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Emergency Department Encounters Among Youth With Suicidal Thoughts or Behaviors During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Are emergency department encounters among youth with suicidal thoughts or behaviors higher during the COVID-19 pandemic?

Findings  In this cross-sectional study, the incidence rates of suicide-related emergency department encounters among youth in 2020 were comparable with 2019 incidence rates except for a decrease in March to May 2020 vs the same period in 2019 and an increase among girls in June through December 2020 vs the same period in 2019. Youth with no previously documented mental health treatment had more visits in September to December 2020 compared with this period in 2019.

Meaning  The COVID-19 pandemic may worsen mental health for some groups of youth; emergency department–based interventions may support this population.

Abstract

Importance  Population-level reports of suicide-related emergency department (ED) encounters among youth during the COVID-19 pandemic are lacking, along with youth characteristics and preexisting psychiatric service use.

Objective  To characterize population-level and relative change in suicide-related ED encounters among youth during the COVID-19 pandemic compared with 2019.

Design, Setting, and Participants  This cross-sectional study evaluated ED encounters in 2019 and 2020 at Kaiser Permanente Northern California—a large, integrated, community-based health system. Youth aged 5 to 17 years who presented to the ED with suicidal thoughts or behaviors were included.

Exposure  The COVID-19 pandemic.

Main Outcomes and Measures  Population-level incidence rate ratios (IRRs) and percent relative effects for suicide-related ED encounters as defined by the US Centers for Disease Control and Prevention–recommended International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes in 4 periods in 2020 compared with the same periods in 2019.

Results  There were 2123 youth with suicide-related ED encounters in 2020 compared with 2339 in 2019. In the 2020 group, 1483 individuals (69.9%) were female and 1798 (84.7%) were aged 13 to 17 years. In the 2019 group, 1542 (65.9%) were female, and 1998 (85.4%) were aged 13 to 17 years. Suicide-related ED encounter incidence rates were significantly lower in March through May 2020 compared with this period in 2019 (IRR, 0.57; 95% CI, 0.51-0.63; P < .001), then returned to prepandemic levels. However, suicide-related ED visits among female youth from June 1 to August 31, 2020, and September 1 through December 15, 2020, were significantly higher than in the corresponding months in 2019 (IRR, 1.19; 95% CI, 1.04-1.35; P = .04 and IRR, 1.22; 95% CI, 1.11-1.35; P < .001, respectively), while suicide-related ED visits for male youth decreased from September 1 through December 15, 2020 (IRR, 0.81; 95% CI, 0.69 to 0.94). Youth with no history of outpatient mental health or suicide encounters (129.4%; 95% CI, 41.0-217.8) and those with comorbid psychiatric conditions documented at the ED encounter (6.7%; 95% CI, 1.0-12.3) had a higher risk of presenting with suicide-related problems from September to December 2020 vs the same period in 2019.

Conclusions and Relevance  In this cross-sectional study of youth experiencing suicidal thoughts and behaviors, suicide-related presentations to the ED initially decreased during the COVID-19 pandemic, likely owing to shelter-in-place orders, then were similar to 2019 levels. However, a greater number of female youth, youth with no psychiatric history, and youth with psychiatric diagnoses at the time of the ED encounter presented for suicide-related concerns during the pandemic, suggesting these may be vulnerable groups in need of further interventions. Adjustments in care may be warranted to accommodate these groups during periods of crisis.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: July 12, 2021.

Published Online: September 1, 2021. doi:10.1001/jamapsychiatry.2021.2457

Corresponding Author: Kathryn K. Ridout, MD, PhD, Kaiser Permanente, 401 Bicentennial Way Santa Rosa, CA 95403 (kathryn.erickson-ridout@kp.org).

Author Contributions: Drs K. K. Ridout and Iturralde had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: K. K. Ridout, S. J. Ridout, Awsare, Harris, Weisner, Iturralde.

Acquisition, analysis, or interpretation of data: K. K. Ridout, Alavi, Koshy, Harris, Vinson, Weisner, Sterling, Iturralde.

Drafting of the manuscript: K. K. Ridout, Alavi, S. J. Ridout, Iturralde.

Critical revision of the manuscript for important intellectual content: K. K. Ridout, Koshy, Awsare, Harris, Vinson, Weisner, Sterling, Iturralde.

Statistical analysis: K. K. Ridout, Alavi, Weisner, Sterling.

Obtained funding: K. K. Ridout, Koshy.

Administrative, technical, or material support: K. K. Ridout, S. J. Ridout, Awsare, Harris, Weisner.

Supervision: Awsare, Iturralde.

Conflict of Interest Disclosures: None reported.

Funding/Support: This project was supported by the Permanente Medical Group Delivery Science and Applied Research program. Drs K. K. Ridout and Vinson were supported by the Permanente Medical Group Physician Researcher Program.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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