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Hospital presentations for self-poisoning during COVID-19 in Sri Lanka: an interrupted time-series analysis
The Lancet Psychiatry ( IF 64.3 ) Pub Date : 2021-07-29 , DOI: 10.1016/s2215-0366(21)00242-x
Duleeka Knipe 1 , Tharuka Silva 2 , Azra Aroos 3 , Lalith Senarathna 4 , Nirosha Madhuwanthi Hettiarachchi 5 , Sampath R Galappaththi 5 , Matthew J Spittal 6 , David Gunnell 7 , Chris Metcalfe 8 , Thilini Rajapakse 2
Affiliation  

Background

There is widespread concern over the impact of public health measures, such as lockdowns, associated with COVID-19 on mental health, including suicide. High-quality evidence from low-income and middle-income countries, where the burden of suicide and self-harm is greatest, is scarce. We aimed to determine the effect of the pandemic on hospital presentations for self-poisoning.

Methods

In this interrupted time-series analysis, we established a new self-poisoning register at the tertiary care Teaching Hospital Peradeniya in Sri Lanka, a lower-middle-income country. Using a standard extraction sheet, data were gathered for all patients admitted to the Toxicology Unit with self-poisoning between Jan 1, 2019, and Aug 31, 2020. Only patients classified by the treating clinician as having intentionally self-poisoned were included. Data on date of admission, age or date of birth, sex, and poisoning method were collected. No data on ethnicity were available. We used interrupted time-series analysis to calculate weekly hospital admissions for self-poisoning before (Jan 1, 2019–March 19, 2020) and during (March 20–Aug 31, 2020) the pandemic, overall and by age (age <25 years vs ≥25 years) and sex. Individuals with missing date of admission were excluded from the main analysis.

Findings

Between Jan 1, 2019, and Aug 31, 2020, 1401 individuals (584 [41·7%] males, 761 [54·3%] females, and 56 [4·0%] of unknown sex) presented to the hospital with self-poisoning and had date of admission data. A 32% (95% CI 12–48) reduction in hospital presentations for self-poisoning in the pandemic period compared with pre-pandemic trends was observed (rate ratio 0·68, 95% CI 0·52–0·88; p=0·0032). We found no evidence that the impact of the pandemic differed by sex (rate ratio 0·64, 95% CI 0·44–0·94, for females vs 0·85, 0·57–1·26, for males; pinteraction=0·43) or age (0·64, 0·44–0·93, for patients aged <25 years vs 0·81, 0·57–1·16, for patients aged ≥25 years; pinteraction=0·077).

Interpretation

This is the first study from a lower-middle-income country to estimate the impact of the pandemic on self-harm (non-fatal) accounting for underlying trends. If the fall in hospital presentations during the pandemic reflects a reduction in the medical treatment of people who have self-poisoned, rather than a true fall in incidence, then public health messages should emphasise the importance of seeking help early.

Funding

Elizabeth Blackwell Institute University of Bristol, Wellcome Trust, and Centre for Pesticide Suicide Prevention.

Translations

For the Sinhalese and Tamil translations of the abstract see Supplementary Materials section.



中文翻译:

斯里兰卡 COVID-19 期间自我中毒的医院介绍:中断的时间序列分析

背景

人们普遍担心与 COVID-19 相关的公共卫生措施(例如封锁)对心理健康(包括自杀)的影响。来自自杀和自残负担最重的低收入和中等收入国家的高质量证据很少。我们的目的是确定大流行对医院自我中毒表现的影响。

方法

在这个中断的时间序列分析中,我们在中低收入国家斯里兰卡的佩拉德尼亚三级护理教学医院建立了一个新的自我中毒登记册。使用标准提取表,收集了 2019 年 1 月 1 日至 2020 年 8 月 31 日期间因自毒入院的所有毒理学病房患者的数据。仅包括被治疗临床医生归类为故意自毒的患者。收集了有关入院日期、年龄或出生日期、性别和中毒方法的数据。没有关于种族的数据。我们使用间断时间序列分析来计算在大流行之前(2019 年 1 月 1 日至 2020 年 3 月 19 日)和期间(2020 年 3 月 20 日至 8 月 31 日)每周因自我中毒入院的人数,整体和按年龄(年龄 <25年≥25 岁)和性别。入院日期缺失的个体被排除在主要分析之外。

发现

2019 年 1 月 1 日至 2020 年 8 月 31 日期间,1401 人(584 名 [41·7%] 男性,761 名 [54·3%] 女性,56 名 [4·0%] 性别不明)因以下原因到医院就诊:自我中毒并有入院日期数据。观察到与大流行前趋势相比,大流行期间因自我中毒而入院的人数减少了 32%(95% CI 12-48)(率比 0·68,95% CI 0·52-0·88;p =0·0032)。我们没有发现大流行的影响因性别而异的证据(率比 0·64,95% CI 0·44–0·94,女性vs 0·85,0·57–1·26,男性;p相互作用=0·43) 或年龄 (0·64, 0·44–0·93, 对于年龄 <25 岁的患者vs 0·81, 0·57–1·16, 对于年龄≥25 岁的患者;p相互作用= 0·077)。

解释

这是来自中低收入国家的第一项估计大流行对自我伤害(非致命)影响的研究,并说明了潜在趋势。如果大流行期间医院就诊率的下降反映了对自毒者的医疗减少,而不是发病率的真正下降,那么公共卫生信息应该强调及早寻求帮助的重要性。

资金

布里斯托尔大学伊丽莎白布莱克威尔研究所、威康基金会和农药自杀预防中心。

翻译

有关摘要的僧伽罗语和泰米尔语翻译,请参阅补充材料部分。

更新日期:2021-09-17
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