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Suicide remains to be one of the leading causes of death amongst young people worldwide. Help-seeking, however, remains disproportionately suboptimal in the youth population. Identifying more effective and less stigmatizing markers of suicidal ideation and behaviours can be important for improving early engagement and intervention work. We therefore examined the prevalence of suicidal ideation, plan, and attempt in a large epidemiological youth sample in Hong Kong (n = 2540) during the period of 2019-2021, as well as the factors associated with each of these outcomes using separate multivariable logistic regression models. In this sample, the 12-month prevalence of suicidal ideation, plan, and attempt was 20.0%, 4.6%, and 1.3%, respectively. In particular, we found 'suicide-related rumination' to be amongst the only factor that was significant for all three outcomes (p < .010). Using a two-stage approach (i.e., selecting only those with suicidal ideation), we found that suicide-related rumination, poorer cognitive ability, and 12-month major depressive episode were specifically associated with 12-month suicide plan, while environmental factors, including COVID-19 stressors, personal life stressors, poorer family relationships, as well as non-suicidal selfharm, were specifically associated with 12-month suicide attempt. A two-stage approach should be considered in future interventions targeting youth suicide. Suicide-related rumination may be an important marker of overall suicidal risk. The role of environmental stressors in addition to intrinsic vulnerability also need to be emphasized to best support young people at risk.
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In recent years, especially after the outbreak of COVID-19, a large number of non-suicidal self-injury (NSSI) behaviors in adolescents have emerged, which has attracted wide attention from the society and become a serious public mental health problem. Repeated NSSI is also considered as an addictive behavior, which shares many similar neurobiological mechanisms with substance addiction, such as the dopamine reward system and the endogenous opioid system. This paper aims to review the domestic and international research progress on the characteristics of addiction in NSSI, including the general background, mechanism, assessment, and intervention.Copyright © 2022 Chinese Journal of Psychiatry. All rights reserved
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The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes (1) our screening and case identification process, (2) variation among adolescents versus young adults, and (3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12-24 years with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk indicators: 97% past-year suicidal ideation, 83% past suicidal behavior;and 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported more past-year suicide attempts (47% vs. 21%, p <.001) and NSSI (past 6 months, 64% vs. 39%, p <.001);less depression, anxiety, posttraumatic stress, and substance use;and greater social connectedness. Pandemic onset was associated with lower participation of racial-ethnic minority youths (18% vs. 33%, p <.015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.Copyright © 2023 Society of Clinical Child and Adolescent Psychology.
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Objective: Suicide is one of the leading causes of death in the world. The present research aimed to investigate the moderating role of thwarted belongingness, perceived burdensomeness, and suicidal capability in suicidal ideation, behavior, and attempts among the Iranian population. Method(s): The data were analyzed using cross-sectional regression models. The population of this study included 600 students of the University of Mohaghegh Ardabili. The tools used to collect the data in this study were the Patient Health Questionnaire-2, the Depressive Symptom Index-Suicidality Subscale (DSI-SS), the Suicide Attempt Questionnaire, the Interpersonal Needs Questionnaire (IPTS), the Suicide Capacity Scale-3, the Adverse Childhood Experiences, the Generalized Anxiety Disorder Questionnaire, and the Suicidal Behaviors Questionnaire-Revised. Result(s): The results of this study showed that there was an interaction between thwarted belongingness and perceived burdensomeness in suicidal behavior and DSI-SS. The results also showed that the acquired and practical capability subscales (suicidal capability) strengthen the relationship between suicidal behavior and the DSI-SS, on the one hand, and suicide attempt, on the other hand. Conclusion(s): The findings of the study showed that the interpersonal theory of suicide can pave the way to prevent suicidal ideation and behavior in Iranian society, and it is recommended that Iranian practitioners apply the theory in practice.Copyright © 2022 Yerkure Tanitim ve Yayincilik Hizmetleri A.S.. All rights reserved.
