Impact of COVID-19 and Public Health Measures on Positive Suicide Screens Among Emergency Department Children

Abstract

Objective: The aim of this study was to examine the association between prolonged time in the COVID-19 pandemic and rates of positive routine suicide screens among youth accessing healthcare in the pediatric emergency department.

Methods: Participants were English- and Spanish-speaking youth aged 10-18 years presenting without an acute mental/behavioral health concern to the emergency department or urgent care of a large hospital system, serving a 7-state region, who completed routine screening for suicide risk. Visits between March 1, 2019 and December 31, 2021 were included. We conducted a quasi-experimental interrupted time series analysis and categorized visits into the prepandemic year, COVID-19 year 1 (Y1), and COVID-19 year 2 (Y2). The primary outcome measure was rate of positive suicide screen.

Results: A total of 33,504 children completed routine suicide screening; 2689 children had a positive screen. The overall rate of positive suicide screens increased throughout the pandemic compared with baseline (7.5% prepandemic, 8.4% Y1, 9.3% Y2; P < 0.01). Rates of positive suicide screens in Y1 increased 0.04% per week and surpassed prepandemic rates, then decreased 0.1% per week throughout Y2 ( P < 0.01), during a time when social distancing mitigation efforts decreased.

Conclusions: Cumulative time in the COVID-19 pandemic was associated with increased positive suicide screens in children. School reopening and normalization of social routines preceded an observed negative trend in rates of positive suicide screens in Y2 of the pandemic. This study demonstrates fluctuating trends in suicide screen positivity, potentially influenced by social distancing and public health measures. Our study may support that maintaining social connectedness and access to school-based or community resources may be a protective factor for youth suicide risk during a pandemic or other natural occurrence.