Widening Excess Mortality During the COVID-19 Pandemic in Individuals Who Self-Harmed: A Whole-Population-Based E-Cohort Study in Wales, UK, April 2016–March 2021

TL;DR

This study found that people who self-harmed had higher mortality rates during the early stages of the COVID-19 pandemic in Wales compared to those who did not self-harm.

Contribution

The study is the first whole-population-based analysis to show increased excess mortality in self-harmers during the early pandemic in Wales.

Findings

Excess mortality in self-harmers doubled during the first and second waves of the pandemic compared to pre-pandemic levels.

Younger individuals (under 65) showed higher mortality risk, though subgroup differences were not statistically significant.

The study highlights the need for targeted interventions to reduce mortality in individuals who self-harm during public health crises.

Abstract

Abstract:
Background: Studies on COVID-19 pandemic-associated changes in
mortality following self-harm remain scarce and inconclusive.
Aims: To compare mortality risks in individuals who had
self-harmed to those for individuals who had not, before and during the COVID-19
pandemic (Waves 1 and 2) in Wales, the United Kingdom, using population-based
routinely collected data. Method: We linked whole population
health data to all-cause mortality following an episode of self-harm between
April 2016 and March 2021. Propensity score matching, Cox regression, and
difference-in-differences were applied to compute changes in excess mortality
(as ratios of hazard ratios, RHRs) before and during the pandemic for
individuals who self-harmed. Results: The difference in
mortality for individuals who self-harmed compared to those who did not widened
during Wave 1 (RHR = 2.03, 95% CI: 1.04–4.03) and Wave 2 (RHR =
2.19, 95% CI: 1.12–4.29) from before the pandemic. Stratification by sex
and age group produced no significant subgroup differences although risk for
younger than 65 years group were higher. Limitations:
Limitations include small sample size and incomplete data on cause-specific
deaths during the pandemic. Conclusion: Our results underscore
continuous monitoring of mortality of individuals who self-harm and effective
interventions to address any increases in mortality.

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