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Background: This study analyzed the causes of death in the Korean population in 2020. Method(s): Cause-of-death data for 2020 from Statistics Korea were examined based on the Korean Standard Classification of Diseases and Causes of Death, 7th revision and the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Result(s): In total, 304,948 deaths occurred, reflecting an increase of 9,838 (3.3%) from 2019. The crude death rate (the number of deaths per 100,000 people) was 593.9, corresponding to an increase of 19.0 (3.3%) from 2019. The 10 leading causes of death, in descending order, were malignant neoplasms, heart diseases, pneumonia, cerebrovascular diseases, intentional self-harm, diabetes mellitus, Alzheimer disease, liver diseases, hypertensive diseases, and sepsis. Cancer accounted for 27.0% of deaths. Within the category of malignant neoplasms, the top 5 leading organs of involvement were the lung, liver, colon, stomach, and pancreas. Sepsis was included in the 10 leading causes of death for the first time. Mortality due to pneumonia decreased to 43.3 (per 100,000 people) from 45.1 in 2019. The number of deaths due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 950, of which 54.5% were in people aged 80 or older. Conclusion(s): These changes reflect the continuing increase in deaths due to diseases of old age, including sepsis. The decrease in deaths due to pneumonia may have been due to protective measures against SARS-CoV-2. With the concomitant decrease in fertility, 2020 became the first year in which Korea's natural total population decreased.Copyright © Korean Medical Association.
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Aim Functional neurological disorders (FND) are one of the most common presentation in neurology clinics, causing a significant disability and economic burden. Cognitive behavioural therapy (CBT) has one of the best available evidence in managing FND, although access remains limited. Queen Square, London neuropsychiatry experts have established an excellent model for a CBT based, Guided Self Help (GSH) programme, which is preparatory to a multidisciplinary inpatient treatment. It has been shown to have good outcomes. This study was designed to ascertain the feasibility and acceptance of this QGSH model, in an Exonian cohort of FND patients, whilst piloting its stand-alone version, without the inpatient component. Additionally, the study explores the need and types of modifications required for the stand-alone adaptation of QGSH. Method Consecutive patients referred to Exeter FND Service, between February to June 2020, who had internet access, were offered the QGSH pilot. Patients with a primary mental disorder concurrent drug/alcohol misuse or risk of self-harm or suicide were excluded. Ethics approval was not required. The QGSH intervention constitutes of 11 modules focussing on specific elements crucial to FND management along with homework tasks, delivered by the author, under supervision by QGSH experts. Patients completed Pre and Post-intervention questionnaires as well as structured feedback. Results Three successive patients with varied FND symptoms were recruited to the pilot between February and June 2020. The baseline health status of these patients was worse as compared to EQ-5D-5L population norms with significant baseline psychiatric comorbidity. Outcome measures used before and after QGSH intervention included PHQ 9, GAD 7, EQ-5D-5L and a locally devised symptom severity questionnaire. Necessary modifications were made to the program based on the patients informal feedback and structured formal feedback was sought in the end. Conclusion All patients derived some benefit from QGSH and certain modifications were suggested in patient feedback to improve engagement. Despite study limitations, especially small size and the impact of Covid 19 pandemic during the intervention;QGSH model appears acceptable and feasible in an Exonian cohort, however, some modifications are recommended for the stand-alone version to succeed. The recommendations will be presented.
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Introduction: There is sparse literature on child and adolescent consultation liaison psychiatry during the COVID pandemic in India. Aims and objectives: To study the patterns of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital Material(s) and Method(s): This was a retrospective chart-based study. Institutional Ethics Committee clearance was obtained. It was conducted from April 2020-21. The inclusion criteria comprised records of children and adolescents who were referred for consultation liaison services while they were admitted in COVID-19 designated tertiary hospital. Incomplete records were excluded. Data was tabulated and analysed with descriptive analysis. Result(s): We found 50 referrals out of which 42 records were complete and 8 incomplete were excluded. There were 47.62% boys and 52.38% girls with the mean age (10.8 years) All the 42 patients had been tested for COVID-19 at the time of intake admission as per hospital protocol. We found that 11.9% were confirmed cases of COVID-19 disease and 88.1% had tested negative for COVID-19 disease .The referrals were received mostly from Paediatric Intensive Care Unit (57.14%) followed by Paediatric ward (26.19%) and Special Paediatrics COVID High Dependency Unit (16.67%). The most common psychiatric disorder in COVID negative patients was adjustment disorder with deliberate self-harm (35.14%) and in COVID positive patients was delirium (60%) .The most commonly used medication were Escitalopram, Risperidone and Clonazepam. Conclusion(s): We conclude that psychiatric disorders were prevalent in child and adolescent patients admitted during COVID 19 pandemic and had a distinct profile.
