Suicides in state prisons in the United States: Highlighting gaps in data.

OBJECTIVES: Our objectives were to document data availability and reporting on suicide mortality in state prison systems. The United States leads the world in mass incarceration, a structural determinant of health, but lacks real-time reporting of prison health statistics. This absence is particularly notable in suicides, a leading cause of death that carceral policies play a key role in mitigating. METHODS: Suicide data for each state prison system from 2017-2021 were gathered through statistical reports, press releases, and Freedom of Information Act requests. We graded states based on data availability. RESULTS: Only sixteen states provide updated, frequent, granular, freely provided suicide data. An additional thirteen states provided frequently updated data but that had little granularity, was incomplete, or was not freely provided. Eight states provided sparse, infrequent, or outdated data, and thirteen provided no data at all. CONCLUSIONS: The 2000 Death in Custody Reporting Act requires that states provide these data freely, yet the majority of states do not. There is a need for reliable, real-time data on suicides, suicide attempts, and conditions of confinement to better understand the harms of the carceral system and to advocate for change.

A pilot predictive model based on COVID-19 data to assess suicidal ideation indirectly.

The COVID-19 pandemic has had a negative impact on the mental health of the population. Many studies reported high levels of psychological distress and rising rates of suicidal ideation (SI). Data on a range of psychometric scales from 1790 respondents were collected in Slovenia through an online survey between July 2020 and January 2021. As a worrying percentage (9.7%) of respondents reported having SI within the last month, the goal of this study was to estimate the presence of SI, as indicated by the Suicidal Ideation Attributes Scale (SIDAS). The estimation was based on the change of habits, demographic features, strategies for coping with stress, and satisfaction with three most important aspects of life (relationships, finances, and housing). This could both help recognize the telltale factors indicative of SI and potentially identify people at risk. The factors were specifically selected to be discreet about suicide, likely sacrificing some accuracy in return. We tried four machine learning algorithms: binary logistic regression, random forest, XGBoost, and support vector machines. Logistic regression, random forest, and XGBoost models achieved comparable performance with the highest area under the receiver operating characteristic curve of 0.83 on previously unseen data. We found an association between various subscales of Brief-COPE and SI; Self-Blame was especially indicative of the presence of SI, followed by increase in Substance Use, low Positive Reframing, Behavioral Disengagement, dissatisfaction with relationships and lower age. The results showed that the presence of SI can be estimated with reasonable specificity and sensitivity based on the proposed indicators. This suggests that the indicators we examined have a potential to be developed into a quick screening tool that would assess suicidality indirectly, without unnecessary exposure to direct questions on suicidality. As with any screening tool, subjects identified as being at risk, should be further clinically examined.

Association of mental health status between self-poisoning suicide patients and their family members: a matched-pair analysis.

BACKGROUND: The objective of this study was to examine the relationship of mental health status between self-poisoning suicide patients and their family members, and it also sought to identify potential patient's risk and parental factors for the prediction of suicide attempt, anxiety, and depression. METHODS: In this study, 151 poisoned patients were prospectively included, and they were matched 1:1 with 151 family members. We gathered information on patient's and their matched family member's demographics, lifestyle choices, mental health status, level of intimacy, and history of psychiatry disease. The relationship of patient's and their family member's mental health state was investigated using a correlation matrix. Multivariable analyses (multiple logistic regression) were conducted among patients and their matched family members, to identify potential risk factors for self-poisoning suicide, anxiety, and depression. RESULTS: Of the total patients, 67.55% (102/151) attempted self-poisoning suicide. Poisoned patients had more severe anxiety and depression symptoms than their matched family members, and this difference was even more pronounced among patients with self-poisoning suicide. Generalized anxiety disorder-7 (GAD-7) score for family members was significantly and favorably correlated with patient's GAD-7 score after eliminating non-suicide patients and their matched family members. The patient health questionnaire-9 (PHQ-9) score showed a similar pattern, and the family member's PHQ-9 score was strongly and favorably associated with patient's PHQ-9 and Beck hopelessness scale-20 (BHS-20) score. Multivariable analysis showed that married marital status (P = 0.038), quitting smoking (P = 0.003), sedentary time of 1 to 6 h (P = 0.013), and participation in a sports more than five times per week (P = 0.046) were all significantly associated with a lower risk of suicide by self-poisoning, while a more serious anxiety state (P = 0.001) was significantly associated with a higher risk of self-poisoning suicide. Multivariable analysis demonstrated that, specifically among self-poisoning suicide patients, married marital status (P = 0.011) and no history of psychiatry disease (P < 0.001) were protective factors for anxiety, while divorced or widowed marital status (P = 0.004), a sedentary time of 1 to 3 h (P = 0.022), and a higher monthly income (P = 0.027) were significant contributors to anxiety. The propensity of additional family-matched characteristics to predict patient's suicidality, anxiety, and depression was also examined. CONCLUSIONS: Self-poisoning suicide patients have severe mental health issues. Patients who self-poison have a close connection to their family member's mental health, particularly their levels of anxiety and depression. According to the findings, being married and adopting healthy lifestyle habits, such as quitting smoking and drinking, increasing their physical activity levels, and managing their idle time, are able to help patients with mental health concerns and even suicidal thoughts.

