Hospitalization for self-harm, overdose lower during start of pandemic vs. before

The first wave of the COVID-19 pandemic saw a drop in hospitalization for self-harm or overdose in adolescents and young adults compared to the 2 years before, according to a population-based cohort study published in JAMA Network Open.

“Within North America, self-harm and deaths among adolescents and young adults aged 14 to 24 years remain prevalent and are notably related to drug poisonings and suicide. The risk of premature death increases around age 14 years, especially among males, rural residents and those who exhibit persistently high despair scores — so-called deaths of despair,” Joel G. Ray, MD, MSc, of St. Michael’s Hospital at the University of Toronto, and colleagues wrote. “With the emergence of the COVID-19 pandemic, a high rate of suicidal thoughts, severe depression and anxiety was seen among university and elementary students during quarantine.”

Ray and colleagues sought to evaluate the risk of self-harm, overdose and mortality of all types among the population 14 to 24 years old during the initial stages of the COVID-19 pandemic from April 1, 2020, to June 30, 2021, and compare with statistics relative to the 2-year period before the pandemic, from March 1, 2018, to Feb. 28, 2020.

The researchers culled information from 1,690,733 young persons born between 1990 and 2006, in Ontario, Canada, aged 14 to 24 years between March 1, 2018, and June 30. 2021.

Data were broken down by frequency of ED visits or hospitalizations due to either self-harm or overdose. Follow-up was initiated at the later date between March 1, 2018, or a participant’s 14th birthday, with chronological age used as the time scale.

Results showed that almost twice as many study participants (12,970) experienced episodes of self-harm or overdose during the prepandemic period as those who did during the initial pandemic period (6,224). In addition, the risk of incidence of either self-harm or overdose leading to hospitalization was lower during the pandemic, as was the risk for secondary outcomes of either self-harm or overdose.

During the pandemic, self-harm was the most prevalent outcome, followed by overdose and death. Measured individually, risk of death was the sole outcome that did not change from prepandemic times to pandemic onset.

Lower hazard risk for primary outcomes was more pronounced for participants aged 18 to 24 years than those aged 14 to 17 years, the authors noted.

“The robust nature of the current findings suggests that, at least up to the middle of 2021, the COVID-19 pandemic has not led to an excess of intentional injury among adolescents and young adults,” Ray and colleagues wrote.