Psychiatric emergency care during Coronavirus 2019 (COVID 19) pandemic lockdown: results from a Department of Mental Health and Addiction of northern Italy

Obsessive-Compulsive Disorder During the COVID-19 Pandemic: a Systematic Review

PURPOSE OF REVIEW

This systematic review evaluated the impact of the COVID-19 pandemic on obsessive-compulsive symptoms.

RECENT FINDINGS

Most studies showed that obsessive-compulsive symptoms worsened during the early stages of the pandemic, particularly for individuals with contamination-related obsessive-compulsive disorder (OCD), though other symptoms dimensions were found to worsen as well. Many patients and individuals in the general population experienced new obsessive-compulsive-like symptoms centered on COVID-19. Self-reported rates of symptom exacerbation and COVID-19-focused symptoms were consistently lower in studies that recruited patients from specialty clinics (compared to online samples). Most studies were conducted in Spring/Summer, 2020. The COVID-19 pandemic has been an enormous stressor for individuals with OCD, especially for those with contamination symptoms. Regardless, there is strong reason to believe gold standard treatment approaches for OCD have maintained strong efficacy. Disseminating and effectively delivering evidence-based treatments for OCD is an urgent public health priority.

Impact of the COVID-19 pandemic on acute inpatient psychiatric units in Spain

Patients with more severe mental health symptoms are treated in acute inpatient psychiatric units (AIPUs), but the functioning of these units throughout Spain has been challenged by the COVID-19 pandemic. We therefore conducted a descriptive, cross-sectional study to assess the situation. An online survey was distributed to all hospitals with AIPUs in Spain and made accessible for 28 days. Two scientific coordinators were appointed to supervise the scientific and methodological aspects of the study. The most relevant findings include reductions in numbers of beds and staff, insufficient material resources, changes in action protocols and in admission processes, and limitations in routine therapies, such as group and occupational therapy, psychotherapy and psychoeducational programmes. The possibility of performing ECT was also seriously curtailed. This is the first study to evaluate the impact of the first wave of the COVID-19 pandemic on AIPUs. These data may help improve the quality of care of patients with mental illness in the future.

A 6-month study on the pattern of emergency department presentations for schizophrenia and other psychotic disorders during COVID-19 lockdown

This study investigated the characteristics of patients with schizophrenia and other psychotic disorders presenting to emergency departments (ED) for psychiatric treatment during the first six months of the COVID-19 lockdown in Melbourne. This cross-sectional data-base study included adult patients in the North West Area Mental Health Service's catchment area who had visited two emergency departments (EDs) during the study period (March 16-September 16, 2020) and the control period (March 16-September 16, 2019). Compared to the control period (n = 467), the lockdown period (n = 451) had a 6.8% more psychotic disorders. This increase was particularly noted for schizophrenia and acute transient psychosis. In a sub-analysis of psychotic disorder group alone, compared to the control period, more patients were discharged to the community in the lockdown period. In another sub-analysis, compared to the mood disorder group, psychotic disorder group included more patients in 26-35 and 46-55 age groups, men, emergency triage category, and hospital admissions and higher mean duration of ED stay in the lockdown period. Overall, patients with psychotic disorders had increased ED presentations and appeared to be in an emergency state when they present to ED during the lockdown.

[Neuropsychiatric Aspects of COVID-19 - A Narrative Overview]

The SARS-CoV-2 virus (Severe Acute Respiratory Syndrome Coronavirus Type 2) and COVID-19 (Coronavirus Disease 2019) can affect numerous organ systems. In the present paper we offer an overview of the current state of knowledge about the psychiatric aspects of SARS-CoV-2 infection.Medline, Embase und LIVIVO were searched for relevant literature, the last query dating from March 2nd, 2021. Different stress factors in the context of the pandemic can lead to manifest mental illnesses. In addition, there is a risk of neuropsychological changes due to the biological effects of the virus itself.Our work describes the psychological symptoms of COVID-19 sufferers themselves and the psychological effects of the epidemic and the associated socio-economic and psychosocial stress factors on those who are not sick.The most common psychiatric complication among people with COVID-19 is delirium, while hospitalized patients seem to have an increased incidence of symptoms of anxiety, depression and PTSD. There are many case reports on psychotic disorders. In general, an existing psychiatric illness (especially dementia and psychotic disorders) also increases the risk of infection and of a more severe course of the disease. After recovery from COVID-19 infection, there is also a higher incidence of mental illnesses, in particular "Chronic Post-SARS Syndrome" with its manifestations such as fatigue, anxiety, depression and PTSD. In addition, the course of dementia seems to be negatively influenced by an infection with SARS-CoV-2.The second part deals with the effects of the epidemic as a stressor and the established socio-political measures on the mental health of people with and without previous mental illnesses. The literature currently available shows high symptom values for anxiety and depressive disorders as well as post-traumatic stress disorders, stress, suicidality, sleep disorders etc. Risk factors seem to include female gender, younger age and fewer resources, as well as previous psychiatric or physical illnesses. Extrinsic factors such as high infection rates, large numbers of deaths, long curfews/lockdowns, low trust in the government and ineffective measures against economic and social consequences increase the burden.

