• Tomoyuki Ushimoto, Koichi Tanaka, Yoshifumi Kaneto, Kento Nakajima, and Hideo Inaba.
• Department of Emergency Medicine, Kanazawa Medical University, 1-1 Daigaku, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan. ushi@kanazawa-med.ac.jp.
• Intern Emerg Med. 2024 Jun 26.

ObjectivesReportedly, coronavirus disease pandemic 2019 (COVID 19) was associated with an increased rate of emergency department visits related to suicide in youth. This study analyzed the influence of the pandemic on the incidence of emergency transportation associated with suicide attempts and self-harm.MethodsThis retrospective cohort study used the Nationwide Emergency Medical Services Transportation Database between 2016 and 2021 for main analyses and extended database for resuscitation-attempted out-of-hospital cardiac arrests cases for secondary analyses.ResultsWe analyzed 204,081 cases with suicidal/self-harm emergencies. Compared with corresponding periods of 4 pre-pandemic years, the incidence of suicidal/self-harm emergencies increased after the end of the first nationwide declaration of emergency and remained high in youth (incidence rate ratio; 95% lower/upper interval, 1.29; 1.22-1.37 and 1.33; 1.28-1.39,), particularly in females (1.35; 1.27-1.46 and 1.40; 1.33-1.48) during the remaining pandemic period (Phase I (June 2020 to December 2020) and Phase II (2021), respectively). Compared with other emergencies, suicidal/self-harm emergencies were associated with a much higher proportion of outpatient deaths regardless of the pandemic. Suicidal out-of-hospital cardiac arrests cases were associated with much poorer outcomes.ConclusionThe incidence of suicidal/self-harm emergency transportation in youth considerably increased during COVID 19 after the end of the first state of emergency declaration in Japan. This pandemic's impact varied among sex and region, appearing most prominently in young females. Rapid accumulation of suicidal/self-harm emergency transportation incidences may serve as an early warning sign for mental health problems and suicidality in Japan.© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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