Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Feb 19, 2024
Date Accepted: Dec 21, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Incidence of deliberate self-harm in Hong Kong before and during the COVID-19 pandemic: Interrupted time series analysis of emergency department data between 2016 and 2022
ABSTRACT
Background:
Since the end of COVID-19 on May 5th 2023, The Samaritan Befrienders Hong Kong, a local non-governmental organization, reported increasing suicide rates among youth with possible attributions to the restrictive measures implemented during the pandemic. Therefore, surveillance on the impact of COVID-19 on deliberate self-harm incidences is needed.
Objective:
We aim to present the incidence of emergency department (ED) visits relevant to deliberate self-harm (DSH) and outline the changes brought upon by the COVID-19 pandemic according to sex, age and co-occurring mental health issues based on a territory-wide clinical database in Hong Kong.
Methods:
This cohort study adapted an interrupted time series analysis of ED visits for DSH across sex, age groups and associated mental health issues between 2016 and 2022. Quasi-experiment was used to estimate the quantitative counterfactual results of the pandemic period. We calculated the observed monthly DSH-related ED visits and observed incidence ratios during the pandemic. Then, we estimated the expected monthly DSH-related ED visits and adjusted incidence ratios by fitting a negative binomial model to pre-pandemic data (2016-2019), while considering temporal trends, seasonality, and population variation.
Results:
There were significant differences in demographic characteristics (sex) and clinical characteristics (death within 28 days, co-occurring mental health issue diagnoses, public assistance pay code, and triage level). Also, significant differences in DSH incidence among young adult males (2020: 1·34 (CI: [1·09, 1·67]), 2021: 1·94 (CI: [1·44, 2·67]), 2022: 2·53 (CI: [1·83, 3·65])), adult males (2020: 1·58 (CI: [1·46, 1·71]), 2021: 2·64 (CI: [2·37, 2·92]), 2022: 3·13 (CI: [2·74, 3·51])), adult females (2020: 1·13 (CI: [1·02, 1·25]), 2021: 1·52 (CI: [1·33, 1·76]), 2022: 1·64 (CI: [1·43, 1·95])), and elderly males (2020: 1·53 (CI: [1·23, 1·94]), 2021: 2·37 (CI: [1·75, 3·24]), 2022: 3·01 (CI: [2·08, 4·43])).
Conclusions:
The average annual DSH-related ED visits increased during the pandemic period. Therefore, there is a need to raise awareness for such vulnerable groups in Hong Kong for pandemic preparation.
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