The COVID-19 pandemic has been extensively discussed in the context of its effect on mental health. Although global suicide rates have remained stable during the pandemic, the specific effect on non-fatal suicide behaviours during and after the pandemic remains underexplored. This study aims to investigate patterns of non-fatal suicide behaviours before, during, and after the pandemic. In this cohort study, we used data from all hospitals in Catalonia, Spain, collected through the Catalan Suicide Risk Code, which is a specifically designed suicide attempt surveillance protocol, involving a face-to-face, in-depth psychiatric evaluation, after a Catalan resident presents any suicide risk behaviour in any public health-care setting. This evaluation centralises data from suicide registries across the territory. We included non-fatal suicide behaviours, meaning suicidal ideation or attempts that did not result in death, and excluded self-harm behaviours not judged to be linked with suicidal ideation. We considered three periods: the pre-confinement period (Jan 1, 2018, to the enforcement of the lockdown in Spain on March 14, 2020); the confinement period (March 14, 2020, to the end of lockdown on June 21, 2020); and the post-confinement period (June 21, 2020, to Dec 31, 2022). We used Bayesian structural time series models to assess the effect of pandemic phases on non-fatal suicide behaviours, and we ran stratified analyses by sex and age to identify distinct patterns among demographic cohorts. We obtained 26 482 records from Jan 1, 2018, to Dec 31, 2022. The mean age was 37·94 years (SD 18·07), and the sample included 17 584 (66·4%) women and 8898 (33·6%) men. Data on ethnicity were not collected. Temporal trends showed a mild increase in non-fatal suicide behaviours from Jan 1, 2018, to March 13, 2020; a reduction during the confinement period; and a subsequent rise after confinement. Bayesian models suggested a significant causal effect of lockdown easing, resulting in a 50·77% increase in non-fatal suicide behaviours (95% credible interval [CrI] 26·62–76·58; p<0·0001). Stratified analyses indicated that the easing of lockdown resulted in a significant increase in non-fatal suicide behaviours among women (25·92%; 6·71–44·72; p=0·011) and among individuals aged 18 years and younger (72·75%; 38·81–108·11; p<0·0001). This study provides a comprehensive examination of non-fatal suicide behaviours in Catalonia, Spain, emphasising the dynamics of different COVID-19 pandemic phases. The initial reduction during strict lockdown aligns with Joiner's Interpersonal Theory of Suicide, whereas the post-confinement rise reflects complex factors, including social isolation and economic challenges. Sex-specific and age-specific analyses underscore distinct vulnerabilities, emphasising the need for targeted preventive strategies. Centro de Investigación Biomédica en Red de Salud Mental annual budget of G21, Agència de Gestió d’Ajuts Universitaris i de Recerca of the Generalitat de Catalunya. For the Catalan and Spanish translations of the abstract see Supplementary Materials section.

中文翻译：

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COVID-19 大流行各阶段的非致命自杀行为：加泰罗尼亚队列的一项基于人群的研究

人们广泛讨论了 COVID-19 大流行对心理健康的影响。尽管全球自杀率在大流行期间保持稳定，但大流行期间和之后对非致命自杀行为的具体影响仍未得到充分研究。本研究旨在调查大流行之前、期间和之后的非致命自杀行为模式。在这项队列研究中，我们使用了西班牙加泰罗尼亚所有医院的数据，这些数据是通过加泰罗尼亚自杀风险代码收集的，这是一项专门设计的自杀企图监测方案，涉及在经过一段时间的调查后进行面对面、深入的精神评估。加泰罗尼亚居民在任何公共医疗保健环境中出现任何自杀风险行为。这项评估集中了全境自杀登记处的数据。我们纳入了非致命性自杀行为，即自杀意念或未导致死亡的企图，并排除了与自杀意念无关的自残行为。我们考虑了三个时期：封锁前时期（2018年1月1日至2020年3月14日西班牙实施封锁）；禁闭期（2020年3月14日至2020年6月21日禁闭结束）；以及产后期间（2020年6月21日至2022年12月31日）。我们使用贝叶斯结构时间序列模型来评估大流行阶段对非致命自杀行为的影响，并按性别和年龄进行分层分析，以确定人口群体中的不同模式。我们获得了2018年1月1日至2022年12月31日的26 482条记录。平均年龄为37·94岁(SD 18·07)，样本包括17 584名(66·4%)女性和8898名(33·07)女性。 6%) 男性。没有收集种族数据。时间趋势显示，从2018年1月1日到2020年3月13日，非致命自杀行为略有增加；坐月子期间减少；以及限制后随后的上升。贝叶斯模型表明，放松封锁具有显着的因果效应，导致非致命自杀行为增加 50·77%（95% 可信区间 [CrI] 26·62–76·58；p<0·0001）。分层分析表明，封锁的放松导致女性（25·92%；6·71–44·72；p=0·011）和 18 岁及以下个体的非致命自杀行为显着增加（ 72·75%；38·81–108·11；p<0·0001）。这项研究对西班牙加泰罗尼亚的非致命自杀行为进行了全面检查，强调了 COVID-19 大流行不同阶段的动态。严格封锁期间的最初减少与乔伊纳的自杀人际理论相符，而封锁后的上升则反映了复杂的因素，包括社会隔离和经济挑战。针对特定性别和特定年龄的分析强调了不同的脆弱性，强调需要有针对性的预防策略。 G21 精神健康生物医学研究中心年度预算，加泰罗尼亚政府的大学管理机构和研究机构。有关摘要的加泰罗尼亚语和西班牙语翻译，请参阅补充材料部分。