The impact of the COVID-19 pandemic and its related restrictions on people with pre-existent mental health conditions: A scoping review

CONTEXT

Globally, governments have introduced a variety of public health measures including restrictions and reducing face-to-face contact, to control the spread of COVID-19. This has implications for mental health services in terms of support and treatment for vulnerable groups such as people with pre-existent mental health conditions. However, there is limited evidence of the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions.

OBJECTIVES

To identify the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions.

METHODS

A scoping review of the literature was employed. Eight electronic databases (PsycINFO, Cochrane, Web of Science, MEDLINE, EMBASE, CINAHL, Scopus, Academic Search Complete) were searched and 2566 papers identified. 30 papers met the criteria for this review and findings were summarised under three key review questions.

RESULTS

COVID-19 and its related restrictions have had a notable effect on people with pre-existent mental health conditions. Public health restrictions have contributed to increased levels of social isolation, loneliness, and reduced opportunities for people to connect with others. Reduced access to health services and treatments has compounded matters for those seeking support. Exacerbation and deterioration of symptoms are commonly reported and can lead to greater susceptibility to COVID-19 infection.

IMPLICATIONS

The importance of proactive planning, alternative accessible healthcare services and supports for vulnerable and at-risk groups is illuminated. Increased monitoring, early intervention and individually tailored care strategies are advocated. Recommendations revolve around the need for enhanced provision of remote support strategies facilitated using technology enhanced resources. ACCESSIBLE SUMMARY.

Suicide behaviors during the COVID-19 pandemic: A meta-analysis of 54 studies

COVID-19, and efforts to mitigate its spread, are creating extensive mental health problems. Experts have speculated the mental, economic, behavioral, and psychosocial problems linked to the COVID-19 pandemic may lead to a rise in suicide behavior. However, a quantitative synthesis is needed to reach an overall conclusion regarding the pandemic-suicide link. In the most comprehensive test of the COVID-19-suicidality link to date, we meta-analyzed data from 308,596 participants across 54 studies. Our results suggested increased event rates for suicide ideation (10.81%), suicide attempts (4.68%), and self-harm (9.63%) during the COVID-19 pandemic when considered against event rates from pre-pandemic studies. Moderation analysis indicated younger people, women, and individuals from democratic countries are most susceptible to suicide ideation during the COVID-19 pandemic. Policymakers and helping professionals are advised that suicide behaviors are alarmingly common during the COVID-19 pandemic and vary based upon age, gender, and geopolitics. Strong protections from governments (e.g., implementing best practices in suicide prevention) are urgently needed to reduce suicide behaviors during the COVID-19 pandemic.

Narrative Review of COVID-19 Impact on Obsessive-Compulsive Disorder in Child, Adolescent and Adult Clinical Populations

