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Case Reports
. 2023 Aug;73(2):319-324.
doi: 10.1016/j.jadohealth.2023.02.041. Epub 2023 May 3.

Significant Increase in Deliberate Self-Poisonings Among Adolescents During the Second Year of the COVID-19 Pandemic

Arjen Koppen  1 , Ilze M J Thoonen  2 , Claudine C Hunault  2 , Agnes G van Velzen  2 , Dylan W de Lange  3 , Saskia J Rietjens  2
Affiliations
Case Reports

Significant Increase in Deliberate Self-Poisonings Among Adolescents During the Second Year of the COVID-19 Pandemic

Arjen Koppen et al. J Adolesc Health. 2023 Aug.

Abstract

Purpose: The COVID-19 pandemic has been associated with a decline in mental health of adolescents. The aim of this study was to analyze the rate of deliberate self-poisonings (DSPs) among adolescents reported to the Dutch Poisons Information Center before and during the COVID-19 pandemic.

Methods: A retrospective study from 2016 until 2021 was performed to characterize DSPs among adolescents, and to analyze trends in the number of DSPs. All DSPs among adolescents with the age of 13 up to and including 17 years were included. DSP characteristics included: age, gender, bodyweight, used substance, dose, and treatment advice. Trends in the number of DSPs were analyzed using time series decomposition and Seasonal Autoregressive Integrated Moving Average models.

Results: Six thousand nine hundred fifteen DSPs in adolescents were recorded from January first 2016 until December 31st 2021. Females were involved in 84% of adolescent DSPs. A strong increase in the number of DSPs was observed in 2021 (45% increase compared to 2020), which deviated from the predicted trend based on previous years. This increase was most prominent in 13-, 14-, and 15-year-old female adolescents. Commonly involved drugs were paracetamol, ibuprofen, methylphenidate, fluoxetine, and quetiapine. The contribution of paracetamol rose from 33% in 2019 to 40% in 2021.

Discussion: The strong increase in the number of DSPs during the second year of the COVID-19 pandemic suggests that long-term containment measures such as quarantines, lockdowns, and school closures may enhance self-harm behavior among adolescents, especially among younger females (13-15 years of age), with a preference for paracetamol as DSP substance.

Keywords: Adolescent; COVID-19; Deliberate; Intoxication; Overdose; Pandemic; Self-harm; Self-poisoning.

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Figures

Figure 1
Figure 1
Patient selection flowchart, covering all inclusions from January first 2016 until December 31st 2021.
Figure 2
Figure 2
Trends in DSPs by adolescents. (A) SARIMA model of expected rate of DSPs in 2021. The red line represents the percentage of adolescent DSPs relative to the total number of patients reported to the DPIC, per month. The blue line represents the expected percentage of adolescent DSPs from March 2020 onward. CI = confidence interval. (B) DSP rates for girls and boys. Each dot represents the monthly DSP rate (percentage of male (gray circles) or female (black circles) adolescent DSPs in a particular month relative to the total number of patients reported to the DPIC in that month). Dotted lines represent fourth order polynomial trend lines.
Figure 3
Figure 3
Substances used in DSPs by adolescents. (A) Fifteen most frequently used substances during 2016–2021 as percentage of the total number of DSPs in 2016–2021. (B) Annual contribution of the five most frequently used substances in DSPs as percentage of the total number of DSPs in a particular year.
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