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. 2025 Nov 26;26(6):1611-1621.
doi: 10.5811/westjem.47097.

Intersectional Analysis of Suicide-related Emergency Department Visits in Youth in California, 2018-2021

Laura M Prichett  1   2 , Annie Na  1   3 , Hanae Fujii-Rios  2   4 , Emily E Haroz  2   5
Affiliations

Intersectional Analysis of Suicide-related Emergency Department Visits in Youth in California, 2018-2021

Laura M Prichett et al. West J Emerg Med. .

Abstract

Introduction: The COVID-19 pandemic and related anti-Asian political rhetoric had a detrimental impact on the mental health of Asian American and Pacific Islander (AAPI) youth in the United States. Our objective was to quantify trends in suicide-related emergency department (ED) encounters among AAPI youth before and during the COVID-19 pandemic, using an intersectional lens of race and sex and to contextualize these trends on a timeline of political and social events (such as anti-Asian hate crimes) occurring during the same period in California.

Methods: Using data from the California State Emergency Department Database (SEDD) from 2018-2021, we evaluated changes in quarterly proportions of suicide-related ED encounters by age, race, and sex subgroups by comparing mean percentage change in proportions before and during the pandemic among patients 8-21 years of age. We evaluated changes in quarterly proportions of suicide-related ED encounters by age, race, and sex subgroups by comparing mean percentage changes as they related to events around the pandemic and spikes in anti-Asian hate crimes. To compare relative disparities during the periods, we used stratified adjusted mixed multilevel logistic regression, with White males as the reference group.

Results: The overall increase in suicide-related ED visits for all youth during this period was 49.5% (95% CI 46.7-52.2%), representing 2,637 more suicide-related ED visits in 2021 than 2018. The graphical observational analysis of changes in quarterly proportions of suicide-related ED visits showed some temporal correlation between spikes in rates among AAPI and American Indian and Alaska Native (AI/AN) females and specific events, such as anti-Asian hate crimes and school closings. The largest percentage increase was seen among females of all races, and in particular, AI/AN females (+58.1%, representing 471 more suicide-related ED visits in 2021 than 2018) and AAPI females (+57.5%, representing 1,545 more suicide-related ED visits in 2021 than 2018). During the pandemic, the adjusted odds of a suicide-related ED visit among AAPI females 13-17 years of age compared to White males was 2.01 (95% CI, 1.91-2.13). A total of 131 in-ED deaths occurred during the study period, with no significant year-to-year variation in the number of deaths.

Conclusion: Suicide-related ED visits increased for all youth during COVID-19, with the sharpest rise among AAPI and AI/AN females. Asian American and Pacific Islander females 8-12 and 13-17 years of age showed especially large increases. While causality cannot be inferred, patterns aligned with pandemic disruptions and anti-Asian hate crimes. Findings highlight the value of intersectional analysis to identify disproportionately impacted subgroups and inform future, culturally responsive suicide prevention efforts.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. Dr. Prichett’s effort was supported by the National Institutes of Health (NIH)/Office of Research on Women’s Health (ORWH) Building Interdisciplinary Careers in Women’s Health (BIRCWH) Grant mechanism (Dr. Prichett, K12AR084229). No other funding was secured for this study. The NIH ORWH/BIRCWH offices had no role in the design and conduct of the study. The findings and conclusions in this article are those of the authors and do not necessarily reflect the opinions of the NIH.

Figures

Figure 1
Figure 1
Quarterly trends in suicide-related emergency department visits by race and sex, 8–21 years of age, 2018–2021. ED, emergency department; AAPI, Asian American Pacific Islander; AI/AN, American Indian and Alaska Native.
Figure 2
Figure 2
COVID-19-related annotated quarterly trends in suicide-related emergency department visits in California among AAPI and White males and females, 8–21 years of age, 2018–2021. ED, emergency department; AAPI, Asian American Pacific Islander.
See this image and copyright information in PMC

References

    1. Gover AR, Harper SB, Langton L. Anti-Asian hate crime during the COVID-19 pandemic: exploring the reproduction of inequality. Am J Crim Justice. 2020;45(4):647–67. - PMC - PubMed
    1. Saw A, Yi SS, Đoàn LN, et al. Improving Asian American health during the syndemic of COVID-19 and racism. EClinicalMedicine. 2022;45:101313. - PMC - PubMed
    1. Hahm HC, Ha Y, Scott JC, et al. Perceived COVID-19-related anti-Asian discrimination predicts post traumatic stress disorder symptoms among Asian and Asian American young adults. Psychiatry Res. 2021;303:114084. - PMC - PubMed
    1. Lee S, Waters SF. Asians and Asian Americans’ experiences of racial discrimination during the COVID-19 pandemic: impacts on health outcomes and the buffering role of social support. Stigma Health. 2021;6(1):70–8.
    1. Han S, Riddell JR, Piquero AR. Anti-Asian American hate crimes spike during the early stages of the COVID-19 pandemic. J Interpers Violence. 2023;38(3–4):3513–33. - PMC - PubMed

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