The number of emergency department (ED) visits for suicide attempts declined during the COVID-19 pandemic among young people aged 10 to 17 years, most likely due to shelter-in-place orders. However, more young women, more young people with no psychiatric history, and more young people with a psychiatric diagnosis at the time of the ED visit presented with suicidal thoughts, according to the authors of a recent study published in JAMA Psychiatry.

While previous studies explored the association between suicide attempts and COVID-19, the authors of the current study believed the scientific community lacked evidence on diagnosis-based, population-level prevalence of suicide attempts among youth during COVID-19.

The retrospective, observational study was conducted at Kaiser Permanente Northern California. The researchers pulled electronic health record (EHR) data for youth aged 5 to 17 years old who sought emergency treatment for suicidal thoughts between January 1, 2020, and December 15, 2020. They compared that data to the same period in 2019. They found 2123 teens with suicide-related encounters in 2020 and 2339 in 2019.


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Although the number of ED visits year over year was lower overall, suicide-related encounters among youth accounted for a larger percent of overall youth ED visits during the COVID-19 pandemic period compared with 2019. Relative to all youth ED encounters, youth with no history of outpatient encounters associated with mental health or suicide diagnoses during the 2 years prior were found to have a 129.4% higher risk of a suicide-related ED encounter (95% CI, 41.0-217.8) during the fall of 2020 compared with the fall of 2019. The investigators excluded patients without at least 1 year of continuous health insurance enrollment before their first ED visit.

The researchers note that using only data from the EHR limited the study, as it did not capture information about youth who visited non-Kaiser facilities or those who did not seek any care. Further research is needed to determine whether the results were dependent on the pandemic or reflected trends overall.

“These results suggest that, despite reduced health care use in the early months of the

COVID-19 pandemic, ED use among youth with suicidal thoughts or behaviors returned to typical levels by summer 2020,” the researchers concluded. “The disproportionate increase during the summer and fall of 2020 among youth without prior documented mental health use and with comorbid psychiatric disorders may reflect higher suicidality among youth without a previous mental health diagnosis, a shift in new mental health presentations from outpatient settings to the ED, or vulnerability among youth with undocumented prior mental health diagnoses who were not currently engaged with the health care system and may have lost contact with other resources during the pandemic.”

Reference

Ridout KK, Alavi M, Ridout SJ, et al. Emergency department encounters among youth with suicidal thoughts or behaviors during the COVID-19 pandemic. JAMA Psychiatry. Published online September 1, 2021. doi:10.1001/jamapsychiatry.2021.2457