-19 pandemic has adversely affected population mental health. We aimed to assess temporal trends in primary care-recorded common mental illness, episodes of self-harm, psychotropic medication prescribing, and general practitioner (GP) referrals to mental health services during the COVID-19 emergency in the UK. We did a population-based cohort study using primary care electronic health records from general practices registered on the UK Clinical Practice Research Datalink (CPRD). We included patient records from Jan 1, 2010, to Sept 10, 2020, to establish long-term trends and patterns of seasonality, but focused primarily on the period January, 2019–September, 2020. We extracted data on clinical codes entered into patient records to estimate the incidence of depression and anxiety disorders, self-harm, prescriptions for antidepressants and benzodiazepines, and GP referrals to mental health services, and assessed event rates of all psychotropic prescriptions and self-harm. We used mean-dispersion negative binomial regression models to predict expected monthly incidence and overall event rates, which were then compared with observed rates to assess the percentage reduction in incidence and event rates after March, 2020. We also stratified analyses by sex, age group, and practice-level Index of Multiple Deprivation quintiles. We identified 14 210 507 patients from 1697 UK general practices registered in the CPRD databases. In April, 2020, compared with expected rates, the incidence of primary care-recorded depression had reduced by 43·0% (95% CI 38·3–47·4), anxiety disorders by 47·8% (44·3–51·2), and first antidepressant prescribing by 36·4% (33·9–38·8) in English general practices. Reductions in first diagnoses of depression and anxiety disorders were largest for adults of working age (18–44 and 45–64 years) and for patients registered at practices in more deprived areas. The incidence of self-harm was 37·6% (34·8–40·3%) lower than expected in April, 2020, and the reduction was greatest for women and individuals aged younger than 45 years. By September, 2020, rates of incident depression, anxiety disorder, and self-harm were similar to expected levels. In Northern Ireland, Scotland, and Wales, rates of incident depression and anxiety disorder remained around a third lower than expected to September, 2020. In April, 2020, the rate of referral to mental health services was less than a quarter of the expected rate for the time of year (75·3% reduction [74·0–76·4]). Consequences of the considerable reductions in primary care-recorded mental illness and self-harm could include more patients subsequently presenting with greater severity of mental illness and increasing incidence of non-fatal self-harm and suicide. Addressing the effects of future lockdowns and longer-term impacts of economic instability on mental health should be prioritised. National Institute for Health Research and Medical Research Council.