CoChat
Sign Up
Cited by 242Suicide and Self-Harm StudiesCOVID-19 and Mental HealthCOVID-19 and healthcare impacts

Comparison of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation before and during the COVID-19 pandemic: a systematic review and meta-analysis

Open access
Madigan, Sheri, Korczak, Daphne J, Vaillancourt, Tracy, Racine, Nicole, Hopkins, Will G, Pador, Paolo, Hewitt, Jackson M A, AlMousawi, Batool +2 more·2023·The Lancet Psychiatry
DOI 10.1016/s2215-0366(23)00036-6PMC PMC10097509
Open this paper in CoChat — free accountOpen PDF

Abstract

Background There is a lack of consensus about the effect of the COVID-19 pandemic on the mental health of children and adolescents. We aimed to compare rates of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation during the pandemic with those before the pandemic. Methods For this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO for studies published between Jan 1, 2020, and Dec 19, 2022. Studies published in English with data on paediatric (ie, those aged <19 years) emergency department visits before and during the COVID-19 pandemic were included. Case studies and qualitative analyses were excluded. Changes in attempted suicide, self-harm, suicidal ideation, and other mental-illness indicators (eg, anxiety, depression, and psychosis) were expressed as ratios of the rates of emergency department visits during the pandemic compared with those before the pandemic, and we analysed these with a random-effects meta-analysis. This study was registered with PROSPERO, CRD42022341897. Findings 10 360 non-duplicate records were retrieved, which yielded 42 relevant studies (with 130 sample-estimates) representing 11·1 million emergency department visits for all indications of children and adolescents across 18 countries. The mean age of the samples of children and adolescents across studies was 11·7 years (SD 3·1, range 5·5-16·3), and there were on average 57·6% girls and 43·4% boys as a proportion of emergency department visits for any health reasons (ie, physical and mental). Only one study had data related to race or ethnicity. There was good evidence of an increase in emergency department visits for attempted suicide during the pandemic (rate ratio 1·22, 90% CI 1·08-1·37), modest evidence of an increase in emergency department visits for suicidal ideation (1·08, 0·93-1·25), and good evidence for only a slight change in self-harm (0·96, 0·89-1·04). Rates of emergency department visits for other mental-illness indications showed very good evidence of a decline (0·81, 0·74-0·89), and paediatric visits for all health indications showed strong evidence of a reduction (0·68, 0·62-0·75). When rates for attempted suicide and suicidal ideation were combined as a single measure, there was good evidence of an increase in emergency department visits among girls (1·39, 1·04-1·88) and only modest evidence of an increase among boys (1·06, 0·92-1·24). Self-harm among older children (mean age 16·3 years, range 13·0-16·3) showed good evidence of an increase (1·18, 1·00-1·39), but among younger children (mean age 9·0 years, range 5·5-12·0) there was modest evidence of a decrease (0·85, 0·70-1·05). Interpretation The integration of mental health support within community health and the education system-including promotion, prevention, early intervention, and treatment-is urgently needed to increase the reach of mental health support that can mitigate child and adolescent mental distress. In future pandemics, increased resourcing in some emergency department settings would help to address their expected increase in visits for acute mental distress among children and adolescents. Funding None.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/s2215-0366(23)00036-6

Cites

6 of 6 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Young people as a cohort have had a marked increase in distress and disproportionately poorer mental health outcomes since the COVID-19 pandemic, especially those living with social and economic disadvantage.

    “young people as a cohort have had a marked increase in distress and disproportionately poorer mental health outcomes since the COVID-19 pandemic, 75-80 especially those living with social and economic disadvantage.”

    From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [76]

    The Discussion reports increased emergency-department presentations for severe mental distress among children and adolescents during the pandemic, supporting the broad claim of poorer outcomes. But the Results (appendix pp. 20–21) do not support the claim that increases were especially pronounced among socially and economically disadvantaged young people: suicidal ideation or attempt increased in all but the lowest socioeconomic group, and self-harm increased only in the higher socioeconomic group in the studies reporting those data. The paper also cautions that its findings concern emergency-department presentations, not population-wide prevalence. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 54

