Widening Excess Mortality During the COVID-19 Pandemic in Individuals Who Self-Harmed

BackgroundStudies on COVID-19 pandemic-associated changes in mortality following self-harm remain scarce and inconclusive.AimsTo compare mortality risks in individuals’ who had self-harmed to those who had not, before and during the COVID-19 pandemic (Waves 1 and 2) in Wales, United Kingdom, using population-based routinely collected data.MethodWe linked whole population health data to all-cause mortality following an episode of self-harm between April 2016 and March 2021. Propensity score matching, Cox regression, and difference-in-differences were applied to compute changes in excess mortality (as ratios of hazard ratios, RHR) before and during the pandemic for individuals who self-harmed.ResultsThe difference in mortality for individuals who self-harmed compared to those who did not widened during Wave 1 (RHR = 2.0, 95% CI: 1.0-4.0) and Wave 2 (RHR = 2.2, 95% CI: 1.1-4.3) from before the pandemic. Stratification by sex and age group produced no significant subgroup differences although risk for