Objectives Deliberate self-harm (DSH) is the act of self injury with or without suicidal intent. It continues to be a significant concern in our adolescent population.

The rates of emergency admission attendances due to self harm in adolescents rose sharply in Wales from 2011–2015 . We aimed to assess the rates of DSH presenting to emergency departments in Wales over a 5 year period, which includes pre- and during COVID-19 restrictions.

Several risk factors are known to increase the likelihood of DSH, and previous DSH is known to be the strongest risk factor for future suicidal attempts. The impact of socio-economic deprivation is a known risk factor for DSH and we aimed to assess its impact on ED attendance rates for DSH in Wales.

Methods Data were gathered from an all Wales database. We identified emergency department attendances coded as DSH that presented over a five year period (2017–2021), aged 8 to 16 years old.

Results 4703 patients were included. There is a 4.9% increase in cases when comparing 2017 and 2021. However, the highest number of cases were seen in 2019. Higher incidences were seen in patients aged 15 years (n=1418; 30.2%) and 16 years (n=1407; 29.9%). No significant increase in incidence was seen in children aged under 11 years old.

There is a 2 fold increase in incidence of DSH in children from the two most deprived national quintiles compared to children from the two least deprived quintiles.

Conclusions The impact of Covid-19 has not resulted in a significant rise in cases of DSH presenting to emergency departments in Wales. However, DSH continues to be a serious issue for our young people. The highest incidence of DSH was seen in the lower socio-economic quintiles suggesting that intervention needs to be on a national level to address the health inequalities.

It is also important to support individuals in a timely and effective manner to prevent further sequelae of DSH such as accidental death and suicide.