Background: The COVID-19 pandemic and quarantine had a significant impact on mental health which resulted in an increase of anxiety and depression in adult, child and adolescent clinical populations. Less is known about the potential effect of pandemic on obsessive-compulsive disorder (OCD) so there is a lack of review work to illustrate the impact of the COVID-19 pandemic on OCD. Purpose: The main objective is to review all the empirical contributions published after March 2020 that dealt with the impact of the COVID-19 pandemic on OCD in adults, children and adolescents, investigating the state-of-the-art literature concerning the impact on OCD and detailing limitations. Methods: The literature search was conducted using PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, PubMed, and Google Scholar. This review analyzed all studies from January 2020 to 8 January 2021, focusing on clinical populations of children, adolescents, and adults with OCD. Results: A total of 102 articles were screened, resulting in the identification of 64 full-text articles to be further scrutinized. Upon closer examination, there was consensus that 39 articles met the study inclusion criteria and 14 of these were selected for study. Analysis of the results revealed that COVID-19 had an impact on OCD in both adults and young people and seems to have caused exacerbation of symptoms, especially of the contamination/washing subtypes. Eight studies in adult samples showed an increase in the severity of obsessive-compulsive symptoms; two studies underlined a minimal impact of COVID-19 on OCD patients and one study showed a slight improvement in symptoms. Two out of three studies on children and adolescents showed an exacerbation of OCD and a worsening even in the presence of an ongoing treatment. Conclusions: The studies reviewed are few. There are more studies on adult OCD than on children and adolescents. The results are controversial: few studies examined OCD subtypes; in most studies the typology of treatment was not clear and the samples covered a wide age range; a large number of studies did not use the same monitoring period or quantitative measures, both of which make it difficult to compare or rely on the results.

Psychological Health Status of Psychiatric Patients Living in Treatment Communities before and during the COVID-19 Lockdown: A Brief Report

Many studies investigated the psychological impact of lockdown measures on the general population, while few studies focused on the psychiatric population. This study aimed to investigate the role of therapeutic communities in the management and containment of symptoms of patients with psychosis living in psychiatric residential facilities. Data were collected at two different points: November 2019 (Coronavirus disease 19 had not yet spread) and April 2020 (during the lockdown in Italy). Twenty-two study participants were recruited from three residential accredited psychiatric facilities. During lockdown, the patients showed a small increase in symptomatology in terms of emotional isolation. In addition, it was been observed significant differences in certain functional areas of the behavior, measured as lower inclination towards violent behaviors during lockdown, and higher scores in substance abuse and medical impairment. The lockdown condition could represent a form of containment; daily routines, along with adequate social support, are important aspects of the stability and the level of behavioral functioning of psychiatric patients. Social support and continuity of care offered by psychiatric communities can be an effective safeguard against the psychological impact of the COVID-19 epidemic.

Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review

BACKGROUND

The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial.

OBJECTIVE

The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention.

METHODS

This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada's guidance on app assessment and selection.

RESULTS

A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity.

CONCLUSIONS

A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area.

Changing trends in psychiatric emergency service admissions during the COVID-19 outbreak: Report from a worldwide epicentre

BACKGROUND

During the COVID-19 pandemic, a structural reorganization was imposed on public health systems. Psychiatry services were also affected with the imposed reduction of non-urgent consultations. We aim to explore the effect of these changes on a Psychiatry Emergency Service during COVID-19 lockdown in Spain.

METHODS

A retrospective analysis was performed on all patients admitted to our Psychiatric Emergency Service 90 days before and after March 14th, 2020, the first day of lockdown in Spain. Extracted data were compared between the two periods. Poisson regression analysis was performed to analyze changes in admission rates.

RESULTS

1,958 psychiatric emergency admissions were analyzed. Although the number of admissions decreased by 37.9%, we observed a significant increase in the percentage of acute psychiatric hospitalization during the lockdown. Anxiety spectrum disorders accumulated the greatest significant decrease in admission rates during the lockdown. On the other hand, a significant increase in admissions rates was found in patients with dementia, autism spectrum disorders, and substance use disorders during the lockdown.

LIMITATIONS

This study was conducted in a single psychiatric emergency service, preventing a generalization of our results. The comparison time period might have biased our results due to the influence of external factors.

CONCLUSION

Mental health consequences of COVID-19 are becoming apparent. A reduction of admission rates for anxiety disorders might be related telepsychiatry implementation during the lockdown. Other conditions particularly vulnerable to the routine changes and lack of social support have suffered the most, and efforts should be placed to treat these situations.