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Background: The children and adolescents with ASD around the world have experienced a major disruption of their everyday lives due to the COVID-19 pandemic. Social isolation has inflicted a negative impact on the psychological well-being of these children and adolescents. Aim(s): To investigate the impact of COVID-19 pandemic in children and adolescents with ASD in terms of comprehension and adherence to implemented measures and changes in their behavioural problem. Methodology: A retrospective cross-sectional (descriptive) study was done involving 16 ASD children and adolescents attending OPD of a tertiary care institute within a time period of 12 months for various behavioural problems using ISAA scale and Nisonger CBRF. Each subject was assessed on a single occasion for 3 different timelines-Pre-COVID (before March 2020), during full Lockdown (March-May 2020) and Post-Lockdown (January 2021-January 2022). Result(s): The ISAA scoring revealed significant increase in ASDrelated behaviours (i.e. inappropriate emotional response, difficulty in communication etc.) from before pandemic to during pandemic and Post-Lockdown (p value<0.05).The Nisonger Child Behaviour Rating Form revealed deterioration in Positive Social behaviour (p value<0.05).Significant increase in problem behaviour was seen in all the six domains (Conduct problem, Insecure/Anxious, Hyperactive, Self-injury/Stereotype, Self-isolated/Ritualistic and Overtly Sensitive) (p value<0.05). Conclusion(s): Disruption of daily routine and social distancing have led to increase in problem behaviours of the children and adolescents with ASD as well as an increase in deficits of positive behaviours.
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Introduction: The first six months of the COVID-19 pandemic saw a nearly 50% increase in pediatric mental health emergencies. Specific factors contributing to this rise remain poorly characterized. One frequently cited contributor is pandemic-related interruptions of in-person schooling. Early studies indicate that students have experienced significantly greater psychological distress during such disruptions. We set out to investigate what correlation, if any, exists between school modality (ranging from exclusively virtual to exclusively in-person) and pediatric mental health status. Method(s): This is a retrospective, descriptive study combining patient chart review and parental telephone survey, exploring the prevalence and severity of mental illness among inpatients at a single urban, academic, midwestern tertiary care center. The study population included all patients ages 6-18 admitted to the study site during the 2015-19 and 2020- 21 school years who received Psychiatry and/or Psychology consults and/or were admitted to the inpatient psychiatry unit. Parents/guardians of participants from 2020-21 were surveyed regarding their child' educational experiences. We describe and compare participants between school years prior to and during the pandemic using descriptive demographic data and clinical data highlighting monthly admission rates and proxies for illness severity. We then assess for any correlation between these measures and recent virtual schooling. Result(s): Total mental health-related admissions rose from an average of 1070 during pre-pandemic school years to 1111 in 2020-21. Patients admitted in 2020-21 were more likely to be female, non-white, and from ZIP codes with higher median income. Primary diagnosis was more likely to be a mood or eating disorder. Patients were less likely to present primarily for suicidal ideation or self-harm. Proxies of illness severity, including utilization of PRN antipsychotics/benzodiazepines and readmission rates, rose in 2020-21. 255 of 800 (31.9%) families responded to the telephone survey. Respondents were more likely to have a child who was female and slightly younger compared to non-respondents. 98% of respondents reported some virtual schooling for their child, with 77% reporting virtual schooling for the majority of the three months prior to their child' first hospital admission. 61% indicated their child was exclusively in virtual school. No significant relationships were observed between virtual schooling and any outcome measures relating to mental health. Conclusion(s): Pediatric mental health emergencies and hospitalizations have grown and evolved since the start of the COVID-19 pandemic. This study characterizes some of the changes in patient demographics and experience with virtual schooling prior to and following the pandemic. Our results do not support any correlation between virtual schooling and mental illness requiring emergent care or hospitalization. However, this study has many significant limitations. Respondents were not representative of all admitted patients, and survey data were gathered for only one-third of families whose children were admitted at one site. Very few respondents remained in school in person throughout the pandemic, complicating efforts to make meaningful comparisons. Future work should attempt to capture a broader subject pool and obtain prospective data regarding the effects of school modality on mental health.
