{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:50:07Z","timestamp":1782845407814,"version":"3.54.5"},"reference-count":36,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Public Health Surveill"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n COVID-19 ended on May 5, 2023, and since then Hong Kong reported increased mental distress, which was speculated to be from the policies implemented during the pandemic. Despite this, longitudinal surveillance of deliberate self-harm (DSH) incidences throughout the pandemic in Hong Kong remained insufficient.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The objective of this study was to outline the changes in DSH incidences before and during the COVID-19 pandemic in Hong Kong, with respect to sex, age, and co-occurring mental health issues.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A quasi-experiment was conducted using an interrupted time series design to estimate the impact of the pandemic on DSH-related emergency department (ED) visits. This design enabled the estimation of DSH-related ED visits based on prepandemic data from 2016 to 2019, assuming the pandemic had not occurred, and allowed for a comparison with observed DSH-related ED visits during the pandemic. The descriptive results were reported as the observed monthly DSH-related ED visits and observed incidence ratios during the pandemic. Afterwards, a negative binomial model was fitted to the prepandemic data (2016\u20102019) and adjusted for temporal trends, seasonality, and population variation to estimate the expected monthly DSH-related ED visits and adjusted incidence ratios (aIRs).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Between January 2016 and December 2022, a total of 31,893 DSH episodes were identified. Initial descriptive analysis showed a significant difference in demographic characteristics (sex) and clinical characteristics (death within 28 d, diagnoses of co-occurring mental health issues, public assistance pay code, and triage level). Subsequent interrupted time-series analysis demonstrated significantly increasing trends in comparison with the prepandemic period. As reported in the aIRs among young adult males (aIR in 2020=1.34,\n P<\/jats:italic>\n =.002; 2021: aIR=1.94,\n P<\/jats:italic>\n <.001; and 2022: aIR=2.53,\n P<\/jats:italic>\n <.001), adult males (aIR in 2020=1.58,\n P<\/jats:italic>\n <.001; 2021: aIR=2.64,\n P<\/jats:italic>\n <.001; and 2022: aIR=3.13,\n P<\/jats:italic>\n <.001), adult females (aIR in 2020=1.13,\n P<\/jats:italic>\n =.01; 2021: aIR=1.52,\n P<\/jats:italic>\n <.001; and 2022: aIR=1.64,\n P<\/jats:italic>\n <.001), and older male adults (aIR in 2020=1.53,\n P<\/jats:italic>\n <.001; 2021: aIR=2.37,\n P<\/jats:italic>\n <.001; and 2022: aIR=3.01,\n P<\/jats:italic>\n <.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The average annual DSH-related ED visits increased during the pandemic period. Therefore, there is a need to raise awareness for such vulnerable groups in Hong Kong to prepare for postpandemic spillover.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/57500","type":"journal-article","created":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T09:25:41Z","timestamp":1734773141000},"page":"e57500-e57500","source":"Crossref","is-referenced-by-count":1,"title":["Incidence of Deliberate Self-Harm in Hong Kong Before and During the COVID-19 Pandemic: Population-Wide Retrospective Cohort Study"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7269-4995","authenticated-orcid":false,"given":"Luke Y F","family":"Luk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6610-2352","authenticated-orcid":false,"given":"Christie J Y","family":"Ching","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1481-6831","authenticated-orcid":false,"given":"Tsz Fung","family":"Yip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3481-3572","authenticated-orcid":false,"given":"Sunny C L","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8745-5756","authenticated-orcid":false,"given":"Catherine Y T","family":"Lam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1914-3683","authenticated-orcid":false,"given":"Elizabeth T C","family":"Lam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9623-2989","authenticated-orcid":false,"given":"Serena R B","family":"Yue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7657-6881","authenticated-orcid":false,"given":"Hoi Ching","family":"Pang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3000-4577","authenticated-orcid":false,"given":"Janet Y H","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6895-6071","authenticated-orcid":false,"given":"Carlos K H","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0370-9034","authenticated-orcid":false,"given":"Chak Kwan","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8552-1696","authenticated-orcid":false,"given":"Tafu","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3355-3237","authenticated-orcid":false,"given":"Timothy H","family":"Rainer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9984-8156","authenticated-orcid":false,"given":"Abraham K C","family":"Wai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2331-7011","authenticated-orcid":false,"given":"Joshua W K","family":"Ho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.09.030","article-title":"Mental