Emergency Department Encounters Among Youth With Suicidal Thoughts or Behaviors During the COVID-19 Pandemic

Ridout, Kathryn K.; Alavi, Mubarika; Ridout, Samuel J.; Koshy, Maria; Awsare, Sameer; Harris, Brooke; Vinson, David R.; Weisner, Constance; Sterling, Stacy; Iturralde, Esti

doi:10.1001/jamapsychiatry.2021.2457

Cited by 70 publications

(62 citation statements)

References 21 publications

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“…25 In a recent study of 6,816 adolescents who visited the ED due to suicidal ideation or a suicide attempt, female youth and adolescents with no previous psychiatric history were reported to be the most vulnerable group. 26 However, in this study, we find patients with a history of mental illness to be the most vulnerable group. During the COV-ID-19 pandemic, the number of suicide attempts made by people with a history of mental illness increased by 34.7%, which was statistically significant (P = 0.005).…”

Section: Discussionmentioning

confidence: 48%

Suicide attempts presenting to the emergency department before and during the COVID-19 pandemic: a comparative study

et al. 2022

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Objective To compare and analyze the differences in the sociodemographic and clinical characteristics of suicide attempters who visited an emergency department (ED) before and during the coronavirus disease (COVID-19) pandemic.Methods This single center, retrospective study was conducted by reviewing the medical records of patients in the “self-injury/suicide” category of the National Emergency Department Information System who visited an ED between January 2019 and December 2020. We obtained information on baseline characteristics, suicide attempt, and disposition. Data were analyzed using the chi-squared test.Results A total of 456 patients were included. The number of patients visiting the ED for suicide attempts increased by 18.2% (from 209 to 247 cases) during the COVID-19 pandemic, and the ratio of suicide attempters to the total number of ED visits increased by 48.8% (from 0.43% to 0.64%, P<0.001). There were significant differences in methods of suicide attempt, endotracheal intubation, ED disposition, and the presence of mental illness. Drug overdose (42.1% vs. 53.4%) and gas inhalation (5.7% vs. 8.5%) increased, and hanging decreased (6.0% vs. 2.0%) during the pandemic. Endotracheal intubation (13.9% vs. 5.7%) and intensive care unit admission (29.7% vs. 14.6%) decreased. More patients with the history of mental illness visited during the pandemic (54.0% vs. 70.1%).Conclusion Since the COVID-19 pandemic began, suicide attempts have increased in this single ED although the lethality of those attempts is low.

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Section: Discussionmentioning

confidence: 48%

Suicide attempts presenting to the emergency department before and during the COVID-19 pandemic: a comparative study

et al. 2022

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“…Women and younger age were frequently identified as a risk factor of mental distress during the pandemic [ 17 , 18 ]. Furthermore, another survey revealed the prevalence of more female patients than male patients among young patients who visited EDs for suicide-related behaviors during the pandemic [ 19 ]. A US national surveillance of persons aged 12–25 years revealed a decrease in ED visits at the beginning of the pandemic, followed by an increase, particularly among women [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in self-harm- and violence-related urgent psychiatric consultation in the emergency department during the different stages of the COVID-19 pandemic

Liu

Chen

et al. 2022

BMC Psychiatry

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Background The coronavirus disease 2019 pandemic significantly affected emergency department (ED) visits and urgent psychiatric consultation (UPC) seeking behavior in EDs. Our study explored the changes in UPCs during and after the pandemic peak. Methods This retrospective observational study evaluated UPCs in the ED of a referral medical center in Taiwan, where treated both physical and psychiatric complaints. We defined the COVID-19 pandemic peak period as calendar week 4–18, 2020. The corresponding baseline as calendar week 4–18, 2019, and the slack period as week 4–18, 2021. The total number of UPCs, patient demographic data such as sex and age of the patients seen, the referral system (whether police or emergency medical service [EMS] or other sources), and the chief complaint (self-harm or violence) were recorded. Results Compared with the baseline period, a significant decline in UPCs was observed in the pandemic peak period, and a rebound was observed in the slack period, with the median [IQR] Q1, Q3 values of 22 [18, 26], 12 [10, 17]), and 16 [15, 23], respectively. We observed significantly few men (34.9% vs 45.2%) and less violence (10.2% vs 17.6%) in the peak period compared with in the baseline period, but no significant difference was found compared with the slack period. Throughout the pandemic, younger patients (41.8 ± 17.4 in 2019, 39.2 ± 18.5 [p = 0.121] in 2020, and 35.6 ± 17.2 [p < 0.001] in 2021), higher proportions of police/EMS referral (38.7% in 2019, 41.9% [p = 0.473] in 2020, and 51.9% [p = 0.001] in 2021) and self-harm–related complaints (57% in 2019, 62.4% [p = 0.233] in 2020, and 64.9% [p = 0.049] in 2021) was noted among UPC seekers during the pandemic. However, the proportion of violence-related UPCs (17.6% in 2019, 10.2% [p = 0.023] in 2020, and 12.3% [p = 0.072] in 2021) declined. Conclusions This study found that UPCs changed throughout the pandemic. This result raises the concern that mental health needs are masked during the pandemic.

