A population-based cohort study found that during the initial 15 months of the COVID-19 pandemic, hospitalization for self-harm or overdose was reduced among adolescents and young adults. These findings were published in JAMA Network Open.

Data for this study were sourced from Ontario, Canada’s universal health care system. Adolescents and young adults aged 14 to 24 years (N=1,690,733) were assessed for emergency department (ED) visits for self-harm or overdose occurring during the first 15 months of the COVID-19 pandemic (April 1, 2020 to June 30, 2021) and compared with rates during the 2 years preceding the pandemic (March 1, 2018 to February 28, 2020).

The study cohort was aged median 19.8 (IQR, 16.2-23.5) years at the start of the COVID-19 pandemic, 51.3% were boys or men, and 1.6% had a history of self-harm or overdose.

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ED visits for self-harm or overdose occurred at a rate of 39.7 per 10,000 person-years (py) during the pandemic and 51.0 per 10,000 py prior to the pandemic. Of note, the transitional period between prepandemic and pandemic (March 2020), was associated with the lowest rate (37.3 per 10,000 py).

During the pandemic, self-harm occurred at the highest rate (28.1 per 10,000 py) followed by overdose (15.9 per 10,000 py) and death (3.9 per 10,000 py).

The pandemic was associated with decreased risk for ED visit (hazard ratio [HR], 078; 95% CI, 075-0.80) or hospitalization (HR, 0.85; 95% CI, 0.81-0.90) for self-harm or overdose and for self-harm, overdose, or death (HR, 0.78; 95% CI, 0.76-0.81).

Stratifying by gender, income, or rurality did not alter the observed trends. The reduction in ED visits for self-harm or overdose were more pronounced among individuals aged 18 to24 years (HR, 0.74; 95% CI, 0.71-0.77) compared with those aged 14 to 17 years (HR, 0.84; 95% CI, 0.80-0.88).

This study was limited by not having access to data about self-harm or overdose events that did not have a hospital or ED encounter.

“In this study, there was a relative decline in hospital encounters for self-harm or overdose among adolescents and young adults during the first 15 months of the COVID-19 pandemic. It should be determined if this phenomenon continued within subsequent waves of the pandemic, or if unrealized self-harm or overdose events have occurred outside of a hospital setting,” the study authors concluded.


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