Increased Screen Use on Days With Increased Perceived COVID-19-Related Confinements-A Day Level Ecological Momentary Assessment Study

Introduction: Coronavirus 2019 (COVID-19) quickly evolved into a global pandemic in early 2020, and most countries enforced social confinements to reduce transmission. This seems to dovetail with increasing, potentially problematic, screen use habits, such as gaming and "binge-watching." Yet, the subjective experience of the common confinements may vary not only between individuals depending on age, sex, and living conditions (i.e., living alone) but also within individuals from day to day: confinements might interfere with habitual activity schedules more strongly on some days than on others. Such dynamic confinement experience has not been studied in relation to screen use yet but might guide targeted intervention. Method: In total, 102 participants (n = 83 female, n = 80 university students) completed 14 days of ecological momentary assessment during a COVID-19-related lockdown in Germany and Austria. Each evening, they indicated the extent to which they felt restricted by confinements in their social and work lives and whether they engaged in unusually high and intense levels of television watching, social media use, news consumption, internet surfing, and gaming. They also reported on how much they experienced their day to be structured. Results: Experienced work confinements were positively associated with social media usage. Further, work confinements were positively associated with gaming in males and with news consumption, especially in individuals living alone. Social confinements were positively associated with watching television especially in younger participants and with social media consumption in younger participants. Higher experienced day structure was related to less television watching, gaming, and internet surfing but more news consumption. Discussion: Screen use behaviors increased with higher confinements within person, dependent on sex, age, and living situation. Such knowledge allows tailoring on the person level (who should be addressed?) and the time level (when should interventions be scheduled?) as the negative consequences of excessive screen use behaviors on mental and physical health are well-documented. One potential low-threshold intervention might be day-structuring.

Impact of the COVID-19 Pandemic on Psychiatric Admissions to a Large Swiss Emergency Department: An Observational Study

The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency with profound mental health consequences. The psychiatric emergency department (ED) plays a key role during this mental health crisis. This study aimed to investigate differences in admissions at a Swiss psychiatric ED from 1 April to 15 May during a “pandemic-free” period in 2016 and a “during-pandemic” period in 2020. The study included 579 consultations at psychiatric ED in the “during-pandemic” period and 702 in the “pandemic-free” period. Sociodemographic and clinical characteristics were compared, and logistic regression analysis was performed to identify variables associated with psychiatric admissions during the pandemic. A reduction in total psychiatric ED admissions was documented during COVID-19. Logistic regression analysis predicted the independent variable (ED admission during the pandemic) and estimated odds ratio (OR) for being unmarried/not in a relationship, arrival in an ambulance, suicidal behavior, behavioral disorders and psychomotor agitation. Though only statistically significant in bivariate analysis, patients were also more likely to be involuntarily hospitalized. This picture appears to be reversed from a sociodemographic and clinical point of view to our observation of psychiatric ED consultation in 2016. These findings highlight that the reduction in psychiatric ED admissions during the pandemic seems to be associated with living alone and more severe psychopathologies, which must alert psychiatrists to ensure access to mental health care in times of pandemic.

Psychological Distress, Loneliness, and Boredom Among the General Population of Tyrol, Austria During the COVID-19 Pandemic

Background: COVID-19-related mental health problems are considered a public health challenge. The aim of this study was to investigate psychological distress, loneliness, and boredom among the general population of the federal state of Tyrol, Austria. Methods: Residents of Tyrol aged ≥ 18 years were recruited via dissemination of a link through social media and other advertisements and invited to complete an online survey from June 26th to August 20th, 2020. Next to the collection of sociodemographic and COVID-19 related variables the Brief Symptom Checklist (BSCL), the Three-Item Loneliness Scale (TILS), and the Multidimensional State Boredom Scale-Short Form (MSBS-SF) were used to assess psychological distress, loneliness, and boredom. Results: 961 participants took part in the survey (68.3% woman). Of these, 14.4% were burdened from psychological distress (BSCL), 22.6% reached a TILS score ≥ 7 and were therefore classified as severely lonely, and boredom levels lay by a mean of 25.9 ± 11.0 points in the MSBS-SF (range: 7-56). Women, singles, low-income people as well as those who were unemployed were significantly more often affected by all of the selected outcomes compared to the remaining sample and they had significantly more frequently consumed alcohol or other substances since the outbreak of the pandemic in order to feel better. In addition, young and middle-aged adults were particularly burdened by loneliness and boredom. Discussion: Our findings identify vulnerable groups and factors associated with higher psychological distress, loneliness, and boredom in the context of the pandemic. In order to prevent mental health problems it will be critical to identify options of maintaining social contacts and remaining active despite pandemic-related restrictions.

