Elevated rates of mental health concerns have been identified during the coronavirus disease 2019 (COVID-19) pandemic. In this study, we sought to evaluate whether youth reported a greater frequency ...of suicide-related behaviors during the 2020 COVID-19 pandemic as compared with 2019. We hypothesized that rates of suicide-related behaviors would be elevated between the months of March and July 2020 as compared with 2019, corresponding to the onset of the COVID-19 pandemic.
Routine suicide-risk screening was completed with youth aged 11 to 21 in a pediatric emergency department. Electronic health records data for suicide-risk screens completed between January and July 2019 and January and July 2020 were evaluated. A total of 9092 completed screens were examined (mean age 14.72 years, 47.7% Hispanic and/or Latinx, 26.7% non-Hispanic white, 18.7% non-Hispanic Black).
Rates of positive suicide-risk screen results from January to July 2020 were compared with corresponding rates from January to July 2019. Results indicated a significantly higher rate of suicide ideation in March and July 2020 and higher rates of suicide attempts in February, March, April, and July 2020 as compared with the same months in 2019.
Rates of suicide ideation and attempts were higher during some months of 2020 as compared with 2019 but were not universally higher across this period. Months with significantly higher rates of suicide-related behaviors appear to correspond to times when COVID-19-related stressors and community responses were heightened, indicating that youth experienced elevated distress during these periods.
BACKGROUND
Mental health concerns increased during the coronavirus disease 2019 pandemic, but previous studies have not examined depression screening in pediatric primary care. We aimed to describe ...changes in screening, depressive symptoms, and suicide risk among adolescents during the coronavirus disease 2019 pandemic.
METHODS
In a repeat cross-sectional analysis of electronic health record data from a large pediatric primary care network, we compared the percentage of primary care visits where adolescents aged 12 to 21 were screened for depression, screened positive for depressive symptoms, or screened positive for suicide risk between June and December 2019 (prepandemic) and June and December 2020 (pandemic). Changes were examined overall, by month, and by sex, race and ethnicity, insurance type, and income. Modified Poisson regression was used to calculate prevalence ratios (PRs) for the prepandemic to pandemic changes.
RESULTS
Depression screening at primary care visits declined from 77.6% to 75.8% during the pandemic period (PR: 0.98, 95% confidence interval CI: 0.90–1.06). The percentage of adolescents screening positive for depressive symptoms increased from 5.0% to 6.2% (PR: 1.24, 95% CI: 1.15–1.34), with greater increases among female, non-Hispanic Black, and non-Hispanic white adolescents. Positive suicide risk screens increased from 6.1% to 7.1% (PR: 1.16, 95% CI: 1.08–1.26), with a 34% relative increase in reporting recent suicidal thoughts among female adolescents (PR: 1.34, 95% CI: 1.18–1.52).
CONCLUSIONS
Results suggest that depression and suicide concerns have increased during the pandemic, especially among female adolescents. Results underscore the importance of consistent depression and suicidality screening.
Suicide ideation (SI) and suicide attempts (SAs) have been reported as increasing among US children over the last decade. We examined trends in emergency and inpatient encounters for SI and SA at US ...children's hospitals from 2008 to 2015.
We used retrospective analysis of administrative billing data from the Pediatric Health Information System database.
There were 115 856 SI and SA encounters during the study period. Annual percentage of all visits for SI and SA almost doubled, increasing from 0.66% in 2008 to 1.82% in 2015 (average annual increase 0.16 percentage points 95% confidence intervals (CIs) 0.15 to 0.17). Significant increases were noted in all age groups but were higher in adolescents 15 to 17 years old (average annual increase 0.27 percentage points 95% CI 0.23 to 0.30) and adolescents 12 to 14 years old (average annual increase 0.25 percentage points 95% CI 0.21 to 0.27). Increases were noted in girls (average annual increase 0.14 percentage points 95% CI 0.13 to 0.15) and boys (average annual increase 0.10 percentage points 95% CI 0.09 to 0.11), but were higher for girls. Seasonal variation was also observed, with the lowest percentage of cases occurring during the summer and the highest during spring and fall.
