​​One year after the COVID-19 pandemic, girls are twice as prone to seeking medical care for self-harm compared to before the pandemic​

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports significant international increases in the rates of pediatric emergency department visits during the COVID-19 pandemic due to self-harm (including suicide attempt) and other psychiatric concerns. Notably, girls were found to be at greater risk, as the odds of self-harm presentations made by female children and adolescents doubled when comparing 1-year post-pandemic to the pre-pandemic period.

The COVID-19 pandemic imposed substantial burdens on youth and families from changes in schooling, social isolation, and family stressors. While the acute phase of the outbreak may have passed, the impacts on mental health are long-lasting and profound. Children and adolescents are particularly at risk due to likely induced or amplified adverse childhood experiences. Self-harm, defined as any self-directed act of harming oneself irrespective of suicidal intent, is one of the major concerns, considering it is a leading cause of death for young people globally.

Researchers and psychiatrists from 62 emergency departments in 25 developed and developing countries provided new insights on this topic by examining the clinical records of a retrospective cohort of children and adolescents from March-April 2019, 2020, and 2021.

Incidence rates of hospital visits for any psychiatric reasons were 50% higher in March-April 2021, compared with March-April 2019, whereas the rate of visits for self-harm increased by 1.7 times in the same period. These increases exceeded the initial decline in visit rates observed early in the pandemic.

Dennis Ougrin, MD, senior author and professor at Queen Mary University of London, said “COVID-19 is likely to continue to impact young people’s mental health in the future. Recognizing the impact of both the pandemic and pandemic response on mental health should be a key priority in planning for managing pandemics in the future.”

The over-representation of girls in self-harm figures at emergency departments worldwide was notable with the rate of self-harm related visits by girls doubling between March-April 2019 and March-April 2021, and 62% higher compared with early the early pandemic period. The study did not find similar increases in the clinical diagnoses or self-harm methods that are common in adolescent girls, such as self-poisoning or eating disorders. This indicates potential changes in the clinical profiles of this demographic.

Ben Hoi-Ching Wong, first author and clinical researcher at East London NHS Foundation Trust and the Youth Resilience Unit of Queen Mary University of London said, “Girls may be disproportionately affected by the pandemic, and we are now observing some of the mental health consequences. This is consistent across a socioeconomically diverse range of countries on five continents. It is critical that schools, community services, and parents continue to encourage and support help-seeking, so that young people who are at risk of self-harm will access the support they need.”

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Notes for editors

The article is "​Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study​," by Ben Hoi-Ching Wong, MScSamantha Cross, MSc, Patricia Zavaleta-Ramírez, MD, MSc, et al. (​https://doi.org/10.1016/j.jaac.2022.11.016​). It appears in the ​​Journal of the American Academy of Child and Adolescent Psychiatry​​, volume ​62​, issue ​9​ (​September 2023​), published by Elsevier. Copies of this paper are available to credentialed journalists upon request; please contact ​Ben Hoi-Ching Wong, MSc,​ at [email protected].

About ​JAACAP​ 

Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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