Peripandemic psychiatric emergencies: impact of the COVID-19 pandemic on patients according to diagnostic subgroup

On March 11th, 2020, the outbreak of coronavirus disease 2019 (COVID-19) was declared a pandemic. Governments took drastic measures in an effort to reduce transmission rates and virus-associated morbidity. This study aims to present the immediate effects of the pandemic on patients presenting in the psychiatric emergency department (PED) of Hannover Medical School. Patients presenting during the same timeframe in 2019 served as a control group. A decrease in PED visits was observed during the COVID-19 pandemic with an increase in repeat visits within 1 month (30.2 vs. 20.4%, p_BA = 0.001). Fewer patients with affective disorders utilized the PED (15.2 vs. 22.2%, p_BA = 0.010). Suicidal ideation was stated more frequently among patients suffering from substance use disorders (47.4 vs. 26.8%, p_BA = 0.004), while patients with schizophrenia more commonly had persecutory delusions (68.7 vs. 43.5%, p_BA = 0.023) and visual hallucinations (18.6 vs. 3.3%, p_BA = 0.011). Presentation rate of patients with neurotic, stress-related, and somatoform disorders increased. These patients were more likely to be male (48.6 vs. 28.9%, p_BA = 0.060) and without previous psychiatric treatment (55.7 vs. 36.8%, p_BA = 0.089). Patients with personality/behavioral disorders were more often inhabitants of psychiatric residencies (43.5 vs. 10.8%, p_BA = 0.008). 20.1% of patients stated an association between psychological well-being and COVID-19. Most often patients suffered from the consequences pertaining to social measures or changes within the medical care system. By understanding how patients react to such a crisis situation, we can consider how to improve care for patients in the future and which measures need to be taken to protect these particularly vulnerable patients.

Decreasing Psychiatric Emergency Visits, but Stable Addiction Emergency Visits, During COVID-19-A Time Series Analysis 10 Months Into the Pandemic

Background: The COVID-19 pandemic has been suspected to increase mental health problems, but also to possibly lead to a decreased treatment seeking, for example due to fear of attending hospital. Early findings demonstrate decreased treatment seeking for mental health, which may differ across diagnostic groups. This study aimed to examine treatment uptake at a general psychiatry emergency unit and at an addiction psychiatry emergency unit in Malmö, Sweden, separately. In addition, the study aimed to investigate treatment uptake for different diagnostic groups-during and prior to the COVID-19 pandemic. Methods: Monthly data for number of unique patients and number of contacts were extracted for the three-year period of January 2018 through December 2020. Data from each facility were analyzed separately for women, men and patients with psychotic, affective, anxiety and substance use-related disorders. Interrupted time series were used to demonstrate possible effects of COVID-19. Results: COVID-19 was associated with a marked decrease in treatment contacts, both for women and men, in the general psychiatry emergency unit-driven by a significant decrease in anxiety-related disorders (p < 0.001) and affective disorders (p < 0.01)-but not in psychotic or substance use disorders (SUDs). Also, in the addiction psychiatry emergency unit, no significant impact of COVID-19 was seen. Conclusions: COVID-19 may decrease treatment uptake for acute affective and anxiety-related disorders. Given the hypothesized increase in the population regarding these conditions, societal efforts are needed to facilitate adequate treatment for these patients during the COVID-19 pandemic. Society should also remain vigilant with respect to SUDs during the pandemic.

Psychiatric emergency visit trends and characteristics in a mental health epicenter in Istanbul during COVID-19 lockdown

BACKGROUND

We aimed to explore the impact of the preventive measures and partial lockdown to the psychiatric emergency department (PED) visits during COVID-19 pandemic in a mental health epicenter in Istanbul.

METHODS

A total of 5839 patients admitted to PED during the lockdown period (LP) between March 30 and May 31, 2020, were enrolled in this retrospective cohort study. Data of these patients were compared to those of patients in the same period in 2019 between April 1 and June 2, 2019 (non-LP). We also investigated the monthly number of PED visits and hospitalizations between March 1 and December 31, 2020, and compared it to the same period in 2019.

