More Ontario teens report cases of self-harm during the pandemic

Young people in Ontario have shown worsening mental health and incidents of self-harm during the first two years of the COVID-19 pandemic, said a new study published in the Canadian Medical Association Journal (CMAJ).

The authors said the study was to evaluate rates of pediatric acute care visits for self-harm during the pandemic according to age, sex and mental health service use.

The study was done in Ontario and measured regular emergency department visits and hospital admissions for incidents of self harm for youth aged 10 to 17 years between January, 2017 and June, 2022. 

The study found that in a population of about 1.3 million children and adolescents, rates of acute care visits for self-harm during the pandemic were higher than expected for emergency department visits — 27 per 1,000 population versus 21 per 1,000 population — in the pre-pandemic years. Hospital admissions were also higher — 74 per 10,000 population versus 43 per 10,000 population before the pandemic.

"This increase was primarily observed among females. Rates of emergency department visits and hospital admissions for self-harm were higher than expected for both those aged 10–13 years and those aged 14–17 years, as well as for both those new to the mental health system and those already engaged in care," said the study.

In an interpretation of the numbers, the authors wrote that because the incidents were higher than expected in the first 28 months of the pandemic, particularly among females, it shows there is a need for more accessible and intensive prevention and mental health support in that segment of the population.

"Self-harm among children and adolescents is a serious public health concern. A growing body of evidence, including from systematic reviews, suggests that during the COVID-19 pandemic, youth have reported higher levels of distress, increased symptoms of anxiety and depression and greater use of mental health services,” the report states.

The authors further stated that "self-harm is a contemporaneous and objective indicator of child and adolescent mental health problems. It is more common than suicide and, therefore, leads to more reliable estimates of population trends; it is also a well-established predictor of suicide attempts among youth.”

In conclusion, the authors of the study said there was a large and sustained increase of higher-than-expected levels of self-harm by children and adolescents during the pandemic. The study said the continued demand for mental health services in this respect suggests "lasting effects" of the pandemic, despite the lifting of the pandemic restrictions.

"Beyond the pandemic, it will be important to understand the factors driving the observed upward trend in self-harm among youth. Long-term suicide prevention strategies among youth should be age-, sex-and gender-specific; include upstream interventions; and target pandemic-associated stressors. In the short term, accessible and intensive mental health supports are needed for this segment of the pediatric population.

The study was carried out by Rachel H.B. Mitchell, Alene Toulany, Hannah Chung, Eyal Cohen, Longdi Fu, Rachel Strauss, Simone N. Vigod, Therese A. Stukel, Kimberly Moran, Astrid Guttmann, Paul Kurdyak, Azmina Artani, Monica Kopec and Natasha R. Saunders, a group of physicians and scientists associated with Sunnybrook Health Sciences Centre; University of Toronto Department of Psychiatry; The Hospital for Sick Children; Sick Kids Research Institute; Institute of Health Policy, University of Toronto; the Women’s College Hospital Institute for Health System Solutions and Virtual Care; Ontario College of Family Physicians and the Centre for Addiction and Mental Health, Toronto.

The full text of the study is available online here: