Impact of the COVID-19 pandemic on self-harm and self-harm/suicide ideation: population-wide data linkage study and time series analysis

Euan Neil Paterson, Lisa Kent, Dermot O'Reilly, Denise O'Hagan, Siobhan M O'Neill, Aideen Maguire

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The COVID-19 pandemic and associated lockdowns were predicted to have a major impact on suicidal behaviour, including self-harm. However, current studies have produced contradictory findings with limited trend data. Nine years of linked individual-level administrative data were utilised to examine changes in hospital-presenting self-harm and ideation (thoughts of self-harm or suicide) before and during the pandemic. National self-harm registry data were linked to demographic and socioeconomic indicators from healthcare registration records ( = 1 899 437). Monthly presentations of self-harm or ideation were split (pre-COVID-19 restrictions: April 2012 to February 2020; and during restrictions: March to September 2020). Auto-regressive integrated moving average (ARIMA) models were trained in R taking into consideration trends and seasonal effects. Forecast ('expected') monthly values were compared with 'actual' values, stratified by demographic factors and method of harm. The number of individuals presenting with self-harm or ideation dropped significantly at the beginning of the pandemic (March-May 2020), before returning mostly to expected trends from June 2020. Stratified analysis showed similar presentation trends across most demographic subgroups except for those aged over 65 years, living alone or in affluent areas, where presentations remained unaffected, and those aged under 16 years, where numbers presenting with self-harm or ideation increased above expected levels. Although population trends show an overall drop in presentations before a return to 'normal' from June 2020, the demographic profile of those presenting with self-harm or ideation varied significantly, with increases in children under the age of 16 years. This highlights important potential target groups who may have been most negatively affected by the pandemic.
Original languageEnglish
Pages (from-to)509-517
Number of pages9
JournalBritish Journal of Psychiatry
Issue number5
Early online date21 Sept 2023
Publication statusPublished online - 21 Sept 2023

Bibliographical note

Funding Information:
This work was supported by both the UK Research and Innovation's (UKRI's) Administrative Data Research Centre Northern Ireland (ADRC-NI) (ES/S00744X/1) and the Northern Ireland Public Health Agency's Health and Social Care Research and Development Division (COM/5625/20).

Funding Information:
We would like to acknowledge the help provided by the staff of the Honest Broker Service (HBS) within the Business Services Organisation Northern Ireland (BSO). The HBS is funded by the BSO and the Department of Health. The authors alone are responsible for the interpretation of the data and any views or opinions presented are solely those of the author and do not necessarily represent those of the BSO. We also thank the staff of the Northern Ireland Registry of Self-Harm (NIRSH) and the National Suicide Research Foundation's (NSRF) National Registry of Self-Harm (NRSH) for their support and data provision.

Publisher Copyright:
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.


  • COVID-19
  • mental health
  • self-harm
  • self-harm/suicide ideation
  • administrative data


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