Epidemiological patterns and inequalities of emergency department visits for self-harm and interpersonal violence before and after the first COVID-19 lockdown

Violence is a major public health concern associated with substantial health burdens and social inequalities. Routinely collected healthcare data can support surveillance and prevention strategies. We conducted a retrospective study of all Emergency Department visits for violence and self-harm recorded in a North Italian Region between January 2016 and September 2025 using the regional healthcare data warehouse. Descriptive analyses were performed to characterize temporal and sociodemographic patterns. An Interrupted Time Series based on a negative binomial regression model assessed changes associated with COVID-19 lockdown measures. Among 5,409,509 ED visits, 53,086 (0.98%) were related to violence or self-harm. Rates varied across provinces. Foreign nationals accounted for approximately one-third of visits, with an increasing trend overtime, suggesting possible inequalities in ED attendance. Visits were more frequent among males, during evening and nighttime hours, on weekends, and in the summer months. Among Italian residents, interpersonal violence-related ED visits decreased by approximately 55% during the lockdown period (IRR 0.449, 95% CI 0.365–0.552; p < 0.001), while self-harm-related visits decreased by approximately 25% (IRR 0.750, 95% CI 0.571–0.985; p = 0.039). Trends among foreign residents were in the same direction for both outcomes but for self-harm did not reach statistical significance, likely reflecting smaller event counts in this subgroup. Violence- and self-harm-related ED visits showed marked temporal and sociodemographic disparities. Changes observed during pandemic-related restrictions are consistent with altered exposure opportunities and may reflect underlying inequalities, providing evidence to guide targeted prevention and surveillance strategies.