Suicidality Among Pediatric Patients Decreased Following COVID-19–Related School Closures

Rates of emergency department (ED) visits and hospitalizations for suicidality among children and adolescents decreased following school closures associated with the onset of the COVID-19 pandemic, according to the results of a population-based, cross-sectional study.

Researchers examined 73,123 ED visits and hospitalizations to observe trends in suicidality rates, examine the seasonality in suicidality, and highlight disrupted seasonality patterns by COVID-19 related school closures. Administrative data claims of children aged 10 to 12 years and adolescents aged 13 to 18 years from 2016 through 2021 were included. All participants were commercially insured.

The mean annual incidence of ED visits and hospitalizations was 964 per 100,000 children and adolescents (95% CI; 956-972 per 100,000).

In 2016, the mean annual incidence was 760 per 100,000 (95% CI; 745-775 per 100,000). This number increased to 1006 in 2019 (95% CI; 988-1024). There was a temporary decrease in 2020 with an incidence of 942 (95% CI; 924-960) but the mean annual incidence increased in 2021 to 1160 (95% CI; 1140-1181).

The rate of suicidality peaked in April (incidence rate ratio [IRR] 1.15; 95% CI; 1.11-1.19) and October (IRR 1.24; 95% CI; 1.19-1.29) when compared with January. In both pre-COVID-19 years and 2021, the all-time low was in July (IRR 0.63; 95% CI; 0.61-0.66). However, the lowest rates in 2020 were in April and May when schools were closed due to the pandemic. 

Limitations to the study include that all participants were commercially insured, and therefore, the study results may not be generalizable to all US children and adolescents. Additionally, the study included data on suicidal ideation and suicide attempt but did not include data on completed suicides unless death occurred while undergoing treatment. 

“The presence of seasonal patterns and the observed unexpected decrease in suicidality among children and adolescents after the spring 2020 COVID-19-related school closures highlight the potential association between suicidality and the school calendar,” the authors concluded. “Prevention efforts can benefit by targeting periods of heightened risk.”

Reference:

Kim Y, Krause TM, Lane SD. Trends and seasonality of emergency department visits and hospitalizations for suicidality among children and adolescents in the US from 2016 to 2012. JAMA Netw Open. 2021;6(7):e2324183. doi:10.1001/jamanetworkopen.2023.24183.