  1. [2]Neville RD Lakes KD Hopkins WG Global changes in child and adolescent physical activity during the COVID-19 pandemic: a systematic review and meta-analysis JAMA Pediatr 176 2022 886 894 35816330 PMC9274449
  2. [3]Rosen ML Rodman AM Kasparek SW Promoting youth mental health during the COVID-19 pandemic: a longitudinal study PLoS One 16 2021 e0255294 PMC8357139 34379656
  3. [4]Letourneau N Luis MA Kurbatfinski S COVID-19 and family violence: a rapid review of literature published up to 1 year after the pandemic declaration EClinicalMedicine 53 2022 101634 PMC9472575 36119559
  4. [7]Hillis S N'konzi J-PN Msemburi W Orphanhood and caregiver loss among children based on new global excess COVID-19 death estimates JAMA Pediatr 176 2022 1145 1148 36066897 PMC9449868
  5. [9]Agostino H Burstein B Moubayed D Trends in the incidence of new-onset anorexia nervosa and atypical anorexia nervosa among youth during the COVID-19 pandemic in Canada JAMA Netw Open 4 2021 e2137395 PMC8652595 34874405
  6. [10]Ferrando SJ Klepacz L Lynch S Psychiatric emergencies during the height of the COVID-19 pandemic in the suburban New York City area J Psychiatr Res 136 2021 552 559 33158555 PMC7992036
  7. [11]Bruns N Willemsen L Stang A Pediatric intensive care unit admissions after adolescent suicide attempts during the pandemic Pediatrics 150 2022 e2021055973 35534988
  8. [12]Ougrin D Wong BHC Vaezinejad M Pandemic-related emergency psychiatric presentations for self-harm of children and adolescents in 10 countries (PREP-kids): a retrospective international cohort study Eur Child Adolesc Psychiatry 31 2022 1 13 PMC7937052 33677628
  9. [13]DeLaroche AM Rodean J Aronson PL Pediatric emergency department visits at US children's hospitals during the COVID-19 pandemic Pediatrics 147 2021 e2020039628 33361360
  10. [14]Gill PJ Mahant S Hall M Berry JG Reasons for admissions to US children's hospitals during the COVID-19 pandemic JAMA 325 2021 1676 1679 33904877 PMC8080216
  11. [15]Kim S Ro YS Ko SK The impact of COVID-19 on the patterns of emergency department visits among pediatric patients Am J Emerg Med 54 2022 196 201 35158262 PMC8820089
  12. [16]Edgcomb JB Benson NM Tseng CH Mental health-related emergency department visits among children during the early COVID-19 pandemic Psychiatr Res Clin Pract 4 2022 4 11 35602579 PMC9115451
  13. [17]Gracia R Pamias M Mortier P Alonso J Pérez V Palao D Is the COVID-19 pandemic a risk factor for suicide attempts in adolescent girls? J Affect Disord 292 2021 139 141 34119869 PMC8777066
  14. [18]Mayne SL Hannan C Davis M COVID-19 and adolescent depression and suicide risk screening outcomes Pediatrics 148 2021 e2021051507 34140393
  15. [19]Corrigan C Duke G Millar J Admissions of children and adolescents with deliberate self-harm to intensive care during the SARS-CoV-2 outbreak in Australia JAMA Netw Open 5 2022 e2211692 PMC9096595 35544133
  16. [20]Hiscock H Chu W O'Reilly G Association between COVID-19 restrictions and emergency department presentations for paediatric mental health in Victoria, Australia Aust Health Rev 46 2022 529 536 35787299
  17. [21]Ridout KK Alavi M Ridout SJ Emergency department encounters among youth with suicidal thoughts or behaviors during the COVID-19 pandemic JAMA Psychiatry 78 2021 1319 1328 34468724 PMC8411357
  18. [22]Korczak DJ Madigan S Vaillancourt T Data divide—disentangling the role of the COVID-19 pandemic on child mental health and well-being JAMA Pediatr 176 2022 635 636 35467721
  19. [24]Stallard P Spears M Montgomery AA Phillips R Sayal K Self-harm in young adolescents (12–16 years): onset and short-term continuation in a community sample BMC Psychiatry 13 2013 328 24294921 PMC4219511
  20. [26]Bridge JA Ruch DA Sheftall AH Youth suicide during the first year of the COVID-19 pandemic Pediatrics 2023 published online Feb 15. 10.1542/peds.2022-058375 PMC10227859 36789551 · DOI
  21. [28]Yang M A review of random effects modelling in SAS (release 8.2) 2003 Centre for multilevel modelling London
  22. [29]Higgins JPT Commentary: heterogeneity in meta-analysis should be expected and appropriately quantified Int J Epidemiol 37 2008 1158 1160 18832388
  23. [30]Borenstein M In a meta-analysis, the I-squared statistic does not tell us how much the effect size varies J Clin Epidemiol 152 2022 281 284 36223816
  24. [31]Gelman A Scaling regression inputs by dividing by two standard deviations Stat Med 27 2008 2865 2873 17960576
  25. [32]Rothman KJ Epidemiology: an introduction 2012 Oxford University Press New York, NY
  26. [33]Hopkins WG Replacing statistical significance and non-significance with better approaches to sampling uncertainty Front Physiol 13 2022 962132 PMC9578285 36267575
  27. [34]Ashworth E Provazza S McCarthy M Saini P Children and young people presenting in a pediatric emergency department in north-west England in suicidal crisis: an exploratory case series study Front Psychiatry 13 2022 892939 PMC9081675 35546930
  28. [35]Berger G Häberling I Lustenberger A The mental distress of our youth in the context of the COVID-19 pandemic Swiss Med Wkly 152 2022 w30142 35230030
  29. [36]Bergmans RS Larson PS Suicide attempt and intentional self-harm during the earlier phase of the COVID-19 pandemic in Washtenaw County, Michigan J Epidemiol Community Health 75 2021 963 969 33782051 PMC8008914
