Self-Harm Presentations to a Pediatric Trauma Centre During the First Year of the COVID-19 Pandemic.

Background: The COVID-19 pandemic raised concerns regarding increased youth suicidal behaviour. Trends in the volume and characteristics of hospital self-harm presentations may inform future suicide-prevention strategies. Objective: We compared the number and characteristics of pre - vs. intra-pandemic self-harm presentations to the Emergency Department (ED) of a major Canadian pediatric trauma centre. Method: Using time series analysis, we compared intra-pandemic (March 2020-February 2021) monthly self-harm presentation counts to forecasts based on the previous nine years. We compared the proportion of ED presentations for self-harm between the intra-pandemic period and the preceding three years. A detailed chart review of ED self-harm visits from March 2019 to February 2021 examined the demographic, clinical, and psychosocial features of pre- vs. intra-pandemic presentations. Results: Compared to pre-pandemic forecasts, ED self-harm presentation counts were decreased in March and May 2020 but increased in December 2020-January 2021. The self-harm proportion of ED presentations during the pandemic's first year was double that of the preceding three years (0.19% vs. 0.09%; OR=2.08, 95% CI=1.62-2.67). Compared to pre-pandemic self-harm presentations, patients presenting intra-pandemic were more likely to be seen for a psychiatry consultation in the ED or hospital ward (OR=2.38, 95% CI=1.04-5.43), to be admitted to a medical unit (OR=3.81, 95% CI=1.28-11.39), and to be living with parents (OR=2.58, 95% CI=1.09-6.09). Conclusions: The pandemic's association with the volume of self-harm visits to a pediatric ED appears to have varied throughout its duration. During the pandemic, self-harm visits had an increased representation among ED presentations and exhibited potential indicators of increased medical and psychiatric acuity.