How Did COVID-19 Affect Suicidality? Data from a Multicentric Study in Lombardy

Abstract

The aim of the study was to describe the characteristics of subjects accessing the emergency rooms for suicidal behavior during the first epidemic wave of COVID-19 in three Emergency Departments (EDs) in Lombardy (Italy). A retrospective chart review was conducted for the period 8 March–3 June 2020, and during the same time frame in 2019. For all subjects accessing for suicidality, socio-demographic and clinical data were collected and compared between the two years. The proportion of subjects accessing for suicidality was significantly higher in 2020 than in 2019 (13.0 vs. 17.2%, p = 0.03). No differences between the two years were found for sex, triage priority level, history of substance abuse, factor triggering suicidality and discharge diagnosis. During 2020 a greater proportion of subjects did not show any mental disorders and were psychotropic drug-free. Women were more likely than men to receive inpatient psychiatric treatment, while men were more likely to be discharged with a diagnosis of acute alcohol/drug intoxication. Our study provides hints for managing suicidal behaviors during the still ongoing emergency and may be primary ground for further studies on suicidality in the course of or after massive infectious outbreaks.

How Did the COVID-19 Pandemic Affect the Use of Emergency Medical Services by Patients Experiencing Mental Health Crises?

“…Specifically, we searched for and included patients who accessed EMSs themselves or with the help of others. We extracted the events based on the International Classification of Disease (ICD)-10 version 2016 as follows: (1) self-poisoning by drugs (prescribed or over-the-counter drugs; code X60-64); (2) self-poisoning by other means (organic solvents, gases, pesticides, noxious chemicals; code X66-69); (3) intentional self-harm by hanging, strangulation, or suffocation (code X70); (4) intentional self-harm by drowning or submersion (code X71); (5) intentional self-harm by smoke, fire, or flames (code X76); (6) intentional self-harm by a sharp object (code X78); (7) intentional self-harm by a blunt object (code X79); (8) intentional self-harm by jumping from a high place (code X80); (9) intentional self-harm by jumping or lying in front of a moving object (code X81); (10) intentional self-harm by crashing a motor vehicle (code X82); (11) intentional self-harm by other specified means (code X83); and (12) intentional self-harm by unspecified means (a patient who had a suicidal intention, but a specific method was not performed or a patient who left a suicide note, but the specific method of suicide was not known; code X84). We also included patients who used EMSs for anxiety, panic attacks, and depressive moods.…”

“…(5) self-harm by smoke (including fire); (6) self-harm by a sharp object; (7) anxiety, panic attacks, and depressive mood; and (8) others (suicidal intention confirmed, but a specific method was not performed or identified). If the patient had two or more types of MHCs, they were classified according to the more serious medical issue.…”

“…The emergency department (ED) plays an essential role in an acute health care system; it can be a window into a public health crisis. Camilla et al [7] found that the proportion of patients accessing the ED for suicidality was significantly higher in 2020 than in 2019. In contrast, Manuel et al [8] reported a 52.2% decrease in psychiatric ED visits during the COVID-19 emergency state compared to the pre-COVID-19 period.…”

Mental Health Challenges during the COVID-19 Pandemic

“…The paper by Gesi et al [12] reports on the number and characteristics of subjects accessing the emergency rooms for suicidal behavior in three Emergency Departments in Lombardy (Italy) before (2019) and during the first wave (2020) of the COVID-19 pandemic. The proportion of subjects accessing the Emergency Department for suicidality was significantly higher in 2020 than in 2019.…”