Background: The COVID-19 pandemic may have been accompanied by an increased exposure to psychosis risk factors. We used a pre-during-post study design to examine variations in the incidence of First-Episode Psychosis (FEP) before, during, and after the COVID-19 pandemic in South London. We hypothesised that FEP rates rose during the pandemic and subsequently returned to pre-pandemic levels.
Methods: Using the Clinical Record Interactive Search (CRIS) system, we screened individuals referred for FEP to Early Intervention Services for Psychosis (EISs) of the South London and Maudsley NHS Foundation Trust (SLaM) from 1 March 2018 to 29 February 2024. Population data for the SLaM catchment area were obtained from the Office for National Statistics (ONS). We calculated crude incidence rates and used Poisson regression models to estimate age-sex-ethnicity-adjusted variation in incidence by year (March-to-February) expressed as Incidence Rate Ratios (IRR).
Findings: A total of 3752 individuals experienced FEP during 5,487,858 person-years at risk, with a mean crude incidence of 68.4 per 100,000 person-years (95% CI: 66.2-70.6). The Poisson model showed a deviation from this mean at the peak of the COVID-19 pandemic in 2020/21, with FEP rates rising to 77.5 per 100,000 person-years (95% CI: 71.8-83.2) and similar rates in 2021/22. FEP incidence gradually returned to the pre-pandemic levels in the following years. During the COVID-19 pandemic, individuals of Black ethnicity experienced the greatest FEP increase, with an IRR of 1.45 (95% CI: 1.29-1.61) in 2020/21 and similar ratios in 2021/22. An increase was also observed in Asian individuals, with an IRR of 1.54 (95% CI: 1.20-1.88) in 2021/22, whereas no significant changes in incidence were observed for other ethnic groups across the pre-, during-, and post-pandemic periods.
Interpretation: FEP incidence in South London increased during the peak of the COVID-19 pandemic, particularly among Black and Asian individuals.
Funding: None.
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