Physical distancing and emergency medical services utilization after self-harm in Korea during the early COVID-19 pandemic: A nationwide quantitative study

Abstract

Background People experienced various stress and psychological responses to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to examine the changes in emergency medical services (EMSs) utilization by self-harm patients in early pandemic and the impacts of physical distancing measures on the EMSs utilization by self-harm patients. Methods Data for all patients presenting to emergency departments (EDs) after self-harm injuries including self-poisoning were collected from the National ED Information System (NEDIS). Characteristics of patients in two study regions (urban versus rural) were compared. Weekly and annual ED visit rates after self-harm (VRSH) per 100,000 population were calculated. Mobile phone mobility index (MPMI) was calculated by dividing a region’s aggregated mobile phone mobility by mid-year population. Joinpoint regression analysis was conducted to assess changes in 2020 over pre-pandemic years. Test for presence of joinpoint at the end of 2019 was performed. A cross-correlation function was used to estimate the maximal morphological similarity and lag time between changes in MPMI and VRSH. Results In 2020, in early phases of the pandemic, there was a moderate decline in self-harm-related ED visits to 30,797 from a continuously increasing trend seen in previous years. However, proportions of young people (50.1%) and females (62.3%) increased over previous years. VRSHs among women and young people aged 15–34 years showed higher levels in 2020 than in previous five years. There was a significant decrease in the proportion of patients transported directly from the scene. In addition, there was a polarization of mental state upon ED arrival from alert and unresponsive. The median correlation coefficient between MPMI values and VRSH values was 0.601 (interquartile range [IQR]: 0.539–0.619) in urban regions and 0.531 (IQR: 0.454–0.595) in rural regions, showing no statistically significant difference between the two. Conclusion Physical distancing measures adopted to prevent the spread of transmittable diseases following the pandemic had the effect of decreasing ED visits due to self-harm. When the pandemic has ended, and daily life has been restored, it will be particularly important to pay attention to the increased numbers of self-harm patients expected to visit EDs compared to during the pandemic.