Comparison of the Clinical Characteristics of Pediatric Poisoning Patients Who Visited Emergency Department Before and During the COVID-19 Pandemic.

BACKGROUND: We aimed to investigate changes in the clinical characteristics of pediatric poisoning patients who visited the emergency department (ED) before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Poisoning cases below age 18 who visited the ED from January 2018 to December 2021 were retrospectively analysed. The study period was then divided into pre-COVID-19 and COVID-19 pandemic to compare poisoning patterns. RESULTS: During the study period, 86,153 visits to the pediatric ED had been recorded, with 625 patients being included the final analysis. During the COVID-19 period, the proportion of poisoned patients increased from 0.62% to 0.98%. The average age of the patients was higher in the COVID-19 period, with 53.4% of the cases being intentional (pre-COVID-19, 32.5%; P < 0.001). Moreover, 70.4% of poisoning cases during the COVID-19 period were caused by drugs (pre-COVID-19, 60.6%; P = 0.038). More patients underwent decontamination and laboratory investigation during the COVID-19 period than during the previous period (P = 0.007 and P < 0.001, respectively). The length of ED stay and the proportion of hospitalisation were significantly greater during the COVID-19 period. After analysing accidental poisoning cases, we found that antipyretics/nonsteroidal anti-inflammatory drugs and respiratory drugs were more common in the pre-COVID-19 group, whereas iron/vitamins, cardiovascular drugs and hormones were more common in the COVID-19 group. After analysing intentional poisoning cases, we found that 73.6% and 76.4% of the patients in the pre-COVID-19 and COVID-19 group had a history of psychiatric disease, respectively. Although no difference was observed in the frequency of previous first suicide attempts, 19.0% of the patients in the COVID-19 group attempted suicide more than three times. CONCLUSION: During the COVID-19 pandemic, intentional poisoning cases, especially in adolescence, increased and were treated more. Many of the patients with intentional poisoning had a history of mental illness or suicide in the past. Therefore, it seems that policy consideration for mentally vulnerable adolescents during this new pandemic period is necessary.

Emergency Department Visits With Suicidal Ideation: United States, 2016- 2020.

Before the COVID-19 pandemic in the United States, suicide was the 10th highest cause of death overall and the 2nd highest cause for the 10-34 age group (1,2). Suicidal ideation is defined as thinking about, considering, or planning suicide; is predictive of suicide deaths; and may result in injury and hospitalization (3). An estimated 4.0% to 4.8% of adults aged 18 and over have suicidal ideation each year (4,5). The lifetime prevalence of suicidal ideation in the United States is 15.6% (6). This report uses data from the 2016-2020 National Hospital Ambulatory Medical Care Survey to present the annual average emergency department (ED) visit rate per 10,000 people for patients with suicidal ideation.

Suspected Suicide Attempts by Self-Poisoning Among Persons Aged 10-19 Years During the COVID-19 Pandemic - United States, 2020-2022.

The World Health Organization declared COVID-19 a global pandemic on March 11, 2020 (1). As strategies to mitigate the pandemic were implemented, concerns were raised that the containment efforts through quarantine and social distancing practices were negatively affecting the mental and physical health of children and adolescents (2). Suicide is a growing public health problem in the United States. In 2020, suicide was the second leading cause of death among persons aged 10-14 years and the third leading cause among those aged 15-24 years (3). The National Poison Data System (NPDS) database was used to examine trends in suspected suicide attempts by self-poisoning among persons aged 10-19 years before and during the COVID-19 pandemic. Compared with 2019 (prepandemic), during 2021, the overall rate of suspected suicide attempts by self-poisoning increased by 30.0% (95% CI = 28.6%-30.9%), rates among children aged 10-12 years, adolescents aged 13-15 years, and females increased 73.0% (67.4%-80.0%), 48.8% (46.7%-50.9%), and 36.8% (35.4%-38.2%), respectively, and these trends continued into the third quarter of 2022. Substances most frequently involved in overdoses were acetaminophen, ibuprofen, sertraline, fluoxetine, and diphenhydramine. Acetaminophen-involved overdoses increased 71% (67.4%-74.9%) in 2021 and 58.0% (54.5%-61.6%) in 2022. Diphenhydramine-involved overdoses increased 24.2% (19.9%-28.7%) in 2021 and 35.8% (31.2%-40.5%) in 2022. A comprehensive public health approach to suicide prevention, focused on children and adolescents and involving a partnership between families, school teachers, mental health professionals, and public health leadership is needed. The 9-8-8 Suicide and Crisis Lifeline provides crisