Pandemic-related emergency psychiatric presentations for self-harm of children and adolescents in 10 countries (PREP-kids): a retrospective international cohort study

Abstract

To examine the differences in hospital emergency psychiatric presentations for self-harm of children and adolescents during the covid-19 lockdown in March and April 2020 compared with the same period in 2019. Retrospective cohort study. We used electronic patient records from 23 hospital emergency departments in ten countries grouped into 14 areas. We examined data on 2073 acute hospital presentations by 1795 unique children and adolescents through age 18. We examined the total number of emergency psychiatric hospital presentations and the proportion of children and adolescents presenting with severe self-harm as our two main outcome measures. In addition, we examined sociodemographic and clinical characteristics and clinical management variables for those presenting with self-harm. To compare the number of hospital presentations between 2020 and 2019 a negative binomial model was used. For other variables, individual participant data (IPD) meta-analyses were carried out. Emergency psychiatric hospital presentations decreased from 1239 in 2019 to 834 in 2020, incident rate ratio 0.67, 95% CI 0.62–0.73; p < 0.001. The proportion of children and adolescents presenting with self-harm increased from 50% in 2019 to 57% in 2020, odds ratio 1.33, 1.07–1.64; p = 0.009 but there was no difference in the proportion presenting with severe self-harm. Within the subpopulation presenting with self-harm the proportion of children and adolescents presenting with emotional disorders increased from 58 to 66%, odds ratio 1.58, 1.06–2.36; p = 0.025. The proportion of children and adolescents admitted to an observation ward also decreased from 13 to 9% in 2020, odds ratio 0.52, 0.28–0.96; p = 0.036. Service planners should consider that, during a lockdown, there are likely to be fewer emergency psychiatric presentations. Many children and adolescents with psychiatric emergencies might not receive any service. A focus on developing intensive community care services with outreach capabilities should be prioritised.

Referral patterns for specialist child and adolescent mental health services in the Republic of Ireland during the COVID-19 pandemic compared with 2019 and 2018

“…21 Data collected from March to May 2020 from 23 emergency departments internationally, corresponding with phase 1 of this study, showed that despite a decrease in overall referrals, clinical complexity increased and the proportion of youth presenting with self-harm increased. 21 The increased awareness of rising rates of self-harm among youth was already a cause for concern pre-COVID-19 in the UK 22 and the ROI, 23 but had been in parallel with improvements in evidence-based treatments. 24 Increased presentation and lethality of self-harm among adults during COVID-19 has also been reported.…”

Hospital presentations for self-poisoning during COVID-19 in Sri Lanka: an interrupted time-series analysis

“…Evidence from Peru, Serbia, and Turkey suggests a decline in the number of individuals presenting with self-harm to hospitals and suicide deaths. 8,9 The study from Peru did account for underlying trends but was restricted to suicide as the outcome.…”

A longitudinal study of mental health in adolescents before and during the COVID-19 pandemic

“…Importantly, the potential effects of the pandemic on severe psychiatric symptoms such as psychotic experiences and suicidality remain unclear. Although epidemics do not necessarily affect adolescent suicidality 8 , admissions data from hospitals in the United States, Europe, and the Middle East show an increase in self-harm, suicidal ideation, and suicide attempts during the COVID-19 pandemic 21,22 . In addition, an online survey conducted during the pandemic revealed that 37% of adolescents reported having suicidal ideation 23 .…”