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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

Ioannis Bakolis, Robert Stewart Orcid Logo, David Baldwin, Jane Beenstock, Paul Bibby, Matthew Broadbent, Rudolf Cardinal Orcid Logo, Shanquan Chen, Karthik Chinnasamy, Andrea Cipriani Orcid Logo, Simon Douglas, Philip Horner, Caroline A Jackson Orcid Logo, Ann John Orcid Logo, Dan W Joyce, Sze Chim Lee, Jonathan Lewis, Andrew McIntosh Orcid Logo, Neil Nixon, David Osborn, Peter Phiri, Shanaya Rathod, Tanya Smith, Rachel Sokal, Rob Waller, Sabine Landau

BMJ Open, Volume: 11, Issue: 5, Start page: e049721

Swansea University Authors: Ann John Orcid Logo, Sze Chim Lee

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DOI (Published version): 10.1136/bmjopen-2021-049721

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...

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ISSN: 2044-6055 2044-6055
Published: BMJ 2021
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fullrecord <?xml version="1.0"?><rfc1807 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"><datestamp>2022-08-03T15:53:20.9203693</datestamp><bib-version>v2</bib-version><id>60382</id><entry>2022-07-05</entry><title>Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 &#x2018;lockdown&#x2019; policy in 10 UK sites: a regression discontinuity in time design</title><swanseaauthors><author><sid>ed8a9c37bd7b7235b762d941ef18ee55</sid><ORCID>0000-0002-5657-6995</ORCID><firstname>Ann</firstname><surname>John</surname><name>Ann John</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>10628af4988d624b49c4de7bd78b4694</sid><firstname>Sze Chim</firstname><surname>Lee</surname><name>Sze Chim Lee</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2022-07-05</date><deptcode>HDAT</deptcode><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 &#x2018;lockdown&#x2019; 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&amp;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 &#x2018;lockdown&#x2019; 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.</abstract><type>Journal Article</type><journal>BMJ Open</journal><volume>11</volume><journalNumber>5</journalNumber><paginationStart>e049721</paginationStart><paginationEnd/><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2044-6055</issnPrint><issnElectronic>2044-6055</issnElectronic><keywords/><publishedDay>26</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-05-26</publishedDate><doi>10.1136/bmjopen-2021-049721</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>Regarding relevant background infrastructure funding, RSt was part funded by: (1) the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust and King&#x2019;s College London; (2) a Medical Research Council (MRC) Mental Health Data Pathfinder Award to King&#x2019;s College London; (3) an NIHR Senior Investigator Award and (4) the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King&#x2019;s College Hospital NHS Foundation Trust. IB and SL were supported by the NIHR BRC at South London and Maudsley NHS Foundation Trust and King&#x2019;s College London and by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King&#x2019;s College Hospital NHS Foundation Trust. RC&#x2019;s research was funded by the MRC (grant MC_PC_17213) and the NIHR Cambridge BRC. AC was supported by the NIHR Oxford Cognitive Health Clinical Research Facility, by an NIHR Research Professorship (grant RP-2017-08-ST2-006), by the NIHR Oxford and Thames Valley Applied Research Collaboration and by the NIHR Oxford Health BRC (grant BRC-1215-20005). AJ was part funded by MQ ADP and an MRC Mental Health Data Pathfinder Award to Swansea University. AJ and SCL were part funded by Health and Care Research Wales National Centre for Mental Health. DO was supported by the NIHR BRC at University College London Hospitals and by the National Institute for Health Research ARC North Thames. Additional infrastructure funding was provided by the MRC Mental Health Data Pathfinder Award to University of Edinburgh (MC_PC_17209). The collaboration providing Wales data was led by the Swansea University Health Data Research UK team under the direction of the Welsh Government Technical Advisory Cell and includes the following groups and organisations: the Secure Anonymised Information Linkage Databank, Administrative Data Research Wales, NHS Wales Informatics Service, Public Health Wales, NHS Shared Services and the Welsh Ambulance Service Trust and MRC grant MR/V028367. This study was additionally supported by the NIHR Mental Health Translational Research Collaboration. