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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

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    Author
    Nixon, Neil L.
    Keyword
    COVID-19
    SARS-CoV-2
    Mortality
    Home care services
    Mental health services
    Outcome assessment (Health care)
    Psychosis
    Date
    2021
    
    Metadata
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    DOI
    10.1136/bmjopen-2021-049721
    Publisher's URL
    https://bmjopen.bmj.com/content/11/5/e049721
    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 (AE). 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.
    Copyright © 2021 BMJ Publishing Group. All rights reserved.
    Citation
    Bakolis, I., Stewart, R., Baldwin, D., Beenstock, J., Bibby, P., Broadbent, M., Cardinal, R., Chen, S., Chinnasamy, K., Cipriani, A., et al. (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, pp.e049721.
    URI
    http://hdl.handle.net/20.500.12904/14749
    Note
    © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ 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. See: https://creativecommons.org/licenses/by/4.0/.
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