Impact of the COVID-19 Pandemic on Trauma Evaluations for Violent Suicide Attempts and Self-Harm: A Retrospective Comparative Study

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Introduction The COVID-19 pandemic has exacerbated known risk factors for mental health deterioration, including economic instability, social isolation, and uncertainty, while also disrupting access to mental healthcare. Suicide remains a major public health concern in the United States, and self-inflicted injuries, although a minority of emergency department presentations, are associated with high morbidity and mortality. Objective This study examines whether the number of trauma evaluations related to violent suicide attempts or self-harm increased during the pandemic compared to pre-pandemic levels. Materials and methods We conducted a retrospective review of trauma registry data from one Level 1 and one Level 2 trauma center within Bon Secours Mercy Health, a regional hospital system. The pre-pandemic period extended from September 1, 2018, through February 29, 2020, and the pandemic period extended from March 1, 2020, through August 31, 2021. Adults aged 18 years or older who underwent trauma evaluation for a suicide attempt or self-harm were included. Patients younger than 18 years and those pronounced dead on arrival were excluded. The primary outcome was the number of trauma evaluations resulting from suicide attempts or self-harm. The secondary outcome was in-hospital mortality among patients who arrived alive and underwent trauma evaluation. Data were analyzed using two-tailed Wilcoxon two-sample tests, chi-square tests, and Fisher's exact tests, as appropriate. Crude risk ratios with 95% confidence intervals were calculated for in-hospital mortality and ICU admission. Results A total of 147 trauma evaluations occurred among 129 unique patients during the study period. The pre-pandemic period included 76 evaluations among 61 unique patients, whereas the pandemic period included 71 evaluations among 68 unique patients, representing five fewer evaluations during the pandemic period. No patient underwent a qualifying trauma evaluation during both study periods. In-hospital mortality was 18.0% before the pandemic and 22.1% during the pandemic, corresponding to a crude risk ratio of 1.22 (95% CI, 0.61-2.46). ICU admission occurred in 42.6% of pre-pandemic patients and 50.0% of pandemic patients, corresponding to a crude risk ratio of 1.17 (95% CI, 0.81-1.71). Conclusion The pandemic period included slightly fewer trauma evaluations than the pre-pandemic period. No statistically significant differences were observed in the measured patient-level characteristics or in-hospital mortality between the study periods. Although the point estimates for in-hospital mortality and ICU admission rose slightly during the pandemic, the large confidence intervals reflected considerable uncertainty and prevented any conclusion that the periods were comparable. Repeat evaluations demonstrated continued utilization of trauma-system resources by a subset of patients. Larger multicenter studies are warranted to further evaluate temporal patterns in suicide-related trauma presentations.

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