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

Ben Hoi Ching Wong*, Samantha Cross, Patricia Zavaleta-Ramírez, Ines Bauda, Pamela Hoffman, Patricia Ibeziako, Laura Nussbaum, Gregor E. Berger, Hossein Hassanian-Moghaddam, Krisztina Kapornai, Tauseef Mehdi, Jovanka Tolmac, Elizabeth Barrett, Liana Romaniuk, Chiara Davico, Omer S. Moghraby, Giedra Ostrauskaite, Sulagna Chakrabarti, Sara Carucci, Gyula SofiHaseena Hussain, Alexandra S.K. Lloyd, Fiona McNicholas, Ben Meadowcroft, Manish Rao, Györgyi Csábi, Gabriel Gatica-Bahamonde, Hakan Öğütlü, Eirini Skouta, Rachel Elvins, Isabel Boege, Dulangi M.A. Dahanayake, Marija Anderluh, Miyuru Chandradasa, Braulio M. Girela-Serrano, Sara Uccella, Dejan Stevanovic, Marco Lamberti, Amy Piercey, Peter Nagy, Varun S. Mehta, Yasodha Rohanachandra, Jie Li, Ali Evren Tufan, Hassan Mirza, Farah Rozali, Benjamin J. Baig, Isa M. Noor, Saori Fujita, Narges Gholami, Zehra Hangül, Anna Vasileva, Katie Salucci, Öznur Bilaç, Çiğdem Yektaş, Mehmet Akif Cansız, Gülen Güler Aksu, Suleiman Babatunde, Fatima Youssef, Salim Al-Huseini, Fethiye Kılıçaslan, Meryem Ozlem Kutuk, Izabela Pilecka, Ioannis Bakolis, Dennis Ougrin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objective: To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 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 to 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, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 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 using 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 work.

Original languageEnglish
Pages (from-to)998-1009
Number of pages12
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number9
Publication statusPublished - Sept 2023


  • COVID-19 pandemic
  • emergency psychiatric services
  • epidemiology
  • self-injurious behavior
  • youth mental health

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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