Factors associated with gender specific adolescent presentations to the emergency department for suicide risk behaviors during the COVID-19 pandemic

Abstract

Background Adolescent presentations to the emergency department (ED) for suicide-related thoughts and behaviors (SRTBs) increased during the COVID-19 pandemic. Gender expansive youth were particularly impacted by the loss of gender-specific services, however, data examining ED pandemic presentations of gender expansive youth for SRTBs are scarce. Methods Data were collected at a tertiary care center in Canada. Adolescents aged 12 to 17 presenting with SRTBs were recruited during two periods: March 2018 - March 2020 (pre-pandemic) and March 2021 - May 2023 (during pandemic). Patient demographics, mental health symptoms, and pre-ED visit healthcare utilization were examined. Results We identified 202 adolescents (70 pre-pandemic; 132 during pandemic), with a mean age of 14.3 years. Compared with pre-pandemic, during pandemic adolescents were more likely to identify as gender expansive [pre: 5.7% versus during: 24.2%; p = .01] and were of European descent [pre: 28.6% versus during: 59.1%; p < .01]. During the pandemic, gender expansive adolescents, on average, exhibited higher suicidal ideation, measured by Suicide Ideation Questionnaire Junior scores, compared with cisgender adolescents [gender expansive: mean = 64.3 (standard deviation = 12.1) versus cisgender participants: mean = 58.0 (standard deviation = 14.5); p = .03]. There were no differences in demographics, healthcare utilization, depression or anxiety symptom severity between gender expansive and cisgender adolescents. Conclusions Adolescents presenting to the ED with SRTBs during the pandemic were more likely to identify as gender expansive than those presenting pre-pandemic. Gender expansive adolescents exhibited increased suicidal ideation compared to cisgender adolescents during the pandemic.