Did Rates of Self-Harm and Overdose in Youth Actually Decrease During the Pandemic?


New research finds evidence that contradicts previous hypotheses.




Mental health experts and clinicians anticipated an increase in self-harm and overdoses among children and adolescents as a result of the stresses associated with the COVID-19 pandemic. Now, a new study shows the opposite may be true.1

Joel G. Ray, MD, MSc, professor at the University of Toronto, and colleagues compared 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 the pandemic via a population-based cohort study of teenagers and young adults who were born in Ontario between 1990 and 2006. Ray et al compared data for these youth between April 1, 2020 to June 30, 2021, to March 1, 2018 to February 28, 2020, looking at emergency department encounters and hospitalizations for either self-harm or drug overdose. Secondary measures included self-harm, overdose, or all-cause mortality.

A total of 1,690,733 teenagers and young adults were included in the cohort. A little less than half of the cohort were female (48.7%); the median age was 17.7 years at the start of follow-up. With 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 a hazard ratio (HR) of 0.78 (95% CI, 0.75-0.80). Furthermore, the investigators 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).

Ray et al noted a limitation of the study was that less life-threatening cases may have been missed as a result of the design. Similarly, suicides that occurred outside of the hospital setting were also not captured.

“The robust nature of the current findings suggests that, at least up to the middle of 2021, the COVID-19 pandemic has not led to an excess of intentional injury among adolescents and young adults,” Ray et al concluded. “It should be determined if this phenomenon continued within subsequent waves of the pandemic, or if unrealized self-harm or overdose events have occurred outside of a hospital setting.”

(A version of this article appeared on Contemporary Pediatrics, our sister publication.)


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.

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