Comparing rates of self-harm during the pandemic to the preceding time


An investigation examines whether self-harm, suicide or suicidal ideation in children and adolescents saw an increase during the pandemic, as anticipated by many clinicians.

Over the past decade, concerns about the mental health of teenagers has grown as rates of suicidality and self-harm have risen. With the pandemic came a heightened worry that mental health issues in this population would significantly increase as a result of isolation and anxiety about COVID-19. A new report compares the risk of self-harm or overdose among teenagers and young adults living in the Ontario province in Canada during the pandemic with the 2 years preceding it.1

Investigators ran a population-based cohort study that included all teenagers and young adults who were born in Ontario between 1990 and 2006. They compared April 1, 2020 to June 30, 2021, to March 1, 2018 to February 28, 2020. The main outcomes were emergency department encounters and hospitalizations for either self-harm or overdose. Secondary measures included self-harm, overdose, or all-cause mortality.

There were a total of 1,690,733 teenagers and young adults included in the cohort. There were slightly more girls in the cohort and the median age was 17.7 years at the start of follow-up, which was either March 1, 2018 or the participants 14th birthday. Following 4,110,903 person-years of follow-up, investigators found that 6224 participants had experienced a primary outcome of self-harm or overdose during the pandemic (39.7 per 10 000 person-years) vs 12 970 (51.0 per 10 000 person-years) prepandemic, with an hazard ratio (HR) of 0.78 (95% CI, 0.75-0.80). Furthermore, they found that the risk of self-harm, overdose, or death was lower during the pandemic than in the preceding period (HR, 0.78; 95% CI, 0.76-0.81). This was not true of all-cause of mortality (HR, 0.95; 95% CI, 0.86-1.05).

The investigators concluded that contrary to what many predicted, that in the first 15 months of the pandemic, there was a decline in hospital care for either self-harm of overdose in teenagers and adolescents. They noted that this is in line with other research that indicated either little change in mental health care utilization in hospitals or declines in such care.


  1. Ray J, Austin P, Aflaki K, Guttmann A, Park A. 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
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