Department of Nursing, Peking University First Hospital, No. 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034, China.
School of Nursing, Anhui Medical University, No. 69 Mei Shan Road, ShuShan District, Hefei, 230031, Anhui Province, China.
BMC Psychol. 2023 May 5;11(1):149. doi: 10.1186/s40359-023-01181-8.
COVID-19 and its transmission mitigation measures have caused widespread mental health problems. Previous studies have suggested that psychological, economic, behavioral, and psychosocial problems associated with the COVID-19 pandemic may lead to a rise in self-harm. However, little is known about the prevalence of self-harm worldwide during COVID-19. Therefore, a quantitative synthesis is needed to reach an overall conclusion regarding the prevalence of self-harm during the pandemic.
By using permutations of COVID-19, self-harm or relevant search terms, we searched the following electronic databases from November 2019 to January 2022: Web of Science, PubMed, MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, China National Knowledge Infrastructure (CNKI), Wanfang Database and systematically reviewed the evidence according to MOOSE guidelines. We employed Cochran's chi-squared test (Cochran's Q), Itest and subgroup analysis to assess and address the heterogeneity. Sensitivity analysis was conducted by eliminating each included study individually and then combining the effects.
Sixteen studies that met the inclusion and exclusion criteria were identified, with sample sizes ranging from 228 to 49,227. The methodological quality of the included studies was mostly at the medium level. By using a random effect model, the pooled prevalence of self-harm was 15.8% (95% CI 13.3-18.3). Based on subgroup analysis, the following characteristics of the included studies were more likely to have a higher prevalence of self-harm: studies conducted in Asia or prior to July 2020, cross-sectional studies, samples recruited in hospitals or schools, adolescents, females, the purpose of self-harm (NSSI), mental symptoms and restriction experiences.
We provided the first meta-analytic estimated prevalence of self-harm based on a large sample from different countries and populations. The prevalence of self-harm during COVID-19 was not encouraging and requires attention and intervention. Further high-quality and prospective research are needed in order to determine the prevalence of self-harm with greater accuracy because to the clear heterogeneity across the included studies. In addition, this study also provides new directions for future research, including the identification of high-risk groups for self-harm, the formulation and implementation of prevention and intervention programs, and the long-term impact of COVID-19 on self-harm.
COVID-19 及其传播缓解措施导致了广泛的心理健康问题。先前的研究表明，与 COVID-19 大流行相关的心理、经济、行为和社会心理问题可能导致自残行为的增加。然而，目前还不清楚在 COVID-19 期间全球自残的流行率。因此，需要进行定量综合分析，以得出关于大流行期间自残流行率的总体结论。
我们使用 COVID-19、自残或相关搜索词的排列组合，从 2019 年 11 月至 2022 年 1 月，在以下电子数据库中进行了搜索：Web of Science、PubMed、MEDLINE、Embase、PsycINFO、Cochrane 系统评价数据库、中国国家知识基础设施（CNKI）、万方数据库，并根据 MOOSE 指南系统地审查了证据。我们采用 Cochran 的卡方检验（Cochran's Q）、I 检验和亚组分析来评估和解决异质性。通过逐个排除每个纳入的研究，然后合并效应，进行敏感性分析。
确定了符合纳入和排除标准的 16 项研究，样本量从 228 到 49227 不等。纳入研究的方法学质量大多处于中等水平。使用随机效应模型，自残的总流行率为 15.8%（95%CI 13.3-18.3）。基于亚组分析，以下研究特征更有可能导致自残的流行率较高：在亚洲进行的研究或在 2020 年 7 月之前进行的研究、横断面研究、在医院或学校招募的样本、青少年、女性、自残目的（NSSI）、精神症状和限制经历。
我们提供了基于来自不同国家和人群的大样本的首次 meta 分析估计的自残流行率。COVID-19 期间自残的流行率并不乐观，需要引起重视和干预。由于纳入研究的明显异质性，需要进一步进行高质量和前瞻性研究，以更准确地确定自残的流行率。此外，本研究还为未来的研究提供了新的方向，包括识别自残的高风险群体、制定和实施预防和干预计划，以及 COVID-19 对自残的长期影响。