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“…Nevertheless, the simultaneous proportional rise in visits among females, adolescents, and for suicide‐related diagnoses during summer and fall 2020, and proportional reduction in visits among males, younger children, and children with developmental disorders and intellectual disabilities underscores the importance of adjusting for demographic and diagnostic covariates and the limitations of univariate comparisons in examining these trends ( 30 ). In fact, when adjusting for demographic covariates using multivariate regression, differences in frequency of many diagnoses did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…Others have raised concern that existing disparities in pediatric MH diagnosis and treatment have been accentuated, particularly among children vulnerable to loss of special education resources ( 29 ). Despite progress in disentangling trends in MH‐ED use, there are several areas in which this early literature can be extended: first, given substantial co‐occurring demographic and diagnostic shifts in child MH‐ED use observed during the early pandemic (e.g., the simultaneous proportional rise in use by adolescent females and suicide‐related visits), analyses controlling for covariates (vs. descriptive unadjusted analyses) may further clarify subgroups uniquely vulnerable to increased service use or gaps in care ( 25 , 27 , 30 ); second, pediatric‐focused studies reporting multivariate‐adjusted trends have predominantly occurred at single sites ( 14 , 24 ), and expansion to multi‐site analyses across geographically‐diverse regions of the U.S. may further capture national shifts in child MH‐ED use.…”

mentioning

confidence: 99%

Mental Health‐Related Emergency Department Visits Among Children During The Early COVID‐19 Pandemic

Edgcomb

Benson

Tseng

et al. 2022

PRCP

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To measure univariate and covariate-adjusted trends in children's mental health-related emergency department (MH-ED) use across geographically diverse areas of the U.S. during the first wave of the Coronavirus-2019 (COVID-19) pandemic. Method: This is a retrospective, cross-sectional cohort study using electronic health records from four academic health systems, comparing percent volume change and adjusted risk of child MH-ED visits among children aged 3-17 years, matched on 36-week (3/18/19-11/25/19 vs. 3/16/ 20-11/22/20) and 12-week seasonal time intervals. Adjusted incidence rate ratios (IRR) were calculated using multivariate Poisson regression.Results: Visits declined during spring-fall 2020 (n = 3892 vs. n = 5228, −25.5%) and during spring (n = 1051 vs. n = 1839, −42.8%), summer (n = 1430 vs. n = 1469, −2.6%), and fall (n = 1411 vs. n = 1920, −26.5%), compared with 2019. There were greater declines among males (28.2% vs. females −22.9%), children 6-12-year (−28.6% vs. −25.9% for 3-5 years and −22.9% for 13-17 years), and Black children (−34.8% vs. −17.7% to −24.9%). Visits also declined for developmental disorders (−17.0%) and childhood-onset disorders (e.g., attention deficit and hyperactivity disorders; −18.0%). During summer-fall 2020, suicide-related visits rose (summer +29.8%, fall +20.4%), but were not significantly elevated from 2019 when controlling for demographic shifts. In contrast, MH-ED use during spring-fall 2020 was significantly reduced for intellectual disabilities (IRR 0.62 [95% CI 0.47-0.86]), developmental disorders (IRR 0.71 [0.54-0.92]), and childhood-onset disorders ). Conclusions:The early pandemic brought overall declines in child MH-ED use alongside co-occurring demographic and diagnostic shifts. Children vulnerable to missed detection during instructional disruptions experienced disproportionate declines, suggesting need for future longitudinal research in this population.

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Emergency Department Encounters Among Youth With Suicidal Thoughts or Behaviors During the COVID-19 Pandemic

Cited by 70 publications

References 21 publications

Suicide attempts presenting to the emergency department before and during the COVID-19 pandemic: a comparative study

Suicide attempts presenting to the emergency department before and during the COVID-19 pandemic: a comparative study

Changes in self-harm- and violence-related urgent psychiatric consultation in the emergency department during the different stages of the COVID-19 pandemic

Mental Health‐Related Emergency Department Visits Among Children During The Early COVID‐19 Pandemic

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