Substance use and self-harm emergency department presentations during COVID19: evidence from a National Clinical Programme for Self-Harm

Abstract

Introduction: Given the evidence that drinking patterns and self-harm hospital presentations have changed during COVID-19, this study aimed to examine any change in self-harm and suicide-related ideation presentations, together with any possible contribution made by alcohol or substance misuse, to Irish Emergency Departments in 2020, compared with 2018 and 2019. Methods: A population-based cohort with self-harm and suicide-related ideation presenting to Irish hospitals derived from the National Clinical Programme for Self-Harm was analysed. Descriptive analyses were conducted based on sociodemographic variables and types of presentation for the period January to August 2020 and compared with the same period in 2018 and 2019. Binomial regression analyses were performed to investigate the independent effect of demographic characteristics and pre/during COVID-19 periods on the use of substances as contributory factors in the self-harm and suicide-related ideation presentations. Results: 12,075 presentations due to self-harm and suicide-related ideation were recorded for the periods January–August 2018–2020 across nine emergency departments. The COVID-19 year was significantly associated with substances contributing to self-harm and suicide-related ideation ED presentations (OR = 1.183; 95% CI, 1.075–1.301, p < 0.001). No changes in the demographic characteristics were found for those with self-harm or suicide-related ideation across the years. Suicide-related ideation seemed to be increased after May 2020 compared with previous years. In terms of self-harm episodes with comorbid drug and alcohol overdose and poisoning, these were significantly increased in January–August 2020, compared with previous timepoints (χ2 = 42.424, df = 6, p < 0.001). Conclusion: An increase in suicide-related ideation and substance-related self-harm presentations may indicate longer term effects of the pandemic and its relevant restrictions. Future studies might explore whether those presenting with ideation will develop a risk of suicide in post-pandemic periods.

Self‐harm by single‐ and multi‐agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022

“…The available evidence on self‐harm by medication poisoning since 2020 show a decrease in the number of hospital presentations during the initial pandemic wave (March–June 2020, also compared to the corresponding period in 2019) 16,17 . In more longitudinal studies from different countries, some authors failed to show any signs of reprise in the following months 18 and up until mid‐late 2021, 19 while others instead demonstrated a steep re‐rise of cases beginning July 2020 20 . Interestingly, though, two published reports from Poison Control Centers (PCC) database are consistent in showing a decrement in calls concerning self‐harm by poisoning during the first “lockdown” period in Europe in March–June 2020 followed by an increase above pre‐lockdown levels beginning October–November 2020 21,22 …”