Suicide-related ED visits increased among children, adolescents during pandemic

Key takeaways:

• Pediatric emergency visits for suicide attempt and ideation increased during the pandemic.
• Mental health resources should be integrated into the community and education to support children and adolescents.

ED visits for suicide attempts and suicidal ideation increased among children and adolescents during the COVID-19 pandemic, according to data published in The Lancet Psychiatry.

The findings suggest that mental health resources available through community health programs and the education system are “urgently needed” to support this population, Sheri Madigan, PhD, and colleagues wrote.

Madigan, a professor in the department of psychology at the University of Calgary and the Alberta Children’s Hospital Research Institute in Alberta, Canada, and colleagues reviewed databases to identify 42 studies with data on ED visits before and during the COVID-19 pandemic. Only studies with data for children and adolescents aged 19 years or younger were included.

Specifically, the researchers evaluated changes in ED visits for suicide attempts, self-harm, suicidal ideation and mental health challenges such as anxiety, depression and psychosis.

In total, there were 11.1 million ED visits in 18 countries among children and adolescents (mean age, 11.7 years). On average, there were 57.6% girls and 43.4% boys in each study.

Analyses revealed that the risk for ED visit for attempted suicide was higher during vs. before the pandemic (rate ratio [RR] = 1.22; 90% CI, 1.08-1.37). There was modest evidence of an increased risk for ED visit for suicidal ideation during the pandemic (RR = 1.08; 90% CI, 0.93-1.25). There was little evidence of a change in visits for self-harm.

Visits for other mental health conditions (RR = 0.81; 90% CI, 0.62-0.75) and for all indications (RR = 0.68; 90% CI, 0.62-0.75) decreased during the pandemic compared with pre-pandemic levels.

Further analyses showed that during the pandemic, there was good evidence of a greater risk for visits due to suicide attempt or suicidal ideation as a single metric among girls (RR = 1.39; 90% CI, 1.04-1.88); among boys, there was only modest evidence (RR = 1.06; 90% CI, 0.92-1.24).

Stratifying by age, evidence showed that self-harm increased during the pandemic among older children (mean age, 16.3 years; RR = 1.18; 90% CI, 1-1.39) and decreased among younger children (mean age, 9 years; RR = 0.85; 90% CI, 0.7-1.05).

“Our findings are in line with pandemic-related research documenting population-level increases in pediatric mental illnesses such as depression and anxiety symptoms and eating disorders, as well as help-seeking behavior,” Madigan and colleagues wrote. “Thus, efforts to both understand and mitigate underlying factors associated with mental distress among children and adolescents are needed to inform prevention strategies. Our findings should also encourage health initiatives, clinical capacity and targeted emergency department-provider training for managing acute psychiatric distress.”