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Introduction: More evidence confirms a link between maladaptive personality traits and Non-suicidal Self-injury (NSSI). Research suggests that individuals with NSSI were found to have higher levels of negative affect, detachment, antagonism, and psychoticism. Additionally, the interest in the relationship between COVID-19 and NSSI is growing. The present study aims (a) to investigate differences in personality traits between individuals with NSSI, suicidal ideation, NSSI and suicidal ideation co-occurrence and none;(b) to observe which personality traits predominantly influence the occurrence of self-harm acts;(c) to investigate the effects of COVID-19 on selfharm attitude. Method(s): 270 (108 males and 172 females) participants aged between 18-25 were included in the study. Each individual participated in a clinical interview and completed an assessment consisting of the Personality Inventory for DSM-5 (PID-5) and the Health of the Nation Outcome Scales (HoNOS). A multivariate analysis of variance (MANOVA) was conducted to test the differences in personality traits between the groups. Moreover, a multiple hierarchical regression analysis, controlling for age and gender, was performed to measure the association between personality traits and self-harm attitude (HoNOS item 2). Finally, to investigate whether there was a difference in self-harm attitude before and after the pandemic, a T-test was conducted. Result(s): The individuals with the highest levels of negative affectivity, detachment, antagonism, and psychoticism are those who simultaneously present suicidal ideation and NSSI. Additionally, age and detachment predicted higher scores in self-harm attitudes. Our results unexpectedly do not confirm an upward trend of NSSI and suicidal ideation in the pandemic period. Conclusion(s): The study shows that personality, particularly maladaptive traits, is fundamental to a greater understanding of NSSIs. Furthermore, as NSSIs and suicidal ideation are predictive (although not determinative) of suicidal attempts, implementing psychotherapeutic treatments would have a conspicuous impact on self-harm attitudes, thereby reducing suicidal ideation and suicide attempts.
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Objective: Havening is a psychosensory therapeutic technique that purportedly harnesses the power of touch to stimulate oxytocin release and facilitate adaptive processing of distressing thoughts/memories. Although Havening is used in clinics worldwide, with anecdotal evidence, very few empirical studies exist to support its efficacy or mechanism of action. The present study is the first to investigate the effects of Havening Touch on subjective distress, mood, brain function, and well-being. Method(s): Participants (n = 24) underwent a single session of Havening, in response to a self-reported distressing event. Mood and resting-state electroencephalography were assessed prior to, and immediately following, the session. Psychological health was assessed at baseline and 2 weeks followup via an online self-report questionnaire. Result(s): There was a greater reduction in subjective units of distress during sessions that included Havening Touch (H+) than sessions that did not include Havening Touch (H-). Electroencephalography results showed an increase in beta and a reduction in gamma activity in H+. Both groups showed reduction in negative mood states immediately following the session and better psychological health at follow-up. Conclusion(s): Findings suggest both touch and nontouch components of the intervention have therapeutic potential, and that Havening Touch may accelerate a reduction in distress during a single Havening session.Copyright © 2022 American Psychological Association
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Introduction: Suicide represents a significant worldwide disease burden disproportionately affecting younger patients in their prime working years. Mortality by suicide remains within the five leading causes of death up to the age of 60. Compounding this, alcohol use disorder (AUD) is known to be a risk factor for death by suicide and has been on the rise over the last 20 years, particularly during the COVID-19 pandemic. The emergency department (ED) is often the first point of health care contact for those patients that have suicidal thoughts or behaviours and understanding their acute risk of death by suicide when presenting intoxicated with alcohol remains a challenge for ED physicians. While the chronic disease of AUD elevates their lifetime risk for death by suicide, it has not been established how a presentation for suicidality accompanied by acute alcohol intoxication affects this risk. Method(s): This was a retrospective cohort study using population-based linked health administrative data for adult patients aged 18 or above who presented to Alberta (ED) between 2011 and 2021 for suicidal attempt or self-harm behavior. Patients who were acutely intoxicated with alcohol were identified and analyses compared patients with and without alcohol intoxication. The primary outcome was six-month death by suicide. Categorical variables were summarized using proportions, whereas continuous variables were summarized using means and standard deviations (SD) or medians and interquartile ranges (IQR), as appropriate. Competing risk analysis was performed to explore the cumulative incidence of death by suicide within 180 days after their index ED visit and examine the association between death by suicide and alcohol intoxication. Result(s): Patients presenting to the ED for suicide attempt or self-harm behaviour were intoxicated with alcohol in 30% of cases as determined by diagnostic coding and blood alcohol measurements. Intoxicated patients were more likely to be placed under involuntary mental health hold (26% vs 16%) and had on average a longer length of stay in the ED (411 min vs 277 min) but were less frequently admitted (10.8% vs 15.4%). As a departure from previous literature, those intoxicated with alcohol were more likely to be consulted to psychiatry (15.8% vs 12.6%). Mortality due to suicide in the 6 months following the patient' index ED visit were similar between the intoxicated and non-intoxicated groups (0.3% vs 0.3%) however there was a significant increase in all-cause mortality at 6 months in the nonintoxicated group (1.5% vs 2.1%). Discussion(s): This study examined the patient and ED treatment characteristics of patients presenting to the ED with suicide attempt or self-harm behaviour. It found that the 6-month risk of death by suicide was no different in those who presented with acute alcohol intoxication vs those without. While these results differ from other studies discussing how alcohol use disorder confers a chronically increased risk of death by suicide, they provide new evidence for the emergency department providers to consider when assessing the patient who presents with suicidal behaviours while intoxicated.