RESULTS

The volume of PED visits and hospitalizations in LP decreased by 12% and 41.6%, respectively. The rates of patients presenting anxiety and depressive disorders and bipolar disorders were found to significantly increase in LP than non-LP (p < 0.001; p < 0.001; p < 0.01, respectively). Depressive disorders, prior history of mental illness, and aggressive behavior were found to predict frequent PED visits while decrease in age and male gender found to predict hospitalizations. Regarding suicide attempt, younger patients and those with new-onset mental disorders were found to be at high risk in LP. Patients diagnosed with COVID-19 in PED visits were mostly with psychotic and bipolar disorders.

CONCLUSION

Policy-makers should focus on studies on mental health services to reorganize and enhance such services, which are crucial to prevent and manage adverse mental health consequences of the pandemic and congestion in PEDs.

Psychiatric Emergencies During the Covid-19 Pandemic: A 6-Month Observational Study

BACKGROUND

The new SARS-CoV-2 has caused an ongoing pandemic. Health prevention measures to contain the outbreak are profoundly affecting the physical and mental health as well as personal freedom of the population.

AIM

To evaluate psychiatric emergencies in a 6-month period during the COVID-19 pandemic in 2020 compared to those of the corresponding period of the previous year.

METHODS

This monocentric observational study preliminarily collected variables of the urgent psychiatric consultations (UPCs) carried out in emergency room (ER) from 1-3-2020 to 31-8-2020 and the socio-demographic and clinical characteristics of patients who required UPCs in the 6-month period, comparing these data with those collected from 1-3-2019 to 31-8-2019. The data, collected in alpha-numeric code, were statistically analyzed through STATA 12-2011.

RESULTS

This research reported a reduction of both UPCs and hospital psychiatric admissions. Concomitantly, we observed an increase of UPCs required by people already being treated by psychiatric and other health services, residents in psychiatric facilities and non-Italians. In 2020, differently from 2019, the most frequent reasons for urgent psychiatric consultations were aggressive behavior and adjustment disorders with anxiety and depressive mood.

CONCLUSION

This preliminary study suggests that, during the COVID-19 epidemic, urgent psychiatric consultations in ER were reduced, except for the most vulnerable people due to their clinical and/or social conditions.

The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: a living systematic review

Background: The COVID-19 pandemic has caused morbidity and mortality, as well as, widespread disruption to people's lives and livelihoods around the world. Given the health and economic threats posed by the pandemic to the global community, there are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review (LSR) focuses on suicide prevention in relation to COVID-19, with this iteration synthesising relevant evidence up to June 7 th 2020. Method:  Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. Results: Searches identified 2070 articles, 29 (28 studies) met our inclusion criteria, of which 14 articles were research letters or pre-prints awaiting peer review. All articles reported observational data: 12 cross-sectional; eight case series; five modelling; and three service utilisation studies. No studies reported on changes in rates of suicidal behaviour. Case series were largely drawn from news reporting in low/middle income countries and factors associated with suicide included fear of infection, social isolation and economic concerns.   Conclusions:  A marked improvement in the quality of design, methods, and reporting in future studies is needed. There is thus far no clear evidence of an increase in suicide, self-harm, suicidal behaviour, or suicidal thoughts associated with the pandemic. However, suicide data are challenging to collect in real time and economic effects are evolving. Our LSR will provide a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide. PROSPERO registration: CRD42020183326 01/05/2020.

The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review

Background: The COVID-19 pandemic has caused considerable morbidity, mortality and disruption to people's lives around the world. There are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review synthesises findings from emerging literature on incidence and prevalence of suicidal behaviour as well as suicide prevention efforts in relation to COVID-19, with this iteration synthesising relevant evidence up to 19 th October 2020. Method:  Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. We exclude one-off cross-sectional studies without either pre-pandemic measures or comparisons of COVID-19 positive vs. unaffected individuals. Results: Searches identified 6,226 articles. Seventy-eight articles met our inclusion criteria. We identified a further 64 relevant cross-sectional studies that did not meet our revised inclusion criteria. Thirty-four articles were not peer-reviewed (e.g. research letters, pre-prints). All articles were based on observational studies. There was no consistent evidence of a rise in suicide but many studies noted adverse economic effects were evolving. There was evidence of a rise in community distress, fall in hospital presentation for suicidal behaviour and early evidence of an increased frequency of suicidal thoughts in those who had become infected with COVID-19. Conclusions:  Research evidence of the impact of COVID-19 on suicidal behaviour is accumulating rapidly. This living review provides a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide risk as the longer term impacts of the pandemic on suicide risk are researched.