A systematic review and meta-analysis published in The Lancet Psychiatry found that the worldwide rate of attempted suicide among youth likely increased during the COVID-19 pandemic.
Investigators from the University of Calgary in Canada searched publication databases through December 2022 for studies reporting emergency department (ED) visits for attempted suicide, self-harm, or suicidal ideation among youth younger than 19 years prior to and during the COVID-19 pandemic. A total of 42 studies were included in this analysis.
Overall, this analysis included data from 11.1 million ED visits among a patient population aged mean 11.7 (range, 5.5-16.3) years who were majority girls (57.6%).
The ED visits occurred before the pandemic between early 2015 to 2020 and during the pandemic between 2020 and 2021. The studies included data from EDs that were located in Europe (40%), North America (38%), Australia and New Zealand (14%), Asia (5%), and pooled from multiple countries (2%).
Compared with prepandemic trends, during the COVID-19 pandemic ED visits for attempted suicide (rate ratio [RR], 1.22; 90% CI, 1.08-1.37; t, 1.26) and suicidal ideation (RR, 1.08; 90% CI, 0.93-1.25; t, 1.43) increased in magnitude. No clear trend in the rates of ED visit for self-harm were observed (RR, 0.96; 90% CI, 0.89-1.04; t, 1.26).
Conversely, during the pandemic there was a decreasing trend of ED visits for other mental illnesses (RR, 0.81; 90% CI, 0.74-0.89; t, 1.32) and all indications (RR, 0.68; 90% CI, 0.62-0.75; t, 1.38) compared with prepandemic rates.
In subgroup analyses, an increased rate of ED visits for suicidal ideation or suicide attempt during the pandemic was observed among girls (RR, 1.39; 90% CI, 1.04-1.88) and to a lesser extent among boys (RR, 1.06; 90% CI, 0.92-1.24) compared with prepandemic trends. One study reported the greatest increase during the pandemic in ED visits for suicide attempt or ideation among White youth (RR, 1.60; 90% CI, 1.41-1.82), followed by Black youth (RR, 1.12; 90% CI, 1.00-1.26), Asian American youth (RR, 1.38; 90% CI, 0.95-2.00), and Hispanic or Latinx youth (RR, 1.25; 90% CI, 0.94-1.67).
Stratified by geographical region, the greatest increase in suicidal ideation or attempt during the COVID-19 pandemic compared with before the pandemic was observed in studies from North America (RR, 1.27; 90% CI, 1.04-1.53) and Europe (RR, 1.18; 90% CI, 0.99-1.41).
Researchers’ findings are limited by the fact that the data are drawn from electronic health record databases that lack standardization and likely included miscoded or missing information.
These data indicated that during the COVID-19 pandemic, youth had higher rates of ED visits for suicide attempt, especially for those living in North America and Europe. The study authors concluded, “This study provides good evidence of an exacerbation in severe mental distress and resultant emergency department presentations over the course of the COVID-19 pandemic among children and adolescents. Our findings are in line with pandemic-related research documenting population-level increases in [pediatric] mental illnesses such as depression and anxiety symptoms and eating disorders, as well as help-seeking [behavior].”
Madigan S, Korczak DJ, Vaillancourt T, et al. Comparison of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation before and during the COVID-19 pandemic: a systematic review and meta-analysis. Lancet Psychiatry. 2023;S2215-0366(23)00036-6. doi:10.1016/S2215-0366(23)00036-6