Prolonged impact of the COVID-19 pandemic on self-harm hospitalizations in France: A nationwide retrospective observational study

Abstract

Background The first wave of the COVID-19 pandemic in France was associated with a reduced number of hospitalizations for self-harm, with the exception of older people. The on-going pandemic may have both sustained and delayed effects. Methods Data were extracted from the French national hospital database (PMSI), a nationwide exhaustive database. The number of self-harm hospitalizations (ICD-10 codes X60–84) between September 1, 2020 and August 31, 2021 (N = 85,679) was compared to 2019 (N = 88,782) using Poisson regression models. Results There was a decrease in the total number of self-harm hospitalizations during the studied period versus 2019 (−3.5%; Relative Risk [RR] [95% Confidence Intervals] = 0.97 [0.96–0.97]; p < 0.0001). However, sex and age effects were identified. While adults aged 30–59-years-old showed a decrease (monthly decreases: −12.6 to −15.0%), we found an increase in adolescent girls (+27.7%, RR = 1.28 [1.25–1.31]; p < 0.0001), notably since January 2021. Moreover, the numbers were similar to 2019 in adolescent boys, in youths aged 20–29 years, and in people aged 70 and more. Hospitalizations in intensive care units decreased (−6.7%, RR = 0.93 [0.91–0.96]; p < 0.0001) and deaths at hospital following self-harm remained stable (+0.6%, Hazard Ratio = 0.99 [0.91–1.08], p = 0.79). Conclusions During this second stage, the number of self-harm hospitalizations remained at a lower level than in the prepandemic period. However, significant variations over time, age, and sex were observed. Young people (notably adolescent girls) appear to have particularly suffered from the persistence of the pandemic, while older people did not show any decrease since the beginning. Vigilance and continuing prevention are warranted.

Temporal trends in calls for suicide attempts to poison control centers in France during the COVID-19 pandemic: a nationwide study

“…Then, a substantial increase was observed from November 2020 that continued until the end of the study period more than 18 months later. Again, this increase is very similar to which was observed for self-harm hospitalizations [ 19 ]. Therefore, two phases can be identified during the pandemic: a decrease during the first months continuing historical trends, and an increase since the end on 2020.…”

“…Following this early period, warning signs have been reported by clinicians about a possible increase in the number of mental health consultations among children [ 23 ]. Self-harm hospitalizations for the period September 2020-August 2021 showed a persistent decrease in middle-aged people but an important increase in female adolescents from January 2021 [ 19 ]. The prolonged effects of COVID-19 on suicide attempts need to be further examined.…”

“…initial data showed decreasing or stable rates of both suicide deaths [11] and non-fatal self-harming acts [12][13][14] during the early months of the pandemic in 2020. However, data from a few places across the world have shown a more recent increase in self-harm or suicide attempts in young people, notably female adolescents, since 2021 [15][16][17][18][19].…”

Trends in psychotropic drug consumption among French military personnel during the COVID-19 epidemic

“…Other recent work from our team has underlined the challenge of drawing firm conclusions Table 2 Rate ratios for the dispensing of the three psychotropic drug categories between January 1, 2019, and April 30, 2021, among French military personnel, considering that the epidemic breakpoint date was January 24, 2020 *** p < 0.001; ** p < 0.01; * p < 0.05 a Measured in weeks from 24th January 2020 to April 2021 (from week 1 to 124) b Coded 1 from the start of the epidemic, defined at 24th January 2020, 0 otherwise c Measured in weeks, coded 0 before the start of the epidemic and equal to the number of weeks afterwards (from week 1 to 67) about the overall effects of the epidemic. For instance, our analysis of suicide attempts in the general population in France indicated that there was a decrease in selfharm hospitalizations both during the first lockdown [28] and during the second stage of the COVID-19 pandemic [29], except among teenage girls. It is therefore essential to take into account the specificities of the study population, and healthy young individuals from the general active population should be studied specifically before extrapolating our results.…”

“…Other recent work from our team has underlined the challenge of drawing firm conclusions about the overall effects of the epidemic. For instance, our analysis of suicide attempts in the general population in France indicated that there was a decrease in self-harm hospitalizations both during the first lockdown [ 28 ] and during the second stage of the COVID-19 pandemic [ 29 ], except among teenage girls. It is therefore essential to take into account the specificities of the study population, and healthy young individuals from the general active population should be studied specifically before extrapolating our results.…”