Older adult emergency department visits due to self-harm before, during, and after the COVID-19 pandemic in South Korea: a 7-year retrospective study

This study investigated changes in the proportion, clinical characteristics, and precipitating factors of self-harm-related emergency department (ED) visits among older adults (≥ 65 years) before, during, and after the COVID-19 pandemic. We retrospectively analyzed data from the Emergency Department-Based Injury In-Depth Surveillance registry in South Korea (January 2017–December 2023). Patients aged ≥ 65 years were included and compared across pre-pandemic (2017 Q1–2019 Q4), pandemic (2020 Q1–2022 Q1), and post-pandemic (2022 Q2–2023 Q4) periods. Interrupted time series analysis (ITSA) evaluated trends in the proportion of self-harm among injured older ED patients. Binary logistic regression assessed changes in patient characteristics across three pairwise period contrasts (pandemic vs. pre-pandemic, post-pandemic vs. pandemic, and post-pandemic vs. pre-pandemic). Among 287,171 older adult patients, 8,940 (3.11%) presented with self-harm-related injury. The proportion of self-harm among injured older ED patients differed across periods (pre-pandemic 2.99%, pandemic 3.38%, post-pandemic 3.05%; P < 0.05), but ITSA revealed no significant level or slope changes at either inflection point. During the pandemic, the proportion of female patients increased and psychological problems became the predominant precipitating factor, with relative decreases in interpersonal conflict (odds ratio [OR] = 0.62), economic (OR = 0.52), and health-related (OR = 0.72) precipitating factors; cutting-related self-harm also increased (OR = 1.24). Post-pandemic, interpersonal conflict (OR = 1.45), economic (OR = 1.64), and health-related (OR = 1.24) precipitating factors rebounded significantly. In the direct post-pandemic versus pre-pandemic comparison, a lower proportion of male patients, more frequent cutting, greater medical-aid coverage, and higher emergency medical services utilization persisted. The proportion of self-harm among injured older adults presenting to EDs differed across pandemic phases; non-significant ITSA results suggest a gradual rather than abrupt change. Clinically meaningful qualitative shifts in sex distribution, methods, and precipitating factors were observed, with post-pandemic resurgence of interpersonal and socioeconomic stressors. Accordingly, phase-specific suicide prevention strategies are required for older adults.