health crisis under COVID-19 pandemic in Hong Kong, China","volume":"100","author":"Zhao","journal-title":"Int J Infect Dis"},{"issue":"10","key":"R2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17103740","article-title":"Depression and Anxiety in Hong Kong during COVID-19","volume":"17","author":"Choi","journal-title":"Int J Environ Res Public Health"},{"issue":"10220","key":"R3","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/S0140-6736(19)33160-5","article-title":"Depression and post-traumatic stress during major social unrest in Hong Kong: a 10-year prospective cohort study","volume":"395","author":"Ni","journal-title":"Lancet"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"2538","DOI":"10.1007\/s12144-021-02338-7","article-title":"Psychological Distress, Fear and Coping Strategies among Hong Kong People During the COVID-19 Pandemic","volume":"42","author":"Chair","journal-title":"Curr Psychol"},{"key":"R5","unstructured":"Legislative Council of the Hong Kong Special Administrative Region of the People\u2019s Republic of China. Measures to promote mental health during COVID-19. 2021. URL: https:\/\/www.legco.gov.hk\/research-publications\/english\/essentials-2021ise16-measures-to-promote-mental-health-during-covid-19.htm#endnote12 [Accessed 31-01-2025]"},{"key":"R6","unstructured":"The Hong Kong Special Administrative Region of the People\u2019s Republic of China. The Chief Executive\u2019s 2020 Policy Address. 2020. URL: https:\/\/www.policyaddress.gov.hk\/2020\/eng\/p144.html [Accessed 31-01-2025]"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1037\/0022-006X.76.1.28","article-title":"Physiological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers","volume":"76","author":"Nock","journal-title":"J Consult Clin Psychol"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1080\/15374410903401195","article-title":"Longitudinal prediction of adolescent nonsuicidal self-injury: examination of a cognitive vulnerability-stress model","volume":"39","author":"Guerry","journal-title":"J Clin Child Adolesc Psychol"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.psyneuen.2011.05.009","article-title":"Alterations in the neuroendocrinological stress response to acute psychosocial stress in adolescents engaging in nonsuicidal self-injury","volume":"37","author":"Kaess","journal-title":"Psychoneuroendocrinology"},{"issue":"3","key":"R10","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1080\/13811118.2013.824835","article-title":"Negative life events and non-suicidal self-injury in an adolescent inpatient sample","volume":"18","author":"Liu","journal-title":"Arch Suicide Res"},{"issue":"3","key":"R11","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1016\/j.psychres.2015.06.021","article-title":"Non-suicidal self-injury prospectively predicts interpersonal stressful life events and depressive symptoms among adolescent girls","volume":"228","author":"Burke","journal-title":"Psychiatry Res"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2020.100027","article-title":"Prevalence and risk factors for repetition of non-fatal self-harm in Hong Kong, 2002-2016: A population-based cohort study","volume":"2","author":"Chai","journal-title":"Lancet Reg Health West Pac"},{"issue":"Pt 2","key":"R13","doi-asserted-by":"publisher","first-page":"104680","DOI":"10.1016\/j.chiabu.2020.104680","article-title":"Do suicide rates in children and adolescents change during school closure in Japan? The acute effect of the first wave of COVID-19 pandemic on child and adolescent mental health","volume":"110","author":"Isumi","journal-title":"Child Abuse Negl"},{"issue":"6","key":"R14","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1192\/bjp.2020.212","article-title":"Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study","volume":"218","author":"O\u2019Connor","journal-title":"Br J Psychiatry"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2021.114152","article-title":"Deliberate self-harm in adolescents during COVID-19: The roles of pandemic-related stress, emotion regulation difficulties, and social distancing","volume":"304","author":"Robillard","journal-title":"Psychiatry Res"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2021.03.028","article-title":"Self-harm and the COVID-19 pandemic: A study of factors contributing to self-harm during lockdown restrictions","volume":"137","author":"Hawton","journal-title":"J Psychiatr Res"},{"issue":"12","key":"R17","doi-asserted-by":"publisher","first-page":"1555","DOI":"10.1177\/00048674221075540","article-title":"Thoughts of suicide or self-harm among Australian healthcare workers during the COVID-19 pandemic","volume":"56","author":"Bismark","journal-title":"Aust N Z J Psychiatry"},{"key":"R18","unstructured":"Hospital Authority Hong Kong Special Administrative Region of the People's Republic of China. Accident & Emergency (A&E). URL: https:\/\/www.ha.org.hk\/visitor\/ha_serviceguide_details.asp?Content_ID=10051 [Accessed 31-01-2025]"},{"key":"R19","unstructured":"Hospital Authority Hong Kong Special Administrative Region of the People's Republic of China. Multi-tiered Triage and Treatment Strategy to battle a tsunami of COVID-19 cases. 