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The major risk factor for suicide is mostly an untreated and frequently undiagnosed mental disorder. Dr Anitha Gautam will be talking about hidden epidemiology of suicide in India during COVID -19 pandemic. In India, for the past 5 years the number of deaths due to suicide has increased from approximately 1.3 lakhs in 2017 to 1.65 in 2021 (Suicide rate increasing from 9.9 to 12 per 1,00,000 population). Hence, there is need for developing a cost effective module which can address individual specific psychological stressors which are prevailing in Indian context. These psychological aspects can be delivered by non-specialist trained person. Dr.Hemendra Singh will discuss about association of Non- Suicidal Self Injury (NSSI) and suicide attempts among psychiatric patients based on his research and also need of developing a brief suicide prevention module for suicide attempters. As history of past suicide attempt is an important risk factor for future suicide, it is high time that the various factors associated with suicide attempt are to be identified to prevent future suicide. Dr Manaswi Gutam discusses on various strategies for suicide prevention along with highlights on NSSI. Dr Swati C would be discussing her experience of delivering brief intervention module for suicide prevention at a tertiary care hospital. Key Words: Non -Suicidal Self Injury, Suicide attempts, Psychiatric patients, Suicide Prevention.
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Behaviors maintained by automatic reinforcement are often more difficult to treat due to difficulty with identifying the relevant maintaining variable(s). One common intervention to treat automatically maintained behavior includes competing stimuli. Competing stimuli promote item engagement which may replace challenging behavior (i.e., response competition). Competing stimuli have shown to be a widely successful intervention across diverse topographies of challenging behavior;however, few studies have evaluated the use of competing stimuli on destructive behavior. The purpose of the current study was to treat automatically maintained destructive behavior with a competing stimuli intervention package for an adolescent with developmental disabilities. Results showed a decrease in destructive behavior when access to competing stimuli was a component of an intervention package in a clinic setting. Also, preliminary data are provided showing treatment effects when caregivers implemented the intervention. Due to the complexity of the final intervention package, recommendations for clinicians are provided which focus on improving feasibility, practicality, and sustainability of treatment components.Copyright © The Author(s) 2022.
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BACKGROUND: The COVID-19 pandemic is a unique distressing period of experience to the public with strict physical, social and economic restrictions. Moreover, the impact of this experience on children with school closures, online education and social isolation may have a profound psychosocial impact. OBJECTIVE(S): The objective was to evaluate and characterize the changes in mental health issues in children presenting to a large tertiary pediatric emergency department (ED) before and during the COVID-19 pandemic. DESIGN/METHODS: We performed a retrospective chart review of all children who presented with any mental health related diagnosis according to the ICD-10 classification from March 1, 2019 to February 28, 2020, and during pandemic periods (March 1, 2020 to February 28, 2021). Data on presentation, diagnosis and outcome were extracted and compared using Chi square test and z tests as appropriate. RESULT(S): Our centre experienced a 39% reduction (57,522 visits vs. 35,485 visits) in all ED visits but a significant increase (p=0.002) in mental health issues during the pandemic period of 5.22% compared to 4.88% during the previous year (2811/57522 visits vs. 1959/35485). Among 1,959 children presenting to ED during the pandemic, the majority (53%) were female children compared to a male predominance of 55% before the pandemic. The highest peak of visits was observed in the 14 to 16 years age group, irrespective of gender and pre/pandemic periods. The category that included eating disorders showed a distinct rise of 46% (p<0.001) during the pandemic period. Two categories Intentional Self-Harm and External Causes of Morbidity with Undetermined Intention did not show any difference, while Disorders of psychological development had a significantly low 46.5% (P<0.001) presentation during pandemic period. There wasn't an increase in presentation of depression and anxiety to ED during COVID-19. However, admissions were significantly high (p<0.001) during the pandemic 46.5% compared to the pre-pandemic (41.6%) period. CONCLUSION(S): During the pandemic, the percentage of visits related to mental health diagnoses in children increased significantly although the overall ED visits for all patients declined. As COVID-19 is expected to stay with us for the foreseeable future, we hope that this research will provide health care workers with the knowledge and understanding to optimize their approach to children at the ED.
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BACKGROUND: The COVID-19 pandemic has had marked effects on mental health, including in pediatric populations. Pediatric patients have faced mental health concerns at increased rates including anxiety and depression. Furthermore, patients with eating disorders represent a vulnerable group who have been negatively impacted as well, as a result of lack of support, loss of in-person follow-up and increased relapse. In our centre, and nationally, clinicians have noted a trend towards increased eating disorder referrals and increased hospitalizations during the pandemic. OBJECTIVE(S): The objective of this study was to determine the incidence, severity and triggers for eating disorders in the adolescent population during the COVID-19 pandemic and how it compares to the year prior. As well, the subset of patients who were hospitalized for medical stabilization were further analyzed to determine severity of illness. DESIGN/METHODS: A retrospective chart review compared the first year of the COVID-19 pandemic (March 2020-March 2021), to the previous 12 months. Inclusion criteria included referrals to an eating disorder clinic and inpatient admissions to pediatrics or mental health services during the specified time frame. Data collected included age of onset, triggers, comorbid mental health conditions, and weight measures. Among hospitalized patients, orthostatic vital changes, need for NG feeds, length of medical stabilization and length of mental health hospitalization were included. RESULT(S): Overall, 76 patients were included in the study. 44 (57.9%) were referred after COVID, which was significantly increased from the prior year (p=0.05). On average, patients presented at a younger age (14.2 +/- 2.3 vs. 14.9 +/- 1.9;p=0.08). Pre-COVID, approximately 44% of referrals were from family physicians and 19% from pediatrics. During COVID, approximately 39% were from family doctors and 25% from pediatricians. There was an increase in the number of patients requiring hospitalization for treatment (16 vs. 3), with 50% of the post-COVID admissions being direct from the ED Clinic on initial assessment. The reason for hospitalization was unstable vitals/ bradycardia in 68.7% of admissions;self-harm comprised the majority of the other admissions. CONCLUSION(S): Our results support national and international reports that eating disorder incidence has increased during COVID-19. Patients described loss of routine, anxiety, and isolation as triggers related to the pandemic. Disruptions to daily life including school, sports, recreation, and relationships had profound effects on the mental health of children. The effect of social media on body image has also contributed. It is important for clinicians to screen for mental health conditions, including eating disorders at all available opportunities. Furthermore, this study demonstrates the need for increased services at our centre. Limitations for this study include that it is a single-centre study with a relatively small patient population. As well, it does not capture patients who may have been referred only to psychiatry.
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Database, and Hospital Morbidity Database. The primary outcome was ambulatory care visits for a composite of suicidal ideation, intentional self-poisoning, and intentional self-harm. Results were stratified by age and sex and expressed as a rate (proportion of encounters with an outcome per 100 encounters). We compared the differences (delta) in slopes (average increase in outcomes) between April 1, 2015, to March 31, 2020, and April 1, 2020 to March 31, 2021 to determine if the expected rate (pre-pandemic) differed significantly from the observed rate (pandemic). RESULT(S): From April 1, 2020, to March 31, 2021, compared to April 1, 2015, to March 31, 2020, the rate of ambulatory care visits and admissions for all conditions decreased. The average quarterly rate of ambulatory care visits for the composite among males 10-14 years, increased by 40.3%, from 0.57 to 0.8 (slope delta=0.1;95% CI: 0.02, 0.18;p=0.012). Among females 10-14 years, the rate increased by 85.1%, from 1.81 to 3.35 (slope delta=0.7;95% CI: 0.43, 0.97;p<0.001). Among males 15-18 years, the rate increased by 29.5%, from 1.56 to 2.02 (slope delta=0.13;95% CI: -0.02, 0.28;p=0.078). Among females 15-18 years, the rate increased by 33.6%, from 3.18 to 4.25 (slope delta=0.26;95% CI: -0.16, 0.68;p=0.192). The average quarterly rate of admissions was significant for females 10-14 years and increased by 27.7%, from 8.59 to 10.97 (slope delta=1.99;95% CI: 0.57, 3.41;p=0.017). CONCLUSION(S): The proportion of ambulatory care visits and admissions for emotional symptoms, suicidal ideation, and self-harm during the first year of the COVID-19 pandemic increased compared to pre-pandemic rates among adolescents 10-14 years in Canada. Our findings underscore the importance of promoting public health policies that mitigate the impact of pandemics on adolescent mental health.