Incidence trends and clinical management of self-harm in adolescents and young adults in catalonia: primary care cohort study (2013-2022).

Abstract

This study investigates trends in the incidence and clinical management of self-harm among adolescents and young adults in Catalonia from 2013 to 2022, using data from the Information System for Research in Primary Care (SIDIAP). A population-based cohort analysis was conducted to examine temporal trends, demographic inequalities, and clinical care patterns. The study population comprised 1,707,471 eligible individuals aged 10 to 24, contributing 8,868,472 person-years of observation. The incidence of self-harm increased significantly over the study period (Incidence Rate Ratio [IRR] 2022 vs. 2013 for the total cohort: 2.67; 95% CI: 2.31-3.10), particularly during the COVID-19 pandemic (IRR 2022 vs. 2019: 2.06; 95 CI: 1.81-2.35), with rates in girls approximately three times higher than in boys. Socioeconomic deprivation emerged as a major risk factor, with individuals from deprived areas demonstrating elevated self-harm rates. Comorbid mental health disorders, notably anxiety and depression, were highly prevalent among individuals engaging in self-harm. Clinical management strategies differed by age and sex; girls were more frequently referred to mental health services, while psychotropic medication was commonly prescribed for both sexes. The incidence of self-harm has steadily increased reaching unprecedented levels during the pandemic, with significant disparities by sex, age, and socioeconomic status. The findings underscore the need for an appropriate healthcare response addressing the social determinants of health. Monitoring incidence trends and implementing targeted strategies are essential to support youth mental health in the post-pandemic context.