# 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.

## Key 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.