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Factors influencing self-harm thoughts and self-harm behaviours over the first 45 weeks of the COVID-19 pandemic in the UK: a longitudinal analysis of 48,446 adults

Background There is concern that the COVID-19 pandemic and its aftermath will result in excess suicides by increasing known risk factors such as self-harm. However, evidence on how pandemic-related risk factors contribute to changes in these outcomes is lacking. Aims We sought to examine how different adverse experiences and worries about adversity brought about by the COVID-19 pandemic contribute to changes in self-harm thoughts and behaviours over the first 45 weeks of the pandemic. Method Data from 48,446 UK adults in the UCL COVID-19 Social Study were analysed across the first 45 weeks (1 April to 7 February 2021) of the pandemic. Fixed effects regressions explored associations between weekly within-person variation in five categories of adversity experiences and adversity worries with changes in self-harm thoughts and behaviours across age groups (18-29, 30-44, 45-59, and 60+ years). Results More adverse experiences were more strongly related to outcomes than worries. Specific categories of worries and adversities had stronger associations with outcomes than others. The largest contributing factor to increases in both self-harm thoughts (odds ratio (OR) range = 3.38 to 4.00) and behaviours (OR range = 3.72 to 6.82) was physical or psychological abuse amongst all ages. Having had COVID-19 and financial worries were associated with increased likelihood of both outcomes, the latter being more consistently associated with outcomes than actual financial adversity. Conclusions These findings suggest that a significant portion of UK adults may be at increased risk for self-harm thoughts and behaviours during the pandemic, which is concerning given the link between self-harm and suicide. Policies currently place to protect and reassure citizens may be insufficient in assuaging fears and anxieties. Given the likelihood that as time goes on, the economic and social consequences of the COVID-19 pandemic will accumulate, policy makers can begin adapting a variety of existing evidence-based suicide prevention strategies and other social policies to help mitigate its consequences.