Adolescent emergency department visits for self-harm after COVID-19–related social distancing in the Republic of Korea: a 7-year retrospective study

BACKGROUND: Adolescent suicide is a major public health concern and self-harm-related emergency department (ED) visits are key predictors. Although social distancing during and after the pandemic likely affected the incidence of self-harm, few studies have explored these changes. We examined the variations in the incidence of adolescent self-harm-related ED visits before, during, and after social distancing. METHODS: We conducted a retrospective analysis of data from the ED‑Based Injury In‑Depth Surveillance registry in the Republic of Korea from January 2017 to December 2023. Injured patients aged 10 - 17 years were included in this study. The incidence rate of self-harm was recorded quarterly. Data on demographic, pre-hospital, and clinical characteristics were compared across three periods: pre-pandemic; pandemic; and post-pandemic, using data from Quarter 1 of 2020 (when social distancing was implemented) and Quarter 2 of 2022 (when it was fully lifted) as reference points. Multinomial logistic regression analyses were performed for each group to evaluate the association with changes in the incidence of self-harm. RESULTS: We included 109,929 adolescent patients with injuries, 6,316 (5.75%) of whom presented with self-harm. The incidence of self-harm increased significantly during the pandemic (from 3.6% to 8.8%), although this immediate increase was attenuated to borderline significance in a sensitivity analysis incorporating seasonal variation, and decreased modestly after social distancing was lifted (to 7.8%). Self-harm occurring at home, among individuals with medical-aid insurance, and in those with psychiatric problems was significantly associated with these overall changes. CONCLUSIONS: Adolescent self-harm increased with the onset of the pandemic and social distancing, followed by a modest relative decline in incidence after the restrictions were lifted; however, the absolute number of self-harm presentations did not return to pre-pandemic levels. This suggests that social distancing measures may have had a greater impact on adolescents, whose daily lives largely revolve around home and school environments.