Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

Objective: To compare psychiatric emergencies and self-harm at emergency departments (EDs) one year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. Method: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March-April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. Results: Altogether, 8174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3742 of which were self-harm presentations. Rate of psychiatric ED presentations in March-April 2021 was twice as high as March-April 2020 (IRR, 1.93; 95% CI, 1.60-2.33), and 50% higher than March-April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March-April 2020 and March-April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and overall 1.7 times higher than March-April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March-April 2021 with March-April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (OR, 1.30; 95% CI, 1.05-1.62), whilst female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered four times as often (OR, 4.46; 95% CI, 2.32-8.58). Conclusion: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue utilizing follow-up appointments to support discharge from EDs. Diversity & inclusion statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the wor