Suicide-related emergency department visits rose globally among youth during pandemic

Even though paediatric emergency department (ED) visits decreased overall during the COVID-19 pandemic, a newly published study co-authored by Dr. Daphne Korczak at The Hospital for Sick Children (SickKids) and led by Dr. Sheri Madigan at the University of Calgary shows there was a sharp increase in emergency department visits for attempted suicide and suicide ideation among children and adolescents during that same period of time.

The study, published Mar. 9, 2023, in Lancet Psychiatry, provides a meta-analysis of 42 studies representing over 11 million paediatric ED visits across 18 countries, and compares data on ED visits prior to the pandemic with those that took place during the pandemic up to July 2021.

The numbers show that while there was a 32 per cent reduction in pediatric ED visits for any health-related reasons during the pandemic, there was an alarming 22 per cent increase in the number of children and adolescents going to EDs for suicide attempts, and an eight per cent increase in visits for suicide ideation.

Researchers say we need to pay attention to how children and youth are doing today

“It has been incredibly challenging for researchers to both derive and interpret the data in real-time during the COVID-19 pandemic to disentangle the impact on the mental health of children and adolescents,” says Korczak, Child and Adolescent Psychiatrist and Associate Scientist in the Neurosciences & Mental Health program at SickKids. “This work extends our scientific understanding of how young people fared during the pandemic and indicates we need to pay attention to how our children and youth are feeling and functioning today.”

The researchers included studies published between Jan. 1, 2020, and Dec. 19, 2022, that contained data on paediatric ED visits before and during the COVID-19 pandemic up to the summer of 2021. In addition to showing an overall increase of ED visits related to suicide attempts and ideation, the researchers found this change was larger for girls (39 per cent increase) than boys (6 per cent increase). Rates of self-harm also increased substantially among adolescents (18 per cent increase) and decreased among children who were 12 years old and younger by 15 per cent.

While the study shows that rates of ED visits for other mental health concerns, such as anxiety, declined by 19 per cent, the researchers say this finding should be interpreted in the context of an overall 32 per cent decrease of paediatric ED visits for any health concerns during the pandemic. Furthermore, previous data show that calls to crisis hotlines and use of community-based mental health supports increased during the pandemic, suggesting that children and youth experiencing less acute forms of mental distress may have used resources outside of the ED.

Study builds on previous evidence showing pandemic had negative impact on child and youth mental health

At SickKids, Korczak has been leading a group of four research teams examining the pandemic’s impacts on the mental health of children and youth in Ontario. Her previous work has shown that social isolation and a loss of in-person school had a significant impact on mental health and found a strong association between time spent online learning and depression, inattention, irritability and anxiety in school-age children.

“During the pandemic, children and youth experienced a multitude of stressors and had to try and manage these without the help of the support systems that they would have otherwise relied on, like seeing friends, school and extra-curriculars. This study underscores the extent to which children and youth have been struggling and pushed beyond their ability to cope, leading to more ED visits for suicide attempts and ideation,” says Korczak, who is also an Associate Professor in the Department of Psychiatry at the University of Toronto. “Our findings tell us that we need to focus our efforts on providing children with the elements that we know underpin good mental health and integrate mental health supports within our community, education and health-care systems.