  30. [37]Bortoletto R Di Gennaro G Antolini G Sociodemographic and clinical changes in pediatric in-patient admissions for mental health emergencies during the COVID-19 pandemic: March 2020 to June 2021 Psychiatry Res Commun 2 2022 100023 PMC8786397 35098254
  31. [38]Bothara RK Raina A Carne B Paediatric presentations to Christchurch Hospital emergency department during COVID-19 lockdown J Paediatr Child Health 57 2021 877 882 33450120 PMC8014123
  32. [39]Bozzola E Ferrara P Spina G The pandemic within the pandemic: the surge of neuropsychological disorders in Italian children during the COVID-19 era Ital J Pediatr 48 2022 126 35897109 PMC9326438
  33. [40]Brewer AG Doss W Sheehan KM Davis MM Feinglass JM Trends in suicidal ideation-related emergency department visits for youth in Illinois: 2016–2021 Pediatrics 150 2022 e2022056793 36373281
  34. [42]Carison A Babl FE O'Donnell SM Increased paediatric emergency mental health and suicidality presentations during COVID-19 stay at home restrictions Emerg Med Australas 34 2022 85 91 34708565 PMC8652435
  35. [43]Clavenna A Zanini A Pelucchi M Trend of emergency department accesses for mental disorders by adolescents during the pandemic period Pediatr Emerg Care 38 2022 e1233 e1235 35358152
  36. [44]Cozzi G Blasutig F De Nardi L Giangreco M Barbi E Amaddeo A The first winter of social distancing improved most of the health indexes in a paediatric emergency department Acta Paediatr 111 2022 1027 1033 35080037 PMC9303403
  37. [45]Davico C Marcotulli D Lux C Impact of the COVID-19 pandemic on child and adolescent psychiatric emergencies J Clin Psychiatry 82 2021 20m13467 33989466
  38. [46]Díaz de Neira M Blasco-Fontecilla H García Murillo L Demand analysis of a psychiatric emergency room and an adolescent acute inpatient unit in the context of the COVID-19 pandemic in Madrid, Spain Front Psychiatry 11 2021 557508 PMC7873435 33584357
  39. [47]Hill RM Rufino K Kurian S Saxena J Saxena K Williams L Suicide ideation and attempts in a pediatric emergency department before and during COVID-19 Pediatrics 147 2021 e2020029280 33328339
  40. [48]Ibeziako P Kaufman K Scheer KN Sideridis G Pediatric mental health presentations and boarding: first year of the COVID-19 pandemic Hosp Pediatr 12 2022 751 760 35578918
  41. [50]Kim MJ Paek SH Kwon JH Park SH Chung HJ Byun YH Changes in suicide rate and characteristics according to age of suicide attempters before and after COVID-19 Children (Basel) 9 2022 151 35204872 PMC8869908
  42. [51]Kirič B Leben Novak L Lušicky P Drobnič Radobuljac M Suicidal behavior in emergency child and adolescent psychiatric service users before and during the 16 months of the COVID-19 pandemic Front Psychiatry 13 2022 893040 PMC9130484 35633784
  43. [52]Llorca-Bofí V Adrados-Pérez M Sánchez-Cazalilla M Urgent care and suicidal behavior in the child and adolescent population in a psychiatric emergency department in a Spanish province during the two COVID-19 states of alarm Rev Psiquiatr Salud Ment 2022 published online June 15. 10.1016/j.rpsm.2022.03.003 PMC9212908 35755490 · DOI
  44. [53]McDonnell T Conlon C McNicholas F Paediatric hospital admissions for psychiatric and psychosocial reasons during the first year of the COVID-19 pandemic Int Rev Psychiatry 34 2022 128 139 35699100
  45. [56]Petruzzelli MG Furente F Colacicco G Implication of COVID-19 pandemic on adolescent mental health: an analysis of the psychiatric counseling from the emergency room of an Italian university hospital in the years 2019–2021 J Clin Med 11 2022 6177 PMC9604834 36294498
  46. [58]Shankar LG Habich M Rosenman M Arzu J Lales G Hoffmann JA Mental health emergency department visits by children before and during the COVID-19 pandemic Acad Pediatr 22 2022 1127 1132 35667622 PMC9164513
  47. [59]Sokoloff WC Krief WI Giusto KA Pediatric emergency department utilization during the COVID-19 pandemic in New York City Am J Emerg Med 45 2021 100 104 33677263 PMC7896495
  48. [60]Steeg S Bojanić L Tilston G Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: time series analysis of electronic healthcare records for 2·8 million patients in the Greater Manchester Care Record EClinicalMedicine 41 2021 101175 PMC8557994 34746726
  49. [61]Sveticic J Stapelberg NJ Turner K Suicide prevention during COVID-19: identification of groups with reduced presentations to emergency departments Australas Psychiatry 29 2021 333 336 33626306
  50. [62]Wells JM Rodean J Cook L Injury-related pediatric emergency department visits in the first year of COVID-19 Pediatrics 150 2022 e2021054545 35836331
  51. [63]Zhang EWJ Davis A Finkelstein Y Rosenfield D The effects of COVID-19 on poisonings in the paediatric emergency department Paediatr Child Health 27 suppl 1 2022 S4 S8 35620562 PMC9126273
  52. [64]Mitchell RHB Ani C Cyr C Near-fatal self-harm among Canadian adolescents Can J Psychiatry 67 2022 598 607 34846182 PMC9301146
  53. [66]McMahon EM Keeley H Cannon M The iceberg of suicide and self-harm in Irish adolescents: a population-based study Soc Psychiatry Psychiatr Epidemiol 49 2014 1929 1935 24929354
  54. [67]Green C Leyenaar JK Turner AL Leslie LK Competency of future pediatricians caring for children with behavioral and mental health problems Pediatrics 146 2020 e20192884 32561612

Cited by

Sorted by citations

Authors
Madigan, S., Korczak, D. J., Vaillancourt, T., Racine, N., Hopkins, W. G., Pador, P., Hewitt, J. M. A., AlMousawi, B., McDonald, S., & Neville, R. D.
Affiliations
  • University of Calgary (CA)
  • University of Toronto (CA)
  • University of Ottawa (CA)
  • Victoria University (AU)
  • University College Dublin (IE)
Corresponding author
Madigan, Sheri
ORCID
Venue
The Lancet Psychiatry
Publisher
Elsevier BV
Published
2023-05
Volume
10
Issue
5
Pages
342-351
ISSN
2215-0366 (ISSN-L)
DOI
10.1016/s2215-0366(23)00036-6
PMC
PMC10097509
OpenAlex
W4323657400
Cited by
242
References
6
Citations by year
2026: 48 · 2025: 70 · 2024: 79 · 2023: 45
FWCI
12.27
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
Keywords
COVID-19 pandemic, suicide attempts, self-harm, suicidal ideation, children and adolescents, mental health, anxiety, depression, psychosis, emergency department utilization, pre-pandemic comparison, emergency department overcrowding, access to mental health care, health workforce shortage, mental health workforce shortage, mental health funding
MeSH terms
COVID-19, Adolescent, Child, Child, Preschool, Emergency Service, Hospital, Female, Humans, Male, Suicide, Attempted, Self-Injurious Behavior, Pandemics, Suicidal Ideation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review