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Hospitalizations for self-harm, suicidal ideation, and self-poisoning increased among young Canadians — particularly girls — during the pandemic, purdue pharmacy janet lee new research shows.

In a retrospective analysis of emergency department visits and hospital admissions from April 2015 to March 2022, the quarterly percentage of hospital admissions for the composite outcome, relative to all-cause admissions, significantly increased by 0.76% per quarter among girls aged 10-14 years and by 0.56% per quarter among girls age 15 to 18 years.

Dr Naveen Poonai

“Our original assumption was that, similar to pre-pandemic, most mental health sufferers were older adolescents,” study author Naveen Poonai, MD, associate professor of pediatrics at Western University’s Schulich School of Medicine and Dentistry in London, Ontario, told Medscape Medical News. “There is however, an emerging and alarming trend of increased mental health concerns among younger adolescents, even before the pandemic, and our work reflects this.”

The study was published online today in the Canadian Medical Association Journal.

Trend Among Girls

The investigators analyzed data from the Canadian Institute for Health Information on ED visits and hospital admissions to assess pandemic-related changes in healthcare use for the composite of suicidal ideation, self-poisoning, and self-harm among adolescents.

The pre-pandemic period (from April 1, 2015–March 1, 2020) saw an average of 5293 ED visits per quarter for the composite outcome among patients aged 10-18 years. This level increased to 6060 ED visits per quarter during the pandemic period (April 1, 2020–March 31, 2022).

The proportion of visits per quarter for the composite outcome increased from 2.3% of all-cause ED visits to 3.5% of all-cause ED visits. By contrast, the average quarterly number of all-cause ED visits decreased from 230,080 during the pre-pandemic period to 172,180 during the pandemic period.

An average of 1590 hospital admissions per quarter for the composite outcome (or 7.2% of all-cause admissions) occurred among the study population before the pandemic, compared with 1770 admissions per quarter (9% of all-cause admissions) during the pandemic. These data showed a significantly increasing trend (0.36% per quarter) during the pandemic vs pre-pandemic periods, specifically among girls.

The average quarterly number of all-cause hospital admissions fell from 22,137 before the pandemic to 19,762 during the pandemic.

A sensitivity analysis limited to jurisdictions where comprehensive reporting of ED visits was mandated produced results similar to those of the primary analysis.

“The pandemic seems to have been associated with greater severity of presentations: that is, those that prompt hospitalization,” said Poonai. Those hospitalizations increased by 11% from the pre-pandemic period to the pandemic period.

The study was observational and constrained by the limitations of aggregate data and variation in ICD code use in EDs for mental health conditions, wrote the authors.  Nevertheless, the findings underscore “the need to promote public health policies that mitigate the impact of the pandemic on adolescent mental health.”

“Clinicians should be aware that young adolescents are also at risk of adverse mental health issues from social isolation, and this trend has been growing,” said Poonai. “Appropriate screening and follow-up of all adolescents is an important part of holistic care.”

Similar Global Trends

Commenting on the findings for Medscape, Bonnie T. Zima, MD, MPH, professor in residence of child and adolescent psychiatry at the UCLA Center for Community Health, Los Angeles, said, “These findings are similar to those from US studies that examined ED visits for mental health.” Zima did not participate in the research.

For example, a study led by Zima that used discharge data from 44 children’s hospitals in the US found that in the fall of 2020, hospitalizations for suicide attempts or self-injury rose by 41.7%, with 43.8% and 49.2% increases among adolescents overall and girls, respectively.

Dr Bonnie Zima

The current study is also consistent with a recent large international study encompassing 25 countries that was published in the Journal of the American Academy of Child and Adolescent Psychiatry. Zima wrote an editorial that accompanies that study, which found that the rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 and 50% higher than in March to April 2019. The rate of self-harm doubled between March to April 2020 and March to April 2021. It was 1.7 times higher overall than in March to April 2019.

In the editorial for that study, Zima wrote, “The international rise in self-harm ED visits likely driven by the increases among girls is also consistent with prior US studies.”

Taken together, the findings indicate that greater investment must be made in suicide prevention, early intervention, timely access to mental health crisis services, timely outpatient mental health care following a mental health crisis, and more inpatient child psychiatric beds, said Zima.

“The needs for child mental health services across the continuum of care are particularly high for counties and regions with fewer resources or a larger proportion of individuals who are at higher risk for depression and suicide,” she said.

The study was supported by the Lawson Health Research Institute and the Children’s Health Research Institute. Poonai reported research funding from the Canadian Institutes of Health Research and Physicians Services Incorporated. Zima reported grants from Illinois Children’s Healthcare Foundation, the Patient-Centered Outcomes Research Institute, the Substance Abuse and Mental Health Services Administration, the California Department of Health Care Services, and the Mental Health Services Oversight and Accountability Commission.

CMAJ. Published online September 18, 2023. Full text

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