Trends and Seasonality of Emergency Department Visits and Hospitalizations for Suicidality Among Children and Adolescents in the US from 2016 to 2021

פוסט זה זמין גם ב: עברית

Youngran Kim, PhD¹; Trudy Millard Krause, DrPH¹; Scott D. Lane, PhD²

Key Points

Question  Did trends and seasonal patterns of suicidality among children and adolescents change after the onset of the COVID-19 pandemic in March 2020?

Findings  This cross-sectional study of 73 123 emergency department (ED) visits and hospitalizations for suicidality found that the incidence of ED visits and hospitalizations increased from 2016 to 2021, with a temporary decline in 2020. Prior to the pandemic, monthly incidences were typically higher during the school year, but during the spring of 2020, coinciding with school closures, they were substantially lower.

Meaning  This study’s findings suggest that the unexpected decrease in suicidality among children and adolescents after school closures supports hypotheses that suicidality is associated with the US school calendar.

Importance  The detection of seasonal patterns in suicidality should be of interest to clinicians and US public health officials, as intervention efforts can benefit by targeting periods of heightened risk.

Objectives  To examine recent trends in suicidality rates, quantify the seasonality in suicidality, and demonstrate the disrupted seasonality patterns during the spring 2020 COVID-19–related school closures among US children and adolescents.

Design, Setting, and Participants  This population-based, descriptive cross-sectional study used administrative claims data from Optum’s deidentifed Clinformatics Data Mart Database. Participants included children aged 10 to 12 years and adolescents aged 13 to 18 years who were commercially insured from January 1, 2016, to December 31, 2021. Statistical analysis was conducted between April and November 2022.

Exposures  Month of the year and COVID-19 pandemic.

Main Outcomes and Measures  Rates and seasonal patterns of emergency department (ED) visits and hospitalizations for suicidality.

Results  The analysis included 73 123 ED visits and hospitalizations for suicidality reported between 2016 and 2021. Among these events, 66.1% were reported for females, and the mean (SD) age at the time of the event was 15.4 (2.0) years. The mean annual incidence of ED visits and hospitalizations for suicidality was 964 per 100 000 children and adolescents (95% CI, 956-972 per 100 000), which increased from 760 per 100 000 (95% CI, 745-775 per 100 000) in 2016 to 1006 per 100 000 (95% CI, 988-10 024 per 100 000) in 2019, with a temporary decrease to 942 per 100 000 (95% CI, 924-960 per 100 000) in 2020 and a subsequent increase to 1160 per 100 000 (95% CI, 1140-1181 per 100 000) in 2021. Compared with January, seasonal patterns showed peaks in April (incidence rate ratio [IRR], 1.15 [95% CI, 1.11-1.19]) and October (IRR, 1.24 [95% CI, 1.19-1.29]) and a nadir in July (IRR, 0.63 [95% CI, 0.61-0.66]) during pre–COVID-19 years and 2021. However, during the spring of 2020, which coincided with school closures, seasonal patterns were disrupted and April and May exhibited the lowest rates.

Conclusions and Relevance  The findings of this study indicated the presence of seasonal patterns and an observed unexpected decrease in suicidality among children and adolescents after COVID-19–related school closures in March 2020, which suggest a potential association between suicidality and the school calendar.