Pandemic-Related Emergency Psychiatric Presentations for Self-Harm of Children and Adolescents in 10 Countries (PREP-Kids): A Retrospective International Cohort Study

Abstract

To examine the differences in hospital emergency psychiatric presentations for self-harm of children and adolescents during the covid-19 lockdown in March and April 2020 compared with the same period in 2019. Retrospective cohort study. We used electronic patient records from 23 hospital emergency departments in ten countries grouped into 14 areas. We examined data on 2073 acute hospital presentations by 1795 unique children and adolescents through age 18. We examined the total number of emergency psychiatric hospital presentations and the proportion of children and adolescents presenting with severe self-harm as our two main outcome measures. In addition, we examined sociodemographic and clinical characteristics and clinical management variables for those presenting with self-harm. To compare the number of hospital presentations between 2020 and 2019 a negative binomial model was used. For other variables, individual participant data (IPD) meta-analyses were carried out. Emergency psychiatric hospital presentations decreased from 1239 in 2019 to 834 in 2020, incident rate ratio 0.67, 95% CI 0.62-0.73; p < 0.001. The proportion of children and adolescents presenting with self-harm increased from 50% in 2019 to 57% in 2020, odds ratio 1.33, 1.07-1.64; p = 0.009 but there was no difference in the proportion presenting with severe self-harm. Within the subpopulation presenting with self-harm the proportion of children and adolescents presenting with emotional disorders increased from 58 to 66%, odds ratio 1.58, 1.06-2.36; p = 0.025. The proportion of children and adolescents admitted to an observation ward also decreased from 13 to 9% in 2020, odds ratio 0.52, 0.28-0.96; p = 0.036. Service planners should consider that, during a lockdown, there are likely to be fewer emergency psychiatric presentations. Many children and adolescents with psychiatric emergencies might not receive any service. A focus on developing intensive community care services with outreach capabilities should be prioritised.

Mental Health–Related Emergency Department Visits in Adolescents Before and During the COVID-19 Pandemic: A Multicentric Retrospective Study

“…Two studies, one of 16 EDs in British Columbia, Canada [ 8 ], and the other of a single center in the United States [ 9 ], reported significant decreases in mental health–related ED visits (41% and 60% decrease, respectively) during the first two months of the pandemic compared with the same period one year prior. Similarly, a retrospective study from 10 European countries found a significant decrease in the number of psychiatric emergency visits between March and April 2020 versus 2019 with a smaller proportion of youths admitted to an observation unit [ 10 ]. However, a small number of studies analyzing ED visits across the United States during the year 2020 showed a significant increase in the proportion of mental health–related visits among all adolescent visits in the second half of 2020 [ 11 , 12 ], with some studies reporting increases in the proportion of some (i.e., eating disorders, suicidality) but not all types of mental health visits [ 13 , 14 ].…”

Impact of the COVID-19 pandemic on child and adolescent mental health services

“…3 An initial drop in presentations to paediatric emergency departments was also observed. 1 A similar picture has also emerged from the USA in young people from predominantly Hispanic/Latinx backgrounds where reductions in symptoms of mental health problems were found in the first month after COVID-19 restrictions were implemented. 4…”

“…Although the National Child Mortality Database indicated a possible increase in child suicide during the first UK lockdown, 15 self-harm presentations to emergency departments reduced very substantially at the beginning of the pandemic. 1 The impact of the pandemic on suicide remains unclear, but early studies show no substantial increase. 16 However, the longer-term impact of the pandemic and lockdown restrictions on this population remains unknown and we must remain vigilant in supporting these young people.…”

“…The National Health Service (NHS) has had to adapt faster than any of us could have imagined, with unprecedented changes to services provided and a reduction in face-to-face patient care. 1 Alongside the physical health burden of the pandemic, there is the emerging and arguably, more burdensome, mental health epidemic that we are observing across the country and the world. Children and young people have been disproportionately adversely affected, as they have had to adapt to extraordinary changes to the world around them.…”

Promoting Factfulness in the Covid-19 pandemic-related policymaking: a map to understanding school closures

“…Adolescents were found to represent a particularly vulnerable cohort [71]. Concomitantly, the clinical frontlines reported both a significant decline in the incidence of admissions for psychiatric emergencies during lockdowns [72][73][74] and increased suicide ideation and self-harm rates [75]. Such a rise in psychiatric emergencies overall, and specifically in suicide behaviours, is already documented in manifold reports and news article easily found through a Google search: we now await high-quality published studies empirically confirming this alarming trend beyond the grey literature, framing it developmentally as well as clinically.…”