Temporal Trends in Suicide Attempts Among Children in the Decade Before and During the COVID-19 Pandemic in Paris, France

Abstract

Recent studies have reported a deterioration in children's mental health since the start of the COVID-19 pandemic in 2020, with an increase in anxiety and mood disorders. 1 Rates of suicide ideation and suicide attempts among children were also higher when COVID-19-related stressors were heightened in 2020. 2,3 We aimed to better assess temporal trends in suicide attempts among children while adjusting for annual and seasonal fluctuations. We conducted a cross-sectional study of surveillance data collected over the past 10 years at the Robert Debré Hospital in Paris, France, which is one of the largest pediatric centers in Europe. MethodsThis cross-sectional study included all children aged 15 years or younger who attempted suicide and were admitted to the pediatric emergency department of Robert Debré Hospital between January 2010 and April 2021. The study comprised 830 children, with a mean (SD) age of 13.5 (1.5) years and a 1:4 ratio of boys to girls. A suicide attempt was defined as a nonfatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. 4 Deaths by suicide were not included in the analysis because those data were not available in real time.For this study, we conducted a robust seasonal-trend decomposition using locally estimated scatterplot smoothing analysis on the bimestrial time series of all suicide attempts in the 2010 to 2021 surveillance data. 5 The number of suicide attempts observed at time t was decomposed as (1) a seasonal component accounting for the variations observed during the year, (2) a long-term trend, and (3) a remainder. In the absence of atypical events, the remainder should be centered and uncorrelated and should have a constant variance.This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. The independent ethics committee of the Assistance Publique-Hôpitaux de Paris Health Data Warehouse approved the study protocol. Informed consent was not required, in accordance with French law regarding the retrospective use of monocentric anonymized routine data. ResultsThe deseasonalized time series results showed that the number of suicide attempts among children decreased from 12.2 at the lowest level (July to August) in 2019, to 7.8 during the first lockdown period (March to April) in 2020 in France (−36%; Figure; Table ). However, the number of suicide attempts among children increased substantially from the lowest and highest levels of 12.2 (July to August) and 22.5 (November to December) in 2019, to 38.4 just before the second lockdown initiation (September and October) and 40.5 (early November to December) in 2020 (+116% and +299%, respectively). This aberrant dynamic of suicide attempts was independent from its annual seasonality and its trend over the 10-year period, as illustrated by the significant remainder Author affiliations and article information are listed at the end of this article.

Is SARS‐CoV‐2 seroconversion a risk factor for severe and acute psychiatric symptoms in children?

“…Despite the growing evidence supporting the neurotropism of SARS‐CoV‐2, based on quantitative data for tropism, replication kinetics, and cell damage, this virus seems to cause modest neuropsychiatric manifestations in seroconverted children 6 . Finally, our results support further the impact of mitigation strategies on psychiatric symptom deterioration in children reported in early stages of the pandemic 1 …”

“…Since the beginning of the SARS‐CoV‐2 pandemic, studies reported an increase in children's mental health issues 1 . Beyond the surge in environmental stressors such as restrictive isolation measures, the rapid actualization of psychiatric symptoms in children may be directly related to the SARS‐CoV‐2 through its neurotropism 2 .…”

“…Since the beginning of the SARS‐CoV‐2 pandemic, studies reported an increase in children's mental health issues. 1 Beyond the surge in environmental stressors such as restrictive isolation measures, the rapid actualization of psychiatric symptoms in children may be directly related to the SARS‐CoV‐2 through its neurotropism. 2 This could suggest children hospitalized for severe psychiatric symptoms during the early months of the pandemic would have been more infected by the SARS‐CoV‐2 and thus more seroconverted than the general population sex‐ and age‐matched controls.…”

Retrospective analysis of North West London healthcare utilisation by children during the COVID-19 pandemic

“…Likewise, our study would have benefited from more detailed information on mental health issues to verify the reported rise of mental health issues in primary and secondary care elsewhere. 36 37 We were not able to reliably differentiate between face-to-face and virtual appointments in primary care, nor to assess comorbidities or vaccination status.…”

“…For example, studies reported relative unchanged ED attendance rates for urinary tract infections,3 5 and changes in the number of admissions for relatively infrequent safeguarding related injuries will have gone unnoticed. Likewise, our study would have benefited from more detailed information on mental health issues to verify the reported rise of mental health issues in primary and secondary care elsewhere 36 37. We were not able to reliably differentiate between face-to-face and virtual appointments in primary care, nor to assess comorbidities or vaccination status.…”