Registered psychiatric service use, self-harm and suicides of children and young people aged 0–24 before and during the COVID-19 pandemic: a systematic review

Abstract

Background The COVID-19 pandemic has impacted on psychiatric symptoms of children and young people, but many psychiatric services have been disrupted. It is unclear how service use, self-harm and suicide has changed since the pandemic started. To gain timely information, this systematic review focused on studies based on administrative data that compared psychiatric service use, self-harm and suicide before and during the pandemic among children and young people. Methods and finding A systematic review of studies published in English from 1 January 2020 to 22 March 2021 was conducted, using the Web of Science, PubMed, Embase and PsycINFO databases. Increases or reductions in service use were calculated and compared using percentages. Of the 2,676 papers retrieved, 18 were eligible for the review and they provided data from 19 countries and regions. Most studies assessed changes during the early phase of the COVID-19 pandemic, from March to July 2020, and three assessed the changes until October 2020. Fifteen studies reported a total of 21 service use outcomes that were quantitively examined. More than three-quarters of the 21 outcomes (81%) fell by 5–80% (mean reduction = 27.9%, SD = 35%). Ten of the 20 outcomes for psychiatric emergency department (ED) services reduced by 5% to 80% (mean = 40.1%, SD = 34.9%) during the pandemic. Reductions in service use were also recorded for ED visits due to suicide ideation and self-harm, referrals to secondary mental health services, psychiatric inpatient unit admissions and patients receiving treatment for eating disorders. However, there were also some increases. Suicide rate and the number of ED visits due to suicide attempts have increased, and there was an increase in the number of treatment sessions in a service that provided telemedicine. Conclusion Most of the studies showed reductions in the use of psychiatric services by children and young people during the early phase of the pandemic and this highlighted potential delays or unmet needs. Suicide rate has increased during the second wave of the pandemic. Further studies are needed to assess the pattern of service use in the later phases of the COVID-19 pandemic.

Hospitalizations for Anorexia Nervosa during the COVID-19 Pandemic in France: A Nationwide Population-Based Study

“…The results of our study therefore call for special attention to this eating disorder, in which self-harming behaviors increased significantly during the pandemic. This result is consistent with other recent reports showing a marked increase in self-harm among young people younger than 24 years old [ 30 ]. The present study makes an additional contribution by clarifying the pattern of mental health problems in the successive phases of the COVID-19 pandemic in France, i.e., a sharp deterioration in the mental health of girls and young women in terms of anorexia nervosa in the second half of 2020 and throughout 2021.…”

“…Instead, after an ephemeral drop toward baseline, we noticed a substantial increase in hospitalizations for AN, with a significant increase in adolescent girls aged 10 to 19 years and young women aged 20 to 29. This is congruent with studies showing that adolescent mental health has been considerably affected by the pandemic [ 18 , 20 , 30 ], with an impact that was first internalized (e.g., anxiety, depression and eating disorders) and then externalized (e.g., hospitalizations for AN) [ 31 ]. It has been suggested that during the period of isolation, people with AN may have been forced to change their eating routine, to isolate themselves socially or, conversely, to be confined with their families [ 11 , 23 ].…”

“…The present study is the first to examine a potential relationship between the COVID-19 pandemic and hospitalizations for anorexia nervosa, providing a comparative hospital survey between the pre-pandemic period (2018–early 2020) and the pandemic period (2020–2021) based on the French National Health Data System. As hypothesized, at the beginning of the first COVID-19 wave and the first lockdown in March 2020, there was an initial moment of panic during which non-COVID-19 hospital activity collapsed, including hospitalizations for self-harm associated with anorexia nervosa [ 3 , 6 , 27 , 29 , 30 ]. This considerable decrease was not followed by a sustained reduction in inpatient admissions for anorexia nervosa.…”

A systematic review of the mental health changes of children and young people before and during the COVID-19 pandemic

“…In addition, childhood mental health problems have been associated with lower socioeconomic status and less stable social relationships in adulthood [44]. Our previous systematic review showed decreased mental health service use before and during the pandemic in subjects aged 0-24 years during the early phase of COVID-19 pandemic [21]. These two contradictory findings, of increased mental health problems but decreased service use during the early pandemic, indicated unmet needs.…”

“…The periods before and during the pandemic were the pandemic periods defined by the authors of the included studies and at least one corresponding prepandemic period. It is worth noting that we have previously reported findings on the registered mental health service use, self-harm and suicides based on administrative data [21] so these types of studies were also excluded in this review.…”