Self-inflicted cut throat injuries and substance use during COVID-19: An analysis from Nepal

Introduction: Suicide is a major global health challenge. Self-harm and suicide rates increased during the time of the COVID-19 pandemic in Nepal. Cutthroat as a means of suicide is a rare and complex method. There are only a very few studies reporting suicidal cutthroat cases at the time of the COVID-19 pandemic. Likewise, the concerns about substance use were not properly addressed during the pandemic. 
 
Methods: An observational retrospective analysis evaluating the clinic-demographic description of rare suicidal cutthroat cases of thirteen months duration from 1st March 2019 to 30th March 2020 in a tertiary center during the peak period of the COVID-19 pandemic in Nepal.
 
Results: Out of 23 patients, the majority were male (87%, n=20), belonged to age 20-40 years (56.5%, n=13), literate (69.6%, n=16), married (30.4%, n=7), consulted from emergency (60.9%, n=14), and had grade three laryngeal injury (39.1%, n=9).  However, only a minority of cases had a prior history of suicide attempt (30.4%, n=7), family history of suicide (8.7%, n=2), and multiple cut marks (39.1%, n=9). All patients had mental health issues. The most common diagnosis was substance use disorder (47.82%, n=11). Among patients with substance use disorder, 72.72%  had alcohol use disorder, 9.09%  had cannabis use disorder, and 18.18% had multiple substance use disorder (which included alcohol, cannabis, and opioids). 
 
Conclusion: Suicidal cutthroat injuries are always associated with mental health issues and most commonly substance use disorders. The COVID-19 pandemic might have contributed not only to increased rates of mental health issues and suicide but also the substance use patterns.