Psychiatric diagnoses and self-harm episodes among children and young people in UK primary care records before and during the COVID-19 pandemic: a population-based cohort study

Date of Approval
Application Number
Technical Summary

The aim of this time series study is to investigate temporal trends in incidence of primary care-recorded psychiatric diagnoses, self-harm episodes, prescription of psychotropic medications, and referral to mental health services among children and young people in the UK before and during the COVID-19 pandemic.

Using data from the CPRD GOLD and Aurum datasets, we will delineate two cohorts of patients aged 1-24 years during 2010 and early 2022. Depending on the age of eligibility, psychiatric diagnoses examined will include depression, anxiety disorders, eating disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, psychosis, substance misuse, and personality disorders. We will calculate the incidence for each outcome measure for each quarterly (or monthly) period, stratified by age group, gender, and practice-level deprivation quintiles. We will use time series analysis to quantity the changes in temporal trends of the outcome measures, comparing the periods before and after the start of the pandemic. We will use mean-dispersion negative binomial regression models to estimate the expected incidence trends from March 2020 onwards, based on the trends predicted by data from the pre-pandemic period. The ‘effect’ of the pandemic will be calculated as the difference between the observed and predicted incidence rates of the outcome measures, had trends that were observed prior to the start of the pandemic continued.

It is anticipated that the enduring adverse impact of the pandemic on children and young people’s mental health will become evident in the months and years to come, with a sustained increase in demand for healthcare resources. Working with our patient and public involvement and engagement partners, our findings will help to inform health, social, and educational services when designing mental health recovery plans and to facilitate better targeting of resources to tackle young people’s mental health problems.

Health Outcomes to be Measured

• Incidence of psychiatric diagnoses: depression (aged 6-24 years), anxiety disorders (aged 6-24 years), eating disorders (aged 10-24 years), attention deficit hyperactivity disorder (ADHD) (aged 1-24 years), autism spectrum disorder (ASD) (aged 1-24 years), psychosis (aged 13-24 years), personality disorders (aged 16-24 years), and substance misuse (aged 16-24 years).
• Incidence of self-harm (aged 10-24 years).
• Incidence of prescriptions for all psychotropic medications and separately for antidepressants, benzodiazepines, and medications for ADHD (aged 4-24 years).
• Incidence of GP referrals to mental health services (aged 10-24 years).
• All self-harm episodes (i.e. including first and subsequent recorded episodes).
• All prescriptions for antidepressants, benzodiazepines, antipsychotics, and medications for ADHD (i.e. including first and subsequent prescriptions).

Since some mental health conditions are rarely diagnosed at a very young age, the exact age of eligibility for inclusion will vary across the array of outcome measures that will be examined, as indicated above.


Pearl Mok - Chief Investigator - University of Manchester
Pearl Mok - Corresponding Applicant - University of Manchester
Alex Trafford - Collaborator - University of Manchester
Carolyn Chew-Graham - Collaborator - Keele University
Darren Ashcroft - Collaborator - University of Manchester
Matthew Carr - Collaborator - University of Manchester
Roger Webb - Collaborator - University of Manchester
Shruti Garg - Collaborator - University of Manchester


Practice Level Index of Multiple Deprivation