Association Between COVID-19 and Self-Harm: NationwideRetrospective Ecological Spatiotemporal Study inMetropolitan France

Background: The COVID-19 pandemic has not been associated with increases in suicidal behavior at the national, regional,or county level. However, previous studies were not conducted on a finer scale or adjusted for ecological factors. Objective: Our objective was to assess the fine-scale spatiotemporal association between self-harm and COVID-19 hospitali-zations, while considering ecological factors. Methods: Using the French national hospital discharge database, we extracted data on hospitalizations for self-harm ofpatients older than 10 years (from 2019 to 2021) or for COVID-19 (from 2020 to 2021) in metropolitan France. We firstcalculated monthly standardized incidence ratios (SIRs) for COVID-19 between March 2020 and December 2021, using aBesag, York, and Molli & eacute; spatiotemporal model. Next, we entered the SIRs into an ecological regression in order to test theassociation between hospital admissions for self-harm and those for COVID-19. Lastly, we adjusted for ecological variableswith time lags of 0 to 6 months. Results: Compared with a smoothed SIR of <= 1, smoothed SIRs from 1 to 3, from 3 to 4, and greater than 4 for COVID-19hospital admissions were associated with a subsequent increase in hospital admissions for self-harm, with a time lag of 2 to 4months, 4 months, and 6 months, respectively. Conclusions: A high SIR for hospital admissions for COVID-19 was a risk factor for hospital admission for self-harmsome months after the epidemic peaks. This finding emphasizes the importance of monitoring and seeking to prevent suicideattempts outside the epidemic peak periods