Encounters for SI and SA at US children's hospitals increased steadily from 2008 to 2015 and accounted for an increasing percentage of all hospital encounters. Increases were noted across all age groups, with consistent seasonal patterns that persisted over the study period. The growing impact of pediatric mental health disorders has important implications for children's hospitals and health care delivery systems.
The Suicide Crisis Syndrome (SCS) describes a suicidal mental state marked by entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal that has predictive ...capacity for near-term suicidal behavior. The Suicide Crisis Inventory-2 (SCI-2), a reliable clinical tool that assesses SCS, lacks a short form for use in clinical settings which we sought to address with statistical analysis. To address this need, a community sample of 10,357 participants responded to an anonymous survey after which predictive performance for suicidal ideation (SI) and SI with preparatory behavior (SI-P) was measured using logistic regression, random forest, and gradient boosting algorithms. Four-fold cross-validation was used to split the dataset in 1,000 iterations. We compared rankings to the SCI-Short Form to inform the short form of the SCI-2. Logistic regression performed best in every analysis. The SI results were used to build the SCI-2-Short Form (SCI-2-SF) utilizing the two top ranking items from each SCS criterion. SHAP analysis of the SCI-2 resulted in meaningful rankings of its items. The SCI-2-SF, derived from these rankings, will be tested for predictive validity and utility in future studies.
Our primary objective was to examine prevalence rates of suicide behavior across 6 gender identity groups: female; male; transgender, male to female; transgender, female to male; transgender, not ...exclusively male or female; and questioning. Our secondary objective was to examine variability in the associations between key sociodemographic characteristics and suicide behavior across gender identity groups.
Data from the Profiles of Student Life: Attitudes and Behaviors survey (
= 120 617 adolescents; ages 11-19 years) were used to achieve our objectives. Data were collected over a 36-month period: June 2012 to May 2015. A dichotomized self-reported lifetime suicide attempts (never versus ever) measure was used. Prevalence statistics were compared across gender identity groups, as were the associations between sociodemographic characteristics (ie, age, parents' highest level of education, urbanicity, sexual orientation, and race and/or ethnicity) and suicide behavior.
Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%). Identifying as nonheterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (ie, nonbinary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts.
Suicide prevention efforts can be enhanced by attending to variability within transgender populations, particularly the heightened risk for female to male and nonbinary transgender adolescents.
Suicide in elementary school-aged children is not well studied, despite a recent increase in the suicide rate among US black children. The objectives of this study were to describe characteristics ...and precipitating circumstances of suicide in elementary school-aged children relative to early adolescent decedents and identify potential within-group racial differences.
We analyzed National Violent Death Reporting System (NVDRS) surveillance data capturing suicide deaths from 2003 to 2012 for 17 US states. Participants included all suicide decedents aged 5 to 14 years (N = 693). Age group comparisons (5-11 years and 12-14 years) were conducted by using the χ
test or Fisher's exact test, as appropriate.
Compared with early adolescents who died by suicide, children who died by suicide were more commonly male, black, died by hanging/strangulation/suffocation, and died at home. Children who died by suicide more often experienced relationship problems with family members/friends (60.3% vs 46.0%; P = .02) and less often experienced boyfriend/girlfriend problems (0% vs 16.0%; P < .001) or left a suicide note (7.7% vs 30.2%; P < .001). Among suicide decedents with known mental health problems (n = 210), childhood decedents more often experienced attention-deficit disorder with or without hyperactivity (59.3% vs 29.0%; P = .002) and less often experienced depression/dysthymia (33.3% vs 65.6%; P = .001) compared with early adolescent decedents.
These findings raise questions about impulsive responding to psychosocial adversity in younger suicide decedents, and they suggest a need for both common and developmentally-specific suicide prevention strategies during the elementary school-aged and early adolescent years. Further research should investigate factors associated with the recent increase in suicide rates among black children.
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