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR or the UK Department of Health.</funders><projectreference/><lastEdited>2022-08-03T15:53:20.9203693</lastEdited><Created>2022-07-05T12:43:02.9997182</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Ioannis</firstname><surname>Bakolis</surname><order>1</order></author><author><firstname>Robert</firstname><surname>Stewart</surname><orcid>0000-0002-4435-6397</orcid><order>2</order></author><author><firstname>David</firstname><surname>Baldwin</surname><order>3</order></author><author><firstname>Jane</firstname><surname>Beenstock</surname><order>4</order></author><author><firstname>Paul</firstname><surname>Bibby</surname><order>5</order></author><author><firstname>Matthew</firstname><surname>Broadbent</surname><order>6</order></author><author><firstname>Rudolf</firstname><surname>Cardinal</surname><orcid>0000-0002-8751-5167</orcid><order>7</order></author><author><firstname>Shanquan</firstname><surname>Chen</surname><order>8</order></author><author><firstname>Karthik</firstname><surname>Chinnasamy</surname><order>9</order></author><author><firstname>Andrea</firstname><surname>Cipriani</surname><orcid>0000-0001-5179-8321</orcid><order>10</order></author><author><firstname>Simon</firstname><surname>Douglas</surname><order>11</order></author><author><firstname>Philip</firstname><surname>Horner</surname><order>12</order></author><author><firstname>Caroline A</firstname><surname>Jackson</surname><orcid>0000-0002-2067-2811</orcid><order>13</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>14</order></author><author><firstname>Dan W</firstname><surname>Joyce</surname><order>15</order></author><author><firstname>Sze Chim</firstname><surname>Lee</surname><order>16</order></author><author><firstname>Jonathan</firstname><surname>Lewis</surname><order>17</order></author><author><firstname>Andrew</firstname><surname>McIntosh</surname><orcid>0000-0002-0198-4588</orcid><order>18</order></author><author><firstname>Neil</firstname><surname>Nixon</surname><order>19</order></author><author><firstname>David</firstname><surname>Osborn</surname><order>20</order></author><author><firstname>Peter</firstname><surname>Phiri</surname><order>21</order></author><author><firstname>Shanaya</firstname><surname>Rathod</surname><order>22</order></author><author><firstname>Tanya</firstname><surname>Smith</surname><order>23</order></author><author><firstname>Rachel</firstname><surname>Sokal</surname><order>24</order></author><author><firstname>Rob</firstname><surname>Waller</surname><order>25</order></author><author><firstname>Sabine</firstname><surname>Landau</surname><order>26</order></author></authors><documents><document><filename>60382__24450__3b0cc24146b64f82a18998b103e70815.pdf</filename><originalFilename>60382.VOR.pdf</originalFilename><uploaded>2022-07-05T12:46:02.8507174</uploaded><type>Output</type><contentLength>641704</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs><OutputDur><Id>101</Id><DataControllerName>Ioannis Bakolis</DataControllerName><IsDataAvailableOnline>true</IsDataAvailableOnline><DataNotAvailableOnlineReasonId xsi:nil="true"/><DurUrl>https://bmjopen.bmj.com/content/11/5/e049721.info</DurUrl><IsDurRestrictions>true</IsDurRestrictions><DurRestrictionReasonId xsi:nil="true"/><DurEmbargoDate xsi:nil="true"/></OutputDur></OutputDurs></rfc1807>
spelling 2022-08-03T15:53:20.9203693 v2 60382 2022-07-05 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 ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 10628af4988d624b49c4de7bd78b4694 Sze Chim Lee Sze Chim Lee true false 2022-07-05 HDAT 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. Journal Article BMJ Open 11 5 e049721 BMJ 2044-6055 2044-6055 26 5 2021 2021-05-26 10.1136/bmjopen-2021-049721 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University Another institution paid the OA fee Regarding relevant background infrastructure funding, RSt was part funded by: (1) the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust and King’s College London; (2) a Medical Research Council (MRC) Mental Health Data Pathfinder Award to King’s College London; (3) an NIHR Senior Investigator Award and (4) the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. IB and SL were supported by the NIHR BRC at South London and Maudsley NHS Foundation Trust and King’s College London and by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. RC’s research was funded by the MRC (grant MC_PC_17213) and the NIHR Cambridge BRC. AC was supported by the NIHR Oxford Cognitive Health Clinical Research Facility, by an NIHR Research Professorship (grant RP-2017-08-ST2-006), by the NIHR Oxford and Thames Valley Applied Research Collaboration and by the NIHR Oxford Health BRC (grant BRC-1215-20005). AJ was part funded by MQ ADP and an MRC Mental Health Data Pathfinder Award to Swansea University. AJ and SCL were part funded by Health and Care Research Wales National Centre for Mental Health. DO was supported by the NIHR BRC at University College London Hospitals and by the National Institute for Health Research ARC North Thames. Additional infrastructure funding was provided by the MRC Mental Health Data Pathfinder Award to University of Edinburgh (MC_PC_17209). The collaboration providing Wales data was led by the Swansea University Health Data Research UK team under the direction of the Welsh Government Technical Advisory Cell and includes the following groups and organisations: the Secure Anonymised Information Linkage Databank, Administrative Data Research Wales, NHS Wales Informatics Service, Public Health Wales, NHS Shared Services and the Welsh Ambulance Service Trust and MRC grant MR/V028367. This study was additionally supported by the NIHR Mental Health Translational Research Collaboration. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR or the UK Department of Health. 2022-08-03T15:53:20.9203693 2022-07-05T12:43:02.9997182 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Ioannis Bakolis 1 Robert Stewart 0000-0002-4435-6397 2 David Baldwin 3 Jane Beenstock 4 Paul Bibby 5 Matthew Broadbent 6 Rudolf Cardinal 0000-0002-8751-5167 7 Shanquan Chen 8 Karthik Chinnasamy 9 Andrea Cipriani 0000-0001-5179-8321 10 Simon Douglas 11 Philip Horner 12 Caroline A Jackson 0000-0002-2067-2811 13 Ann John 0000-0002-5657-6995 14 Dan W Joyce 15 Sze Chim Lee 16 Jonathan Lewis 17 Andrew McIntosh 0000-0002-0198-4588 18 Neil Nixon 19 David Osborn 20 Peter Phiri 21 Shanaya Rathod 22 Tanya Smith 23 Rachel Sokal 24 Rob Waller 25 Sabine Landau 26 60382__24450__3b0cc24146b64f82a18998b103e70815.pdf 60382.VOR.pdf 2022-07-05T12:46:02.8507174 Output 641704 application/pdf Version of Record true This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made true eng https://creativecommons.org/licenses/by/4.0/ 101 Ioannis Bakolis true https://bmjopen.bmj.com/content/11/5/e049721.info true
title 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
spellingShingle 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
Ann John
Sze Chim Lee
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv ed8a9c37bd7b7235b762d941ef18ee55
10628af4988d624b49c4de7bd78b4694
author_id_fullname_str_mv ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
10628af4988d624b49c4de7bd78b4694_***_Sze Chim Lee
author Ann John
Sze Chim Lee
author2 Ioannis Bakolis
Robert Stewart
David Baldwin
Jane Beenstock
Paul Bibby
Matthew Broadbent
Rudolf Cardinal
Shanquan Chen
Karthik Chinnasamy
Andrea Cipriani
Simon Douglas
Philip Horner
Caroline A Jackson
Ann John
Dan W Joyce
Sze Chim Lee
Jonathan Lewis
Andrew McIntosh
Neil Nixon
David Osborn
Peter Phiri
Shanaya Rathod
Tanya Smith
Rachel Sokal
Rob Waller
Sabine Landau
format Journal article
container_title BMJ Open
container_volume 11
container_issue 5
container_start_page e049721
publishDate 2021
institution Swansea University
issn 2044-6055
2044-6055
doi_str_mv 10.1136/bmjopen-2021-049721
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description 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.
published_date 2021-05-26T04:18:27Z
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score 11.016235

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