2022. URL: https:\/\/www3.ha.org.hk\/ehaslink\/issue119\/en\/cover_story-2.html [Accessed 31-01-2025]"},{"key":"R20","unstructured":"Cheng MCY Tong YH Kwok TC et al. Development journey of clinical data analysis and reporting system (CDARS) in hospital authority of Hong Kong. MedInfo; 2010."},{"key":"R21","unstructured":"Census and Statistics Department The Government of the Hong Kong Special Adminstrative Region. Table 1B: Population by Sex and Age [database on the Internet]. URL: https:\/\/www.censtatd.gov.hk\/en\/web_table.html?id=1B [Accessed 31-01-2025]"},{"key":"R22","unstructured":"Self-harm: assessment, management and preventing recurrence. National Institute for Health and Care Excellence. URL: https:\/\/www.nice.org.uk\/guidance\/ng225\/chapter\/Terms-used-in-this-guideline [Accessed 31-01-2025]"},{"key":"R23","unstructured":"Hospital Authority Hong Kong Special Administrative Region of the People's Republic of China. Waiving of Medical Charges (For Eligible Persons). URL: https:\/\/www.ha.org.hk\/visitor\/ha_visitor_index.asp?Content_ID=259365&Lang=ENG&Dimension=100 [Accessed 31-01-2025]"},{"issue":"1","key":"R24","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1186\/s12888-022-04029-4","article-title":"Changes in self-harm- and violence-related urgent psychiatric consultation in the emergency department during the different stages of the COVID-19 pandemic","volume":"22","author":"Liu","journal-title":"BMC Psychiatry"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1037\/men0000146","article-title":"Health and help-seeking behavior among Chinese men in Hong Kong: The influence of culture","volume":"20","author":"Rochelle","journal-title":"Psychol Men Masculinit"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1127070","article-title":"Association between quarantine and sleep disturbance in Hong Kong adults: The mediating role of COVID-19 mental impact and distress","volume":"14","author":"Fong","journal-title":"Front Psychiatry"},{"key":"R27","unstructured":"Lam RPK . The impact of the COVID-19 pandemic on acute toxicity related to recreational drug abuse presenting to emergency departments. Narcotics Division, Security Bureau, Hong Kong Special Administrative Region of the People's Republic of China. 2023."},{"key":"R28","unstructured":"The Centre for Health Protection DoH, The Government of Hong Kong Special Administrative Region. Alcohol Drinking, COVID-19 and NCDs. 2020."},{"issue":"6","key":"R29","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1136\/tobaccocontrol-2020-055960","article-title":"Exposure to health misinformation about COVID-19 and increased tobacco and alcohol use: a population-based survey in Hong Kong","volume":"30","author":"Luk","journal-title":"Tob Control"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/S2215-0366(20)30004-3","article-title":"Risk of self-harm after the diagnosis of psychiatric disorders in Hong Kong, 2000-10: a nested case-control study","volume":"7","author":"Chai","journal-title":"Lancet Psychiatry"},{"issue":"2","key":"R31","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.annemergmed.2021.09.424","article-title":"Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study","volume":"79","author":"Wai","journal-title":"Ann Emerg Med"},{"issue":"7","key":"R32","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-058600","article-title":"Association between perception of COVID-19 risk, confidence in health services and avoidance of emergency department visits: results from a community-based survey in Portugal","volume":"12","author":"Lopes","journal-title":"BMJ Open"},{"issue":"4","key":"R33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0266967","article-title":"Healthcare contacts with self-harm during COVID-19: An e-cohort whole-population-based study using individual-level linked routine electronic health records in Wales, UK, 2016-March 2021","volume":"17","author":"DelPozo-Banos","journal-title":"PLoS ONE"},{"issue":"3","key":"R34","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1017\/ipm.2022.36","article-title":"Substance use and self-harm emergency department presentations during COVID19: evidence from a National Clinical Programme for Self-Harm","volume":"40","author":"Maguire","journal-title":"Ir J Psychol Med"},{"issue":"1","key":"R35","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1186\/s12879-022-07274-w","article-title":"The fine-scale associations between socioeconomic status, density, functionality, and spread of COVID-19 within a high-density city","volume":"22","author":"Zhang","journal-title":"BMC Infect Dis"},{"key":"R36","unstructured":"The Hong Kong Special Administrative Region of the People's Republic of China. The Chief Executive\u2019s 2024 Policy Address. 2024. URL: https:\/\/www.policyaddress.gov.hk\/2024\/en\/p65.html [Accessed 31-01-2025]"}],"container-title":["JMIR Public Health and Surveillance"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publichealth.jmir.org\/2025\/1\/e57500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:48:10Z","timestamp":1782841690000},"score":1,"resource":{"primary":{"URL":"https:\/\/publichealth.jmir.org\/2025\/1\/e57500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,10]]},"references-count":36,"URL":"https:\/\/doi.org\/10.2196\/57500","relation":{},"ISSN":["2369-2960"],"issn-type":[{"value":"2369-2960","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,10]]},"article-number":"v11i10e57500"}}