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Lockdown stringency and paediatric self-harm presentations during COVID-19 pandemic: Retrospective cohort study

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Ben Hoi Ching Wong, Mehrak Vaezinejad, Paul L. Plener, Tauseef Mehdi, Liana Romaniuk, Elizabeth Barrett, Haseena Hussain, Alexandra Lloyd, Jovanka Tolmac, Manish Rao, Sulagna Chakrabarti, Sara Carucci, Omer S. Moghraby, Rachel Elvins, Farah Rozali, Ereni Skouta, Fiona McNicholas, Benjamin Baig, Dejan Stevanovic, Peter Nagy & 6 more Chiara Davico, Hassan Mirza, Evren Tufan, Fatima Youssef, Ben Meadowcroft, Dennis Ougrin

Original languageEnglish
Article numbere75
JournalBJPsych Open
Issue number2
Published24 Mar 2022

Bibliographical note

Funding Information: This research received no specific grant from any funding agency, commercial or not-for-profit sectors. The Comparison of Effectiveness and Cost-Effectiveness of Intensive Community Care Services versus Usual Inpatient Care for Young People with Psychiatric Emergencies network has received funding from the National Institute for Health Research (NIHR; ). The European College of Neuropsychopharmacology network is funded through membership fees, royalties and interest payments. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

King's Authors


Background Lockdown during the pandemic has had significant impacts on public mental health. Previous studies suggest an increase in self-harm and suicide in children and adolescents. There has been little research on the roles of stringent lockdown. Aims To investigate the mediating and predictive roles of lockdown policy stringency measures in self-harm and emergency psychiatric presentations. Method This was a retrospective cohort study. We analysed data of 2073 psychiatric emergency presentations of children and adolescents from 23 hospital catchment areas in ten countries, in March to April 2019 and 2020. Results Lockdown measure stringency mediated the reduction in psychiatric emergency presentations (incidence rate ratio of the natural indirect effect [IRRNIE] = 0.41, 95% CI [0.35, 0.48]) and self-harm presentations (IRRNIE = 0.49, 95% CI [0.39, 0.60]) in 2020 compared with 2019. Self-harm presentations among male and looked after children were likely to increase in parallel with lockdown stringency. Self-harm presentations precipitated by social isolation increased with stringency, whereas school pressure and rows with a friend became less likely precipitants. Children from more deprived neighbourhoods were less likely to present to emergency departments when lockdown became more stringent, Conclusions Lockdown may produce differential effects among children and adolescents who self-harm. Development in community or remote mental health services is crucial to offset potential barriers to access to emergency psychiatric care, especially for the most deprived youths. Governments should aim to reduce unnecessary fear of help-seeking and keep lockdown as short as possible. Underlying mediation mechanisms of stringent measures and potential psychosocial inequalities warrant further research.

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