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Impact of the COVID-19 lockdown on hangings attended by emergency medical services

      To the Editor
      The UK went into lockdown on 23rd March 2020 to reduce the impact of COVID-19 and protect the National Health Service (NHS). Imposed restrictions were then gradually eased from May onwards. In addition to deaths directly attributable to COVID-19, an increase in the rate of suicides was a predicted impact of the pandemic.
      • Sher L.
      The impact of the COVID-19 pandemic on suicide rates.
      Accordingly, reporting rates of suicide was identified as a priority for mental health research connected to the pandemic.
      • Holmes E.A.
      • O’Connor R.C.
      • Perry V.H.
      • et al.
      Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science.
      Hanging frequently results in cardiac arrest and is the most common method of suicide in England and Wales, accounting for 62% of male suicide and 47% of female suicide in 2019.
      • Office for National Statistics
      Ambulance services are in a unique position to report on suicides, including hangings, as they attend successful and unsuccessful attempts. Data on hangings attended by North East Ambulance Service NHS Foundation Trust (NEAS) (a UK regional ambulance service) were examined to identify any change during the COVID-19 lockdown.
      We obtained time series data on weekly hanging cases from 7th January 2019 until 19th July 2020. To take into account a long-term increasing trend in the data, time series analysis was used to model the weekly differenced data via an MA(1) model with an interruption term (starting 23rd March 2020) to estimate the mean difference before and after lockdown (Fig. 1). There was little evidence of a difference in the number of weekly hanging cases (mean difference −1.4, 95%CI: −5.7 to 2.8).
      Fig. 1
      Fig. 1Weekly hanging cases (blue dots) with estimated mean (red line) ± 1.96 SD (orange lines). The grey shaded area indicates the post lockdown period.
      Although no statistically significant difference was found between the pre and post-lockdown periods, there is a concerning upward trend post-lockdown. The lack of evidence is influenced by the pre-lockdown upward trend, the small number of data points post-lockdown, and the apparent dip at the start of lockdown after which cases rise sharply. The median number of weekly hangings pre-lockdown was 4 (IQR 3–5), whereas post-lockdown it was 8 (IQR 6–11), however this increase in the median is inflated by the long-term increasing trend. The maximum number of weekly cases pre-lockdown was eight whereas five out of seventeen weeks post-lockdown exceeded this.
      There are likely to be multiple contributing factors to the pattern seen in the data, but if this pattern is sustained and repeated in other settings then emergency services and receiving hospitals need to prepare for more calls of this nature if lockdown is re-imposed or the pandemic continues for an extended period.

      Conflicts of interest

      None.

      Funding

      There was no funding for this work.

      Author contributions

      All authors made a substantial contribution to this work.

      References

        • Sher L.
        The impact of the COVID-19 pandemic on suicide rates.
        QJM: Int J Med. 2020; (Accessed 24 September 2020, at)https://doi.org/10.1093/qjmed/hcaa202
        • Holmes E.A.
        • O’Connor R.C.
        • Perry V.H.
        • et al.
        Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science.
        Lancet Psychiatry. 2020; 7: P547-560
        • Office for National Statistics
        Suicides in England and Wales: 2019 registrations. Published online 1st September 2020.
        (Accessed 2 September 2020, at)