The paper, published today in Lancet Psychiatry, provides a meta-analysis of 42 studies representing over 11 million pediatric emergency department visits across 18 countries, comparing the data on visits prior to the pandemic with those that took place during the pandemic, up to July 2021.
22% increase in youth visits to emergency departments for suicide attempts
The numbers show that while there was a 32 per cent reduction in pediatric emergency department visits for any health-related reasons during the pandemic, there was still a 22 per cent increase in children and adolescents going to emergency departments for suicide attempts, and an eight per cent increase in visits for suicide ideation.
Co-author Dr. Tracy Vaillancourt, Canada Research Chair, School-Based Mental Health & Violence Prevention from the University of Ottawa says, “At a time when emergency department visits fell for health problems in children and youth, visits for suicide attempts increased when compared to pre-pandemic visits. This highlights the fact that the pandemic was particularly difficult for young people experiencing mental health problems”.
While the authors of this study are troubled by these findings, they don’t necessarily come as a shock. In the summer of 2021, a study led by a similar team found that depression and anxiety symptoms doubled in children and adolescents during the first year of the pandemic.
“At the beginning of the pandemic our work showed concerning increases in depression and anxiety symptoms among children and youth globally,” explained Dr. Nicole Racine, a clinical psychologist and Chair in Child and Youth Mental Health at CHEO who co-authored the research paper. “This new study further demonstrates that the kids have not been alright during the pandemic, with increased presentation to the emergency department for serious concerns”.
These new concerning findings seem to bear witness to that warning.
The lead author of this study, Dr. Sheri Madigan from the University of Calgary said that in their earlier work on mental health during the pandemic determined that “kids were in crisis, and that we needed to bolster services and resources, or it was going to get worse”. Madigan further stated that “There’s been a debate during the pandemic as to whether the kids are alright or not alright. Now that more data have been published and analyzed, we can more precisely answer that question. The kids are, in fact, not alright.”
At face value, there seems to be a confusing discrepancy between the overall reduction in pediatric emergency department visits during the pandemic, on the one hand, and the spike in visits associated with suicide attempts and suicide ideation, on the other. But, beneath the surface, it makes perfect sense, says Madigan.
“At a time when emergency department visits fell for health problems in children and youth, visits for suicide attempts increased when compared to pre-pandemic visits.”
Dr. Tracy Vaillancourt - Canada Research Chair, School-Based Mental Health and Violence Prevention
“At the beginning of the pandemic our work showed concerning increases in depression and anxiety symptoms among children and youth globally,” explained Dr. Nicole Racine, a clinical psychologist and Chair in Child and Youth Mental Health at CHEO who co-authored the research paper. “This new study further demonstrates that the kids have not been alright during the pandemic, with increased presentation to the emergency department for serious concerns”.
These new concerning findings seem to bear witness to that warning.
The lead author of this study, Dr. Sheri Madigan from the University of Calgary said that in their earlier work on mental health during the pandemic determined that “kids were in crisis, and that we needed to bolster services and resources, or it was going to get worse”. Madigan further stated that “There’s been a debate during the pandemic as to whether the kids are alright or not alright. Now that more data have been published and analyzed, we can more precisely answer that question. The kids are, in fact, not alright.”
At face value, there seems to be a confusing discrepancy between the overall reduction in pediatric emergency department visits during the pandemic, on the one hand, and the spike in visits associated with suicide attempts and suicide ideation, on the other. But, beneath the surface, it makes perfect sense, says Madigan.
The kids are not alright
Fear of COVID-19 infection and other factors kept people away from emergency departments for most health conditions during the pandemic. But in that same period the proven risk factors for mental illness for children and adolescents increased dramatically. Children’s screen time rose greatly during the pandemic as physical activity levels dwindled. Many families were in turmoil as jobs were lost, family violence increased, and the mental health of parents deteriorated.
“These are all accelerants to mental distress,” says Madigan. “Children have an ability to show resilience in difficult times, but they were pushed past what is tolerable, beyond their capacity-to-cope threshold. And now, far more kids and teens are in crisis then was the case before the pandemic.”
The researchers included studies published between January 2020 and July 2021 that contained data on pediatric emergency department visits before and during the COVID-19 pandemic, up to the summer of 2021.
Because ongoing studies on the more recent administrative health data have yet to be published, Madigan says the Lancet Psychiatry article findings provide the clearest snapshot of the pandemic up to about July 2021. Madigan says: “We will continue to monitor the incoming data to see if this trend of increasing emergency department visits for suicide attempts and suicide ideation among children and adolescents continues to climb as the pandemic changes and evolves.”
“At the beginning of the pandemic our work showed concerning increases in depression and anxiety symptoms among children and youth globally”
Dr. Nicole Racine - Clinical psychologist and Chair in Child and Youth Mental Health at CHEO
Need for increased mental health supports
Before the pandemic, about one in five children worldwide were experiencing some form of mental illness, but only 25 per cent in serious need of treatment received it. As mental health stressors escalated overwhelmingly during the pandemic, the need for mental health resources increased in kind, and services and supports are still insufficient to meet the overwhelming demand for mental health treatment.
“We can’t ignore that the mental health of children and adolescents is in crisis,” Madigan says. “We need to prioritize the creation of mental health resources, supports, and services now, to help children shift from languishing to flourishing.” To do so, she suggests that governments need to invest in community resources and infrastructure to support the identification and treatment of mental illness, as well as school programs that focus on prevention and mental health literacy.
Information on suicide prevention can be found here. Distress lines in Canada are open 24 hours a day. Kids Help Phone: 1-800-668-6868. Talk Suicide Canada: 1-833-456-4566.