WARNING – This article deals with self-harm. If you or someone you know is in crisis, refer to the resources available at the bottom of the story.

The rate of hospital visits for self-harm was greater than expected for Ontario youth during the first two and a half years of the COVID-19 pandemic, a new study has found.

The Canadian Medical Association Journal published a that looked at emergency department (ED) visit and hospital admission rates for self-harm in youth 10 to 17 years old between Jan. 1, 2017, and June 30, 2022, which includes the first 28 months of the pandemic.

The study found that among a children and adolescent population of about 1.3 million that was eligible for provincial health insurance, ED visits for self-harm were about 29 per cent higher than expected and 72 per cent greater for hospital admissions.

The study calculated expected rates for self-harm using pre-pandemic figures, with the increase largely occurring in girls.

The researchers say their study may be a reflection of how pandemic stress, including feelings of social isolation and inadequate access to health care, affected youth at a key point in their development.

"These findings support the need for accessible and intensive prevention efforts and mental health supports in this population," the study says.

"Self-harm among children and adolescents is a serious public health concern."

The researchers measured the rate of ED visits at 0.27 per 1,000 people, greater than the expected rate of 0.21 per 1,000, while for hospital admissions it was 0.74 per 10,000 compared to 0.43 per 10,000.

The authors say ED visit and hospital admission rates were higher than expected in children aged 10 to 13 and 14 to 17, as well as those who were new to mental health care or had received services within two years.

Girls made up almost 49 per cent of the population studied and 90 per cent of those studied lived in urban areas.

"Although the absolute increase was small, the period with the greatest observed increase occurred in the latter half of the study period, well after the return of most in-person activities," the researchers write.

The authors say that self-harm, which includes intentional self-poisoning or self-injury regardless of motive or suicidal intent, is a well-established predictor of suicide attempts in young people.

Since it is more common than suicide, the researchers say that makes it a more reliable factor when estimating population trends.

They add that middle schoolers, or those between 10 and 13 years of age, "may have been particularly negatively affected by the pandemic.

"Middle school years are marked by factors that may make this group more susceptible to the deleterious effects of pandemic restrictions, such as extensive brain and cognitive development, immature impulse control, high relative importance of peers and a steep rise in the prevalence of symptoms of mental health disorders, including the onset of self-harm," the study says.

"Youth who used the emergency department as a first point of contact for mental health care during the pandemic, particularly for self-harm, are another group with a distinct profile of mental health needs."

YOUNGER GIRLS SAW LARGEST INCREASE

When it came to emergency department visits, girls had a higher rate than expected at 0.48 per 1,000 people compared to 0.35 per 1,000, while boys saw no difference at 0.08 per 1,000 people.

Hospital admission rates were higher than expected for both girls – 1.31 per 10,000 people vs. 0.73 per 10,000 – and boys – 0.2 per 10,000 vs. 0.15 per 10,000.

Although ED visits and hospital admissions were lower in youth 10 to 13 years old than those 14 to 17, the relative increase in rates during the pandemic was higher in the former, with girls in that age group seeing the largest increase.

"Taken together, the interaction of pandemic-associated stress with pre-existing risk factors could have shifted the tendency toward self-harm among young females," the study says.

The authors note, however, that lower rates in boys don't imply they have less of a need for mental health support.

"Males exhibit less health care-seeking behaviour than females, especially for mental health difficulty. Adolescent males may use coping mechanisms with less potential for a hospital visit, such as avoidance or distraction with video games, or reward-seeking behaviour with gambling."

For youth who were new to mental health care, defined as having no previous acute or outpatient claims within two years, ED rates were higher than expected at 0.05 per 1,000 compared to 0.04 per 1,000. Hospital admissions also were greater at 0.15 per 10,000 compared to 0.07 per 10,000.

Youth who had mental health claims within two years also saw larger than expected increases in ED visits – 0.22 per 1,000 vs. 0.18 per 1,000 – and hospital admissions – 0.6 per 10,000 vs. 0.36 per 10,000.

When it came to location and income, youth living in urban areas and high-income neighbourhoods saw the largest relative increase in ED visits, while those in rural areas and low-income communities had the largest increase in hospital admissions.

"Studies cannot feasibly evaluate the causal link between pandemic restrictions and self-harm among children and adolescents, and many factors are at play," the researchers say.

"But findings may reflect the prolonged and cumulative effects of pandemic-related stressors on this younger age group such as social isolation, loss of routines, missed milestones, changing learning environments, familial stress, inadequately treated psychiatric conditions, substance misuse or changing patterns of mental health service use at a critical point in their developmental trajectory."

The effect the pandemic had on access to health care and staffing may have also contributed, the authors write.

"It is unclear if this trend will persist beyond 2022, but findings from the first two and a half years of the pandemic reflect the complexities and long-term pandemic-related stress among children and adolescents."

If you or someone you know is in crisis, here are some resources that are available:

Canada Suicide Prevention Helpline (1-833-456-4566)

Centre for Addiction and Mental Health (1-800-463-2338)

Crisis Services Canada (1-833-456-4566 or text 45645)

Kids Help Phone (1-800-668-6868)

If you need immediate assistance call 911 or go to the nearest hospital.