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Large rise in hospital visits for self-harm during the pandemic, particularly among young females


Toronto, ON, September 18, 2023 – There was a large and sustained increase in emergency department visits and hospitalizations for self-harm during the COVID-19 pandemic, particularly among females aged 10 to 13, according to a new study from researchers at The Hospital for Sick Children (SickKids), Sunnybrook Health Sciences Centre and ICES.

Notably, the greatest increase in acute care visits occurred in the latter half of the study period, which took place between January 2017 and June 2022, well after pandemic restrictions had eased.

Published in CMAJ, this is the first study to examine patterns of pediatric self-harm during the pandemic among younger (10 to 13 years) and older (14 to 17 years) adolescent age groups and among those who were new to the mental health system versus those already accessing physician-based care in Ontario, Canada.

“These trends indicate that children and adolescents, especially girls, continued to struggle with their mental health even after in-person activities resumed,” says lead author Dr. Rachel Mitchell, Child and Adolescent Psychiatrist and Associate Scientist with the Hurvitz Brain Sciences Research Program at Sunnybrook Health Sciences Centre and the Sunnybrook Research Institute.

The cross-sectional study included health records for approximately 1.3 million people aged 10 to 17 years and the researchers measured monthly rates of emergency department (ED) visits and hospitalizations for self-harm. They also used modelling to compare the observed visit rates to expected visit rates based on a pre-pandemic baseline.

Study findings show:

  1. There was a 29% increase above expected rates of ED visits and a 72% increase in hospitalizations for self-harm during the pandemic among all 10- to 17-year-olds.
  2. The increase in ED visits for self-harm was only observed among females though both males and females had hospitalization rates that were well above expected levels.
  3. For children and adolescents who had never before been engaged in the mental health system, rates of self-harm ED visits were 35% above expected and hospitalizations were twice as high as expected.
  4. Adolescent females (14-17 years) made up the largest group of young people accessing acute care for self-harm but young, 10-13 year old females had the largest relative increase above expected levels in visits, with a sustained increase from as early as the spring of 2020.

The data in this study does not capture self-harm events that did not result in an ED visit or hospitalization, which means that trends in self-harm could be underestimated. Nevertheless, this is a large, population-wide study that shows a concerning and sustained increase in ED visits and hospitalizations for self-harm among youth that continued at least through June 2022.

“We need a multipronged approach that involves healthcare providers, schools, and families. Young people who show up in the emergency department are often in crisis mode, and it’s essential that continuing care and prompt follow-up are facilitated to support safety, reduce distress, and improve overall mental health and wellbeing,” says senior author Dr. Natasha Saunders, Staff Physician and Associate Scientist in the Child Health Evaluative Sciences program at SickKids and Adjunct Scientist at ICES.

“Young people need to know there is always hope,” says Dr. Mitchell. “It is vital they have access to the appropriate supports in order to learn healthy strategies to cope with distress”.

Ontario’s mental health system performance indicators are publicly available through the ICES Mental Health Dashboard, which provides an overview of mental health and addiction trends in Ontario including sociodemographic characteristics.

If you are having thoughts of suicide, or you are worried about someone else, help is available. Kids Help Phone’s e-mental health services are available 24/7. Text CONNECT to 686868 or call 1-800-668-6868. Call Talk Suicide Canada any time at 1-833-456-4566 – or you can text 45645 between 4pm and midnight ET. If you need immediate, in-person emergency care, call 911, or go to your nearest emergency department.

The study, “Self-harm among youth during the first 28 months of the COVID-19 pandemic in Ontario, Canada: a population-based study” was published in CMAJ.

Authors: Mitchell RHB, Toulany A, Chung H, Cohen E, Fu L, Strauss R, Vigod SN, Stukel TA, Moran K, Guttmann A, Kurdyak P, Artani A, Kopec M, Saunders NR.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is a founding member of Kids Health Alliance, a network of partners working to create a high quality, consistent and coordinated approach to paediatric healthcare that is centred around children, youth and their families. SickKids is proud of its vision for “Healthier Children. A Better World.”

Sunnybrook Health Sciences Centre is inventing the future of healthcare for the 1.3 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The Hospital also has a unique and national leading program for the care of Canada’s war veterans. www.sunnybrook.ca


Sarah Warr
Senior Communications Advisor, SickKids
[email protected]

Misty Pratt
Senior Communications Associate, ICES
[email protected]

Idella Sturino
Communications Advisor, Sunnybrook Health Sciences Centre
[email protected]

Read the Journal Article