Comparison of Pediatric Emergency Department Visits for Suicide Attempt, Self-Harm, and Suicidal Ideation Before and During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis
University of Calgary-led study represents more than 11 million pediatric emergency department visits in 18 countries
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Although pediatric emergency department visits decreased significantly overall during the COVID-19 pandemic, a recently published study led by the University of Calgary shows there was also a sharp increase in emergency department visits for attempted suicide and suicidal ideation among children and adolescents in that same period of social isolation.
Dr. Sheri Madigan, a clinical psychologist in the Department of Psychology, is the lead author of the study, published today (March 9) in Lancet Psychiatry , which provides a meta-analysis of 42 studies representing more than 11 million emergency department visits. pediatrics around the world, comparing data from pre-pandemic visits with those carried out during the pandemic, until July 2021.
Figures show that while there was a 32% reduction in pediatric emergency room visits for any health-related reason during the pandemic, there was still a 22% increase in children and teens going to the rooms emergency visits for suicide attempts, and an eight percentage increase in visits for suicidal ideation.
Madigan says, “What this 22% increase means is that in the average emergency department, there were 102 child and teen visits per month for suicide attempts before the COVID-19 pandemic, which increased to 125 per month during the pandemic.”
While Madigan is of course concerned about these findings, they are not necessarily a surprise. In the summer of 2021, her research team led a study that found symptoms of depression and anxiety doubled in children and adolescents during the first year of the pandemic, warning that this was a global mental health crisis. . These worrying new findings seem to bear witness to that warning.
“In our previous work on mental health in the pandemic, we determined that children were in crisis and that we needed to reinforce services and resources, or it was going to get worse,” says Madigan, who is the Canada Research Chair in Determinants. of Child Development. “There has been a debate during the pandemic about whether children are okay or not. Now that more data has been published and analyzed, we can answer that question more precisely. The children, in fact, are not well.”
At first glance, there appears to be a confusing discrepancy between the overall reduction in pediatric emergency department visits during the pandemic, on the one hand, and the increase in visits associated with suicide attempts and suicidal ideation, on the other. But beneath the surface, it makes a lot of sense, says Madigan, co-author of the Lancet Psychiatry study with researchers from the Hospital for Sick Children (SickKids) in Toronto, the University of Ottawa and University College Dublin.
Fear of COVID-19 infection and other factors kept people away from emergency departments for most health conditions during the pandemic. But in that same period proven risk factors for mental illness in children and adolescents increased dramatically. Children’s screen time increased significantly during the pandemic as physical activity levels decreased. Many families were in crisis due to job losses, increased family violence, and deteriorating mental health of parents.
“These are all accelerators of mental distress,” Madigan says.
“Children have the ability to show resilience in difficult times, but they were pushed beyond what is tolerable, beyond their threshold of coping ability. And now, many more children and adolescents are in crisis than before the pandemic.”
The researchers included studies published between January 2020 and July 2021 that contained data on pediatric emergency department visits before and during the COVID-19 pandemic, through summer 2021.
Because ongoing studies on the most recent administrative health data have not yet been published, Madigan says the findings from the Lancet Psychiatry paper provide the clearest snapshot of the pandemic through about July 2021. Madigan says, “We will continue monitoring incoming data to see if this trend of increasing emergency department visits for suicide attempts and suicidal ideation among children and adolescents continues to increase as the pandemic changes and evolves.”
Before the pandemic, Madigan says, about one in five children worldwide suffered from some form of mental illness, but only the 25 percent who needed treatment received it. As mental health stressors overwhelmingly increased during the pandemic, the need for mental health resources has increased in kind, and services and supports are still insufficient to meet the overwhelming demand for mental health treatment.
“We cannot ignore that the mental health of children and adolescents is in crisis,” says Madigan.
“We need to prioritize creating mental health centers and services now, to help children go from languishing to thriving.” To do so, he suggests that governments should invest in community resources and infrastructure to support the identification and treatment of mental illness, as well as school programs that focus on prevention and mental health literacy.
Discussion
In this systematic review and meta-analysis of child and adolescent ED visit rates, evidence on suicide attempt and suicidal ideation indicates some of the adverse effects of the COVID-19 pandemic. Moderator analyzes suggested that increases in suicide ideation or attempts were more conclusive for girls than for boys, and that a conclusive increase in self-harm only occurred among older adolescents (around 16 to 17 years old). .
We observed good evidence of a reduction in visits for all other indications of mental illness (e.g., depression and psychosis) and strong evidence of a reduction in total emergency department visits for any health reason. Compared with the reduction in total emergency department visits for any health reason, the findings reported in this study provide strong evidence of relative increases in suicide attempts, self-harm, and suicidal ideation during the COVID-19 pandemic. Consistent with the accumulation of pandemic stressors, there were decreases in access to several sources of support that have been shown to prevent mental distress or mitigate its progression to serious outcomes. Together, these factors could have pushed children and adolescents, particularly older girls and adolescents, beyond their vulnerability thresholds.
This study provides good evidence of an exacerbation of severe mental distress and resulting emergency department presentations over the course of the COVID-19 pandemic among children and adolescents. 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.
Therefore, efforts are needed to understand and mitigate the underlying factors associated with mental distress among children and adolescents to inform prevention strategies. Our findings should also encourage health initiatives, clinical capacity, and specific training of emergency department providers for the management of acute psychiatric distress.
