Suicide and self-harm in children and adolescents during the COVID-19 pandemic in Brazil: a time series analysis

OBJECTIVE: To investigate changes in self-harm notifications and suicide mortality among children and adolescents during the COVID-19 pandemic. METHODS: We conducted a time-series analysis using data on self-harm notifications and suicide deaths among individuals aged 5-19 years from the Brazilian Notifiable Diseases Information System and Mortality Information System. Pre-pandemic data (March 2015-February 2020) were used to fit autoregressive integrated moving average models to generate counterfactual estimates for the pandemic period. Observed and expected rates were compared overall and stratified by sex, age, and region. Segmented regression analyses assessed immediate and trend changes following the onset of the pandemic. RESULTS: A total of 176,458 self-harm notifications and 7,609 suicide deaths were recorded. Self-harm notifications were more frequent among females (77.0%), adolescents aged 15-19 years (70.8%). Suicide deaths predominated among males (67.7%) and among adolescents aged 15-19 years (84.1%). The most common methods were self-poisoning for self-harm (58.5%) and hanging for suicide (75.5%). During the pandemic, self-harm notification rates were lower than expected based on pre-pandemic trends (observed: 5.8 per 100,000; expected: 16.4; 95% prediction interval [PI]: 11.9-23.2), with a significant immediate reduction in April 2020. In contrast, suicide mortality rates remained within predicted ranges (observed: 0.23 per 100,000; expected: 0.25; 95% PI: 0.17-0.39). Stratified analyses were consistent overall, except for younger children. CONCLUSIONS: The COVID-19 pandemic was associated with marked reductions in self-harm notifications but not with changes in suicide mortality among Brazilian youth, underscoring the importance of continuous surveillance to inform prevention strategies.