Publication: Frontiers in Psychiatry

Chen S, She R, Qin P, Kershenbaum A, Fernández-Egea E, Nelder JR, Ma C, Lewis JR, Wang C, Cardinal RN

26 November 2020

To date, there is a paucity of information regarding the effect of COVID-19 or lockdown on mental disorders.

In this study researchers aimed to quantify the medium-term impact of lockdown on referrals to secondary care mental health clinical services.

They 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. This acceleration was primarily for urgent or emergency referrals, including referrals to liaison psychiatry and mental health crisis teams. The acceleration was significant for females, males, working-age adults, people of White ethnicity, those living alone, and those who had pre-existing depression, severe mental illness, hypertension / cardiovascular / cerebrovascular disease, personality disorders, asthma / chronic obstructive pulmonary disease, dyslipidemia, anxiety, substance misuse or reactions to severe stress.

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.

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Publication: International Journal of Geriatric Psychiatry

Kershenbaum A, Cardinal RN, Chen S, Underwood B, Seyedsalehi A, Lewis JR, Rubinsztein JS

4 November 2020

Previous studies have shown increased rates of death and dementia in older people in specific serious mental illnesses (SMI) such as bipolar disorder or depression.

In this study researchers examined the rates of death and dementia in older people referred into a secondary care psychiatric service across a range of SMIs, using an anonymised dataset across 6 consecutive years with 28,340 patients aged 65 years and older from a single secondary care psychiatric trust in the United Kingdom.

They identified deaths and incident dementia in patients with bipolar disorder/mania, schizophrenia, recurrent depression and anxiety disorders. They compared mortality and dementia rates between these diagnostic groups and in different treatment settings, and also examined mortality rates and dementia rates compared with general population rates.

Patients with schizophrenia showed the highest hazard rate for death compared to other groups with SMIs. Survival was reduced in patients referred to liaison psychiatry services. There were no significant differences between the SMI groups in terms of rates of dementia. However, risks of death and dementia were significantly increased compared to the general population; and older adults referred into an old age psychiatry service showed higher rates of dementia and death than those reported for the general population.

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Publication: Journal of Psychiatric Research

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

22 September 2020

COVID-19 has affected social interaction and healthcare worldwide.

Here researchers examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK (population ~0·86 million), plus service activity and deaths.

They conducted interrupted time series analyses with respect to the time of UK “lockdown”, which was shortly before the peak of COVID-19 infections in this area, and examined changes in standardized mortality ratio for those with and without severe mental illness (SMI).

Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking).

This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for eating disorders, for which there was no evidence of change.

Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality was primarily in the over-70s. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity.

In conclusion, the research showed that COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. “Supply” changes may have reduced access to mental health services for some. “Demand” changes may reflect a genuine reduction of need or a lack of help-seeking with pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.

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