Decline in Self-Harm, Overdose Rates in Adolescents During COVID-19 Pandemic

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A study assessed the risk for self-harm, overdose, and all-cause mortality in adolescents and young adults during the COVID-19 pandemic.

Trends in self-harm and overdose among young adults during the COVID-19 pandemic were outlined in study data published in JAMA Network Open. Compared with the pre-pandemic period, hospital care for self-harm or overdose appeared to decline among adolescents and young adults during the first 15 months of COVID-19.

Prior studies have identified the emergence of the COVID-19 pandemic as a contributor to increasing rates of anxiety, depression, and suicide ideation among adolescents and young adults. However, the effect of these associations on the prevalence of self-harm and overdose remains unknown.

To inform this gap, investigators conducted a population-based cohort study of adolescents and young adults in Ontario, Canada. Patients who were aged 14 to 24 years from 2018 to 2021 were eligible for inclusion. Sociodemographic and clinical data were extracted from the Canadian universal care system database. The primary outcome was emergency department (ED) encounters or hospitalizations for self-harm or overdose. Outcome rates were calculated for the COVID-19 pandemic era — designated as April 1, 2020 to June 30, 2021 — and compared with rates from the preceding 2 years. Cause-specific hazard ratios (HRs) were computed separately for self-harm, overdose, and death.

The study cohort comprised 1,690,733 individuals, of whom 48.7% were girls; 51.3% were boys; 34.8% resided in the lowest 2 income quintile neighborhoods; and 1.6% had a history of self-harm before the study period. Median (interquartile range) age was 17.7 (14.1-21.4) years at the start of follow-up; total follow-up time was 4,110,903 person-years.

Overall, 6,224 adolescents and young adults experienced the primary outcome of self-harm or overdose during the pandemic (39.7 events per 10,000 person-years), compared with 12,970 before the pandemic (51.0 events per 10,000 person-years). The corresponding HR for self-harm and overdose during the pandemic was 0.78 (95% CI, 0.75-0.80), suggesting a substantially decreased risk. The risk for self-harm or overdose requiring inpatient care was also reduced during the pandemic (HR, 0.85; 95% CI, 0.81-0.90).

Risk for the composite outcome of self-harm, overdose, or death was significantly reduced compared with the prepandemic period (HR, 0.78; 95% CI, 0.76-0.81). However, all-cause mortality rates were not significantly lower during the COVID-19 period compared with the preceding 2 years (HR, 0.95; 95% CI, 0.86-1.05). The most common individual outcome during the pandemic was self-harm (28.1 events per 10,000 person-years), followed by overdose (15.9 per 10,000 person-years), and death (3.9 per 10,000 person-years). The lower HR for the primary outcome persisted after stratification for sex, income quintile, and rurality, although event rates were generally higher for girls and residents of low-income and/or rural areas. The effect of the COVID-19 pandemic on self-harm and overdose was more pronounced in individuals aged 18 to 24 years (HR, 0.74; 95% CI, 0.71-0.77) compared with individuals aged 14 to 17 years (HR, 0.84; 95% CI, 0.80-0.88).

As study limitations, investigators noted that their data only captured self-harm or overdose that required an ED encounter or hospitalization. As such, certain cases may have been missed. They suggest that further studies should explore whether this trend persisted into subsequent waves of the pandemic.  

“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,” study authors wrote. “This is contrary to the perceived expectations of others… [but] supports the findings during the first 6 months of the pandemic in Austria, in which there was a relative decline in suicide among all adults.”

Reference

Ray JG, Austin PC, Aflaki K, Guttmann A, Park AL. Comparison of self-harm or overdose among adolescents and young adults before vs during the COVID-19 pandemic in Ontario. JAMA Netw Open. 2022;5(1):e2143144. doi:10.1001/jamanetworkopen.2021.43144