Self-harm emergency department visits in Canada during the COVID-19 pandemic: evidence from a sentinel surveillance system

Abstract

Background

Self-harm is a leading cause of morbidity and mortality globally, though the prevalence tends to be highest among adolescents. As an indicator in suicide surveillance, the incidence of self-harm is useful because it is sensitive to social, environmental, and economic conditions. During the COVID-19 pandemic, the epidemiology of self-harm has varied across contexts. This study aims to investigate the changes in self-harm emergency department visits in 2020 compared to a pre-pandemic period in 2018–2019.

Methods

Self-harm emergency department visits were extracted from the Canadian Hospitals Injury Reporting and Prevention Program database from 2018 to 2020. We compared the data in 2020 with the pre-pandemic baseline in 2018–2019. We examined the changes in volume, the percentages of self-harm cases among all intentional injuries by sex, age group, and the proportions of self-harm cases by method of injury. We also quantified the time trends of the percentages of self-harm cases among all intentional injuries using Joinpoint regression.

Results

The overall volume of emergency visits related to self-harm was higher in 2020 during weeks 24–51 compared to the average volumes for the same weeks of 2018–2019. Percentage of self-harm among all intentional injury emergency department visits was significantly higher by 6.1% among females ( p < 0.05) and by 5.3% among males in 2020 than in 2018–2019 ( p < 0.05). The 11-to-18-year age group showed an increase in the percentage of self-harm among all intentional injury emergency department visits by 7.4% in 2020 when compared to 2018–2019. Time trend analyses showed that the percentages of self-harm among all intentional injury emergency department visits were higher during weeks 4–52 in 2020 than in 2018–2019, for both males and females.

Conclusions

The percentage of emergency department visits related to self-harm among all intentional injury visits were higher during 2020 than in 2018–2019. These results underscore the importance of continued surveillance of self-harm in Canada to better understand the sociodemographic factors affecting self-harm and to inform the prevention strategies and policies.