Suicide-related youth ED visits decreased early in pandemic, then increased for girls
ED visits for youth with suicidal thoughts and behaviors initially decreased during the COVID-19 pandemic, likely because of lockdown orders, then aligned with 2019 levels, according to a cross-sectional study published in JAMA Psychiatry.
“As the pandemic disrupted so many parts of daily life, there was particular concern about the impacts on young people because of their specific developmental and social needs and the changing landscape around their educations and family life,” Kathryn K. Ridout, MD, PhD, of the Permanente Medical Group at Kaiser Permanente Northern California, told Healio Psychiatry. “However, there was a lack of diagnosis-based, population-level evidence around suicidal ideation and behavior in youth.”
To address this research gap, the investigators assessed ED visits of youth aged 5 to 17 years who presented with suicidal thoughts or behaviors in 2019 and 2020 at a large, integrated, community-based health system. Main outcomes and measures included population-level incidence rate ratios (IRRs) and percent relative effects for suicide-related ED encounters defined according to the CDC-recommended ICD-10-CM codes at four time points in 2020 compared with the same points in 2019.
Results showed 2,123 youth with suicide-related ED visits in 2020 vs. 2,339 in 2019. A total of 69.9% of the 2020 group were girls, and 84.7% were aged 13 to 17 years. A total of 65.9% of the 2019 group were girls, and 85.4% were aged 13 to 17 years. During March 2020 through May 2020, suicide-related ED encounter incidence rates significantly decreased compared with the same period in 2019 (IRR = 0.57; 95% CI, 0.51-0.63), then returned to levels prior to the pandemic.
Girls’ suicide-related ED visits between June 2020 and August 2020, and September 2020 through Dec. 15, 2020, significantly increased compared with the corresponding months in 2019 (IRR = 1.19; 95% CI, 1.04-1.35 and IRR = 1.22; 95% CI, 1.11-1.35, respectively). Boys’ suicide-related ED visits decreased between September 2020 and Dec. 15, 2020 (IRR = 0.81; 95% CI, 0.69-0.94).
Factors for increased risk for presenting with suicide-related problems between September 2020 and December 2020 compared with the same period in 2019 included having no history of outpatient mental health or suicide encounters (129.4%; 95% CI, 41-217) and having comorbid psychiatric conditions documented at the ED encounter (6.7%; 95% CI, 1-12.3).
“These data suggest that trends over time (2019 vs. 2020) are generally consistent, although there may be certain groups of young people who need more attention,” Ridout said.
“When people are connected with resources, when they are diagnosed and given some treatment support, they handle these societal stressors relatively well,” Ridout continued. “We all need to be aware of those in our lives who may be struggling but haven't previously needed to seek help.”