Trends in suicidal ideation in an emergency department during COVID-19

Abstract

Objective This study aims to detail changes in presentations at a United States Emergency Department for suicidality before and after the outbreak of COVID-19. Methods A retrospective chart review was conducted of all adult patients who presented to an ED with suicidality and underwent psychiatric consultation during the study period. The cohorts consisted of patients who presented between December 2018 – May 2019 and December 2019 – May 2020. Information was collected on demographics, characteristics of suicidality, reasons for suicidality and disposition. The first wave from March – May 2020 was examined, using a difference-in-differences design to control for factors other than COVID-19 that may have influenced the outcomes' trend. Results Immediately following the pandemic outbreak there was a statistically significant increase in the proportion of undomiciled patients represented in visits for suicidality (40.7% vs. 57.4%; p -value <0.001). In addition, the proportion of patient visits attributed to social (18.0% vs. 29.2%; p-value 0.003) and structural (14.2% vs. 26.4%; p value <0.001) reasons for suicidality increased. Conversely, the proportion of visits due to psychiatric symptoms (70.5% vs 50.0%; p -value <0.001) decreased. Furthermore, patient visits were more likely to result in a medical admission (2.1% vs. 8.3%; p -value 0.002) and less likely to result in a psychiatric admission (68.4% vs 48.6%; p-value <0.001) during the initial phase of the pandemic. Conclusions COVID-19 was associated with increased ED presentations for suicidality among undomiciled patients, as well as greater likelihood of social and structural reasons driving suicidality among all visits.

Suicidality in psychiatric emergency department situations during the first and the second wave of COVID-19 pandemic

“…We chose to control for diagnostic categories and for risk factors found in literature regarding the subject, limiting ourselves to those that were well documented in our primary data. We thus ended up controlling for gender [ 31 ], age [ 32 ], living in a residential psychiatric therapeutic environment [ 37 ], being homeless [ 28 ] and belonging to a Covid-19 risk group [ 38 ]. Since suicidality and self-harming behaviors are one of the key traits to BPD [ 39 , 40 ], we decided to further discriminate between BPD and other PD.…”

“…To date, only few studies have focused on clinical and demographic features of pED presentations with suicidality during the first-wave of Covid-19. One reporting a pandemic-driven increase of suicidality in homeless patients in Boston, USA [ 28 ] and another reporting an increase in suicidal ideation in patients with substance use disorder in Hannover, Germany [ 29 ].…”

“…with current suicidal ideation (SI), suicide plans (SP) and/or suicide attempt (SA) directly before presenting to the pED). For the two first Covid-19 waves in Germany, we were interested in whether there was an effect on suicidality in patients presenting to an pED that could be related to the Covid-19 period independently of major risk factors and comorbidities for suicidality, such as psychiatric diagnoses [ 30 ], gender [ 31 ], age [ 32 ] and homelessness [ 28 ]. Furthermore, we were interested in whether the Covid-19 period would affect diagnostic categories known to be at particular risk of suicidality differently (interaction effect).…”

Increased rates of suicide ideation and attempts in rural dwellers following the SARS‐CoV‐2 pandemic

“…Recent studies have been conducted to evaluate the effects of SARS‐CoV‐2 on suicide. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 A recent meta‐analysis suggests that suicide ideation rates increased by nearly 11%, suicide attempts by 4.68%, and self‐harm by 9.63%. 26 The majority of published studies included samples of pediatric patients and we could not identify any study evaluating the effects of residing in a rural versus an urban geographic location on suicide attempts and suicide ideation.…”

“… 26 The majority of published studies included samples of pediatric patients and we could not identify any study evaluating the effects of residing in a rural versus an urban geographic location on suicide attempts and suicide ideation. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 Because residing in a rural area has been identified as a risk factor for suicide, it is important to understand the potentially compounding effect of SARS‐CoV‐2 on this population. 27 …”