Departments of Medicine and Obstetrics and Gynaecology, St Michael's Hospital.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
JAMA Netw Open. 2022 Jan 4;5(1):e2143144. doi: 10.1001/jamanetworkopen.2021.43144.
Self-harm and deaths among adolescents and young adults are notably related to drug poisonings and suicide. With the emergence of the COVID-19 pandemic, there are projections about a greater likelihood of such events arising among adolescents and young adults.
To evaluate the risk of self-harm, overdose, and all-cause mortality among adolescents and young adults during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study took place in Ontario, Canada, where a universal health care system captures all emergency department (ED) visits, hospitalizations, and deaths. The participants included all adolescents and young adults born in Ontario between 1990 and 2006, who were aged 14 to 24 years between March 1, 2018, and June 30, 2021.
The COVID-19 pandemic era (April 1, 2020 to June 30, 2021), relative to the 2 years preceding the pandemic (March 1, 2018 to February 28, 2020).
ED encounters or hospitalizations for self-harm or overdose. A secondary outcome was self-harm, overdose, or all-cause mortality. Cause-specific hazard models to estimate hazard ratios (HR) and 95% CIs were used for the primary outcome. Follow-up started at March 1, 2018, or the individual's 14th birthday, whichever was later, and age was used as the time scale.
In this study, 1 690 733 adolescents and young adults (823 904 [51.3%] female participants) were included with a median (IQR) age of 17.7 (14.1-21.4) years at start of follow-up. After 4 110 903 person-years of follow-up, 6224 adolescents and young adults experienced the primary outcome of self-harm or overdose during the pandemic (39.7 per 10 000 person-years) vs 12 970 (51.0 per 10 000 person-years) prepandemic, with an HR of 0.78 (95% CI, 0.75-0.80). The risk of self-harm, overdose, or death was also lower during than before the pandemic (HR, 0.78; 95% CI, 0.76-0.81), but not all-cause mortality (HR, 0.95; 95% CI, 0.86-1.05).
Among adolescents and young adults, the initial 15-month period of the COVID-19 pandemic was associated with a relative decline in hospital care for self-harm or overdose.
青少年和年轻人的自残和死亡与药物中毒和自杀显著相关。随着 COVID-19 大流行的出现，预计青少年和年轻人中此类事件的发生可能性更大。
评估 COVID-19 大流行期间青少年和年轻人自残、用药过量和全因死亡率的风险。
设计、地点和参与者：本基于人群的队列研究在加拿大安大略省进行，该省的全民医疗保健系统涵盖了所有急诊部门 (ED) 就诊、住院和死亡情况。参与者包括在安大略省出生于 1990 年至 2006 年之间的所有青少年和年轻人，他们在 2018 年 3 月 1 日至 2021 年 6 月 30 日之间年龄在 14 至 24 岁之间。
COVID-19 大流行时期（2020 年 4 月 1 日至 2021 年 6 月 30 日）与大流行前的 2 年（2018 年 3 月 1 日至 2020 年 2 月 28 日）相比。
ED 就诊或因自残或用药过量而住院。次要结果是自残、用药过量或全因死亡。使用特定于原因的危险模型来估计危险比 (HR) 和 95%CI，用于主要结果。随访从 2018 年 3 月 1 日开始，或个体的 14 岁生日开始，以较晚者为准，年龄用作时间尺度。
在这项研究中，共纳入了 1690733 名青少年和年轻人（823904 名[51.3%]女性参与者），中位（IQR）年龄为 17.7 岁（14.1-21.4）岁，随访开始时。在 4110903 人年的随访后，有 6224 名青少年和年轻人在大流行期间经历了自残或用药过量的主要结局（39.7/10000 人年），而大流行前有 12970 人（51.0/10000 人年），HR 为 0.78（95%CI，0.75-0.80）。大流行期间的自残、用药过量或死亡风险也低于大流行前（HR，0.78；95%CI，0.76-0.81），但全因死亡率并非如此（HR，0.95；95%CI，0.86-1.05）。
在青少年和年轻人中，COVID-19 大流行的最初 15 个月与因自残或用药过量而接受的医院护理相对减少有关。
