COVID-19

Co-lead of the Marginalised Groups: Mental Health subtheme, Prof Roger Webb, wrote an editorial in the journal Epidemiology and Psychiatric Services that described how much influence the COVID-19 pandemic appears to have had on suicide risk in lower- and middle-income countries and among socially marginalised and disadvantaged people in more affluent as well as less affluent nations.

He and co-authors concluded that, although evidence generated to date in high-income countries has mostly been reassuring, showing little evidence of increased suicide risk in all people at national or regional level, evidence relating to the pandemic’s potentially socially uneven impact on suicide risk remains sparse. Also, most studies done so far have not taken account of pre-pandemic trends.

Therefore, the collection of accurate, complete and comparable data on suicide rate trends in ethnic minority and low-income groups, in high-income as well as in middle- and low-income countries, should be prioritised. Also, it is crucial that reassuring messaging highlighting the stability of suicide rates during the pandemic does not lead to complacency among policymakers.

Read the editorial: Has the COVID-19 pandemic influenced suicide rates differentially according to socioeconomic indices and ethnicity? More evidence is needed globally

The centre’s mental health researchers looked at primary care contact for mental illness and self-harm. They also looked at referrals to mental health services before, during and after the acute phase of the COVID-19 pandemic, examining differences by age group, gender, ethnic group and practice-level deprivation.

Papers have been published on this work, including:

• Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study
• Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: Time series analysis of electronic healthcare records for 2.8 million patients in the Greater Manchester Care Record

• For more information about this work, visit this NIHR webpage.

Researchers investigated the indirect effect of the COVID-19 pandemic on people's use of general practices, and how this affected the diagnoses of common physical and mental health conditions in a deprived UK population.

Our findings received national news coverage and were published in the Lancet Public Health:

• Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study.
• Read a blog post about this work.

People with diabetes suffered disproportionately during the COVID-19 pandemic. In the first few months of the pandemic, almost a third of all COVID-19 related deaths were in people with diabetes, but little was known about regional mortality differences. There was also no data on how the pandemic affected the overall care of people with diabetes. Our studies were ‘world firsts’ highlighting indirect effects of the impact of the COVID-19 pandemic on people with type 2 diabetes (T2D). It’s so important because missed diagnoses and inadequate monitoring could cause life-changing complications, such as myocardial infarction and renal failure.

UK-wide research quantified the indirect and direct impacts of the pandemic in patients with T2D. In our first study, we found that in 2020, approximately 60,000 TD2 diagnoses were missed or delayed across the UK.  We also highlighted a reduction in monitoring (HbA1c testing) in 2020 and higher excess mortality rates in England compared to the rest of the UK.

In the second study, we discovered that when compared to 10-year historical trends, in 2020 there were approximately 7.4 million fewer NICE-recommended health care checks performed on people with T2D across UK general practices. We also found that about 31,800 fewer people were prescribed a new diabetes medication, and around 14,600 fewer prescribed a new antihypertensive medication.

Our work contributed to around £10M being made available by NHS England to support National COVID-19 recovery in diabetes.

• Read a blog post about this study

Read papers published on this work:

• Impact of COVID-19 on diagnoses, monitoring, and mortality in people with type 2 diabetes in the UK
• Impact of COVID-19 restrictions on diabetes health checks and prescribing for people with type 2 diabetes: a UK-wide cohort study involving 618 161 people in primary care

Other uses of the research findings:

• Our findings were also presented at The Royal Society of Medicine and Diabetes UK meetings. Our work formed the basis of a BMJ editorial entitled: How routine NHS diabetes care can catch up after covid-19.  
• We were also cited in an editorial written by the American Diabetes Association entitled: Diabetes and COVID-19: Population Impact 18 Months Into the Pandemic.

Almost 1 million people use the Improving Access to Psychological Therapies (IAPT) service each year, in-person and via the telephone. Although telephone-delivered therapy is just as effective as in-person therapy, not everyone is offered it. We developed a quality improvement intervention to address perceived organisational barriers, improve delivery of therapy and increase patient engagement with therapy delivered over the phone.

During the COVID-19 pandemic, from October 2020 to January 2021, we were funded by NHS England to deliver training to more than 400 IAPT practitioners (70% working in high intensity settings) across 60 services including 33 NHS trusts and 3^rd sector organisations. Surveys taken before and after this training highlighted improvements in capabilities and motivations of practitioners.

Our research was identified as an important resource in helping services to transition to telephone delivery. NHS England has funded the development of a stand-alone online training package that will be rolled out to all high intensity IAPT services during 2023.

Our research has indicated an increase in the number of people with serious mental health difficulties due to the COVID-19 pandemic. Our researchers believe that the improvements and expansion of IAPT delivered by telephone will help to ensure more people are able to access help with their mental health in the coming years.

• To read more about the research visit here.

Early evidence suggested that, on the whole, the public did follow the UK government's COVID-19-related instructions. However, interventions to sustain this in the long-term can only be developed if we know why people do or do not comply.

This study is assessing levels of public adherence to these guidelines. It is the first step in developing interventions to support continued public adherence to government instructions.

The following papers have been published on this study:

• What challenges do UK adults face when adhering to COVID-19-related instructions? Cross-sectional survey in a representative sample
•  “We want to live a little longer and our family want[s] us around”: A summative content analysis of adherence to COVID-19-related guidelines using the Theoretical Domains Framework
• Read a blog post about this work.

Researchers from the GM PSTRC have worked with other local organisations, Health Innovation Manchester, NHS organisations in the region, and the company Graphnet Health during the COVID-19 pandemic to establish the Greater Manchester Care Record (GMCR). It collects anonymised data from various NHS services, such as GPs and hospitals. The data are made accessible to clinicians across Greater Manchester to improve their decisions when treating patients.

Although the main purpose of the GMCR is to improve direct patient care, the same data also forms an important resource for our researchers addressing inequities in healthcare safety, with the data also being used for planning and research. Only de-identified data are available (so no names, addresses, NHS numbers, or other information that would identify a person). Researchers from the GM PSTRC have played a key role in making the GMCR available for research, so they can access and use these de-identified data to answer important questions, while ensuring data security and good information governance that can help to improve NHS services.

• Read a blog post about the Greater Manchester Care Record.
• Read about the first published research to use information from the Greater Manchester Care Record to examine self-harm presentation rates during the COVID-19 pandemic.

The COVID-19 pandemic and the required social distancing measures caused huge disruption and changes to the organisation of primary care, particularly for people experiencing homelessness. Remote consultations became the ‘default’ approach with GPs trying to reserve face-to-face appointments for cases where this was considered absolutely necessary.

Against this backdrop, a number of questions were raised. For example, how could people experiencing homelessness be supported to have safe access to primary care (remotely or in person)? And how would the changes to primary care during the pandemic impact on health and healthcare experiences for people experiencing homelessness?

Researchers from GM PSTRC, a homelessness charity called Groundswell, and primary care service providers worked together to evaluate the impact of the changes to primary care on people who are experiencing homelessness. This involved working in 3 primary care sites in different parts of Greater Manchester where services are provided specifically for people experiencing homelessness. Within these sites we asked for the experiences and opinions of healthcare professionals and key stakeholders, as well as people experiencing homelessness. The research demonstrated the importance of collaboration across organisations such as GP practices and hostels, with some staff providing face-to-face support and facilitating access to the right kind of appointment.

These findings have been used to produce guidance to help primary care staff to better support people experiencing homelessness to get access to the right kind of healthcare appointment at the right time.

• Read more about the research here.
• Read the paper: Remote primary care during the COVID-19 pandemic for people experiencing homelessness: a qualitative study

Research to investigate the potential usefulness of a mobile phone app for people living with dementia in the community was due to begin when the UK first went into lockdown in March 2020.

The study aimed to see whether the app could improve communication, safety and wellbeing for those with early stage dementia and their carers.

This work won the ‘Covid-19 special award’ for its Patient and Public Involvement at the 2021 Faculty of Biology, Medicine and Health Outstanding PPIE Awards at The University of Manchester.

• Visit the webpage ‘Living with and caring for people with dementia during COVID-19’.
• Read a blog post about this work.
• Read the paper: Co-designing an Adaption of a Mobile App to Enhance Communication, Safety, and Well-being Among People Living at Home With Early-Stage Dementia: Protocol for an Exploratory Multiple Case Study

During the COVID-19 pandemic, researchers at the GM PSTRC continued to work with members of the public, many of whom are from marginalised groups.  It has been recognised that people from marginalised groups have been most affected by the pandemic and its associated lockdowns.

To continue research with marginalised groups, researchers needed to adapt their work to make it possible for people to continue to participate. This editorial explains how this was done while outlining the challenges as well as the solutions uncovered by researchers.

• Read the editorial: Challenges and adaptations to public involvement with marginalised groups during the COVID-19 pandemic: commentary with illustrative case studies in the context of patient safety research