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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

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
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 differencein-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.
COVID-19, adult psychiatry, mental health, old age psychiatry, organisation of health services
2044-6055
Bakolis, Ioannis
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Stewart, Robert
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Baldwin, David
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Beenstock, Jane
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Bibby, Paul
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Broadbent, Matthew
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Cardinal, Rudolf
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Chen, Shanquan
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Chinnasamy, Karthick
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Cipriani, Andrea
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Douglas, Simon
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Horner, Philip
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Jackson, Caroline A.
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John, Ann
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Joyce, Dan W.
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Chim Lee, Sze
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Lewis, Jonathan
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McIntosh, Andrew
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Nixon, Neil
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Osborn, David
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Phiri, Peter
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Rathod, Shanaya
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Smith, Tanya
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Sokal, Rachel
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Waller, Rob
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Landau, Sabine
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Bakolis, Ioannis
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Stewart, Robert
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Baldwin, David
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Beenstock, Jane
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Bibby, Paul
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Broadbent, Matthew
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Cardinal, Rudolf
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Chen, Shanquan
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Chinnasamy, Karthick
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Cipriani, Andrea
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Douglas, Simon
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Horner, Philip
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Jackson, Caroline A.
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John, Ann
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Joyce, Dan W.
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Chim Lee, Sze
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Lewis, Jonathan
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McIntosh, Andrew
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Nixon, Neil
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Osborn, David
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Phiri, Peter
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Rathod, Shanaya
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Smith, Tanya
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Sokal, Rachel
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Waller, Rob
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Landau, Sabine
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Bakolis, Ioannis, Stewart, Robert, Baldwin, David, Beenstock, Jane, Bibby, Paul, Broadbent, Matthew, Cardinal, Rudolf, Chen, Shanquan, Chinnasamy, Karthick, Cipriani, Andrea, Douglas, Simon, Horner, Philip, Jackson, Caroline A., John, Ann, Joyce, Dan W., Chim Lee, Sze, Lewis, Jonathan, McIntosh, Andrew, Nixon, Neil, Osborn, David, Phiri, Peter, Rathod, Shanaya, Smith, Tanya, Sokal, Rachel, Waller, Rob and Landau, Sabine (2021) 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. BMJ Open, 11 (5), [e049721]. (doi:10.1136/bmjopen-2021-049721).

Record type: Article

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 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 differencein-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.

Text
Bakolis et al (BMJ Open 2021 full) - Version of Record
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Accepted/In Press date: 14 May 2021
e-pub ahead of print date: 14 May 2021
Published date: 26 May 2021
Additional Information: Funding 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.
Keywords: COVID-19, adult psychiatry, mental health, old age psychiatry, organisation of health services

Identifiers

Local EPrints ID: 449641
URI: http://eprints.soton.ac.uk/id/eprint/449641
ISSN: 2044-6055
PURE UUID: 54fece1e-962f-452d-8231-9ab2e50acccd
ORCID for David Baldwin: ORCID iD orcid.org/0000-0003-3343-0907

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Date deposited: 10 Jun 2021 16:30
Last modified: 26 Nov 2021 02:37

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Contributors

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

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