Lockdown stringency and paediatric self-harm presentations during COVID-19 pandemic: retrospective cohort study

Wong, Ben Hoi-Ching; Vaezinejad, Mehrak; Plener, Paul L.; Mehdi, Tauseef; Romaniuk, Liana; Barrett, Elizabeth; Hussain, Haseena; Lloyd, Alexandra; Tolmac, Jovanka; Rao, Manish; Chakrabarti, Sulagna; Carucci, Sara; Moghraby, Omer S; Elvins, Rachel; Rozali, Farah; Skouta, Ereni; McNicholas, Fiona; Baig, Benjamin; Stevanović, Dejan; Nagy, Péter; Davico, Chiara; Mirza, Hassan; Tufan, Ali Evren; Youssef, Fatima; Meadowcroft, Ben; Ougrin, Dennis

doi:10.1192/bjo.2022.41

Cited by 12 publications

(12 citation statements)

References 29 publications

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“…Importantly, a history of suicidal behaviour was present in 26% of patients, more than one-third of whom exhibited actual suicide attempts. Although this could be attributable to a severe burden of depressive symptoms, more information is necessary to evaluate how many of these self-harm behaviours represent suicidal intent and how many are distressed, albeit risky, behaviours [27,28]. Moreover, we did not investigate the frequency of comorbid personality disorders in our adults with FTLBs, nor the frequency of other, non-suicidal self-harm behaviours, for example, cutting.…”

Section: Discussionmentioning

confidence: 99%

The spectrum of functional tic‐like behaviours: Data from an international registry

Martino

Hedderly

Murphy

et al. 2022

Euro J of Neurology

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Background and purpose: Between 2019 and 2022, there was a marked rise in adolescents/young adults seeking urgent help for functional tic-like behaviours (FTLBs). Given the global scale of this phenomenon, we aimed to pool cases from different institutions in an international registry to better characterize this spectrum and facilitate future longitudinal observation.Methods: An international collaborative group from 10 tertiary referral centres for tic disorders collected retrospective data on FTLB patients who sought specialists' attention | 335

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Section: Discussionmentioning

confidence: 99%

The spectrum of functional tic‐like behaviours: Data from an international registry

Martino

Hedderly

Murphy

et al. 2022

Euro J of Neurology

Self Cite

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“…On the other hand, patients may have chosen to avoid PES due to fear of COVID-19 infection, which would have left only patients with the most severe psychiatric conditions in PES programs. While this study was not able to determine how many encounters were associated with self-harm, other studies [44][45][46] found that the stringency of COVID-19-related lockdowns was associated with a 5-fold increase in self-harm presentations by youths. Youths were more vulnerable and more susceptible to abuse and/or neglect during the pandemic.…”

Section: Jama Network Open | Psychiatrymentioning

confidence: 71%

Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic

2023

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ImportancePsychiatric boarding occurs when patients needing intensive psychiatric services who are already under clinical supervision experience delays in their admission to psychiatric facilities. Initial reports have suggested that the US had a psychiatric boarding crisis during the COVID-19 pandemic; however, little is known about the consequences of this crisis for publicly insured youths.ObjectiveTo estimate pandemic-associated changes in psychiatric boarding rates and discharge modalities for people aged 4 to 20 years who accessed psychiatric emergency services (PES) through a mobile crisis team (MCT) evaluation and were covered by Medicaid or health safety net programs.Design, Setting, and ParticipantsThis retrospective cross-sectional study used data from the MCT encounters of a multichannel PES program in Massachusetts. A total of 7625 MCT-initiated PES encounters with publicly insured youths who lived in Massachusetts between January 1, 2018, and August 31, 2021, were assessed.Main Outcomes and MeasuresEncounter-level outcomes (psychiatric boarding status, repeat visits, and discharge disposition) during a prepandemic period (January 1, 2018, to March 9, 2020) were compared with outcomes during a pandemic period (March 10, 2020, to August 31, 2021). Descriptive statistics and multivariate regression analysis were used.ResultsAmong 7625 MCT-initiated PES encounters, the mean (SD) age of publicly insured youths was 13.6 (3.7) years; most youths identified as male (3656 [47.9%]), were of Black race (2725 [35.7%]) or Hispanic ethnicity (2708 [35.5%]), and spoke English (6941 [91.0%]). During the pandemic period, the mean monthly boarding encounter rate was 25.3 percentage points higher than the prepandemic period. After adjustment for covariates, the odds of an encounter resulting in boarding doubled during the pandemic (adjusted odds ratio [AOR], 2.03; 95% CI, 1.82-2.26; P &lt; .001), and boarding youths were 64% less likely to be discharged to inpatient psychiatric care (AOR, 0.36; 95% CI, 0.31-0.43; P &lt; .001). Publicly insured youths who boarded during the pandemic had significantly higher rates of 30-day readmissions (incidence rate ratio, 2.17; 95% CI, 1.88-2.50; P &lt; .001). Boarding encounters during the pandemic were significantly less likely to end in discharge to inpatient psychiatric units (AOR, 0.36; 95% CI, 0.31-0.43; P &lt; .001) or community-based acute treatment facilities (AOR, 0.70; 95% CI, 0.55-0.90; P = .005).Conclusions and RelevanceIn this cross-sectional study, publicly insured youths were more likely to experience psychiatric boarding during the COVID-19 pandemic and, if boarding, were less likely to transfer to a 24-hour level of care. These findings suggest that psychiatric service programs for youths were not prepared to support the levels of acuity and demand that emerged from the pandemic.

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“…With the current data, further sub-classification is not possible. Both decreases and increases in self-harm presentations during the pandemic have been described in the literature [ 19 , 20 ], and both were associated with lockdown stringency [ 21 ]. Our findings of an increased incidence have also been reported by Jollant et al, who reported a significant increase in intentional self-harm after the first months of the pandemic in France [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Adverse effect of lockdowns during the COVID-19 pandemic: increased incidence of pediatric crisis admissions due to eating disorders and adolescent intoxications

et al. 2023

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During the COVID-19 pandemic, countries imposed (partial) lockdowns that reduced viral transmission. However, these interventions may have unfavorable effects on emotional and psychological well-being. The aim of this study was to quantify possible adverse effects of the COVID-19 pandemic on psychological wellbeing in children and adolescents. Hospital admission data between January 2017 and September 2021 from eight general hospitals in the Netherlands was collected, comparing the incidences of sub-categorized psychological diagnoses, more specifically eating disorders, intentional intoxications, accidental intoxications, and excessive crying, before (2017–2019) and during the pandemic (2020–2021). Data was summarized per month and per year, and the years 2020 and 2021 were compared to 2017–2019. The relative increase or decrease in diagnoses since the start of the pandemic was calculated. Overall pediatric hospital admissions decreased with 28% since the start of the pandemic. Non-infectious diagnoses showed a decrease of 8%. Of these non-infectious diagnoses, overall psychosocial admissions were increased (+ 9%), mostly caused by an increase in admissions for eating disorders (+ 64%) and intoxications in adolescents (+ 24%). In addition, the proportion of admissions due to psychosocial diagnoses increased post-pandemic (6% vs 4%, p < 0.001). Overall admissions for intoxications in children (− 3%) and excessive crying (− 1%) did not increase, although peaks in incidence were found at the start of the second lockdown. Conclusion : During the COVID-19 pandemic, admission rates for eating disorders and intentional intoxications showed a substantial increase, indicating a high burden of pediatric psychiatric diseases. What is Known: • The COVID-19 pandemic has had an impact on psychosocial wellbeing in children and adolescents. What is New: • There was an increase in admissions due to psychosocial problems in the Netherlands in the period after the pandemic. • This was mainly caused by an increase in crisis admissions due to eating disorders and intoxications in adolescents. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-022-04773-5.

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Lockdown stringency and paediatric self-harm presentations during COVID-19 pandemic: retrospective cohort study

Cited by 12 publications

References 29 publications

The spectrum of functional tic‐like behaviours: Data from an international registry

The spectrum of functional tic‐like behaviours: Data from an international registry

Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic

Adverse effect of lockdowns during the COVID-19 pandemic: increased incidence of pediatric crisis admissions due to eating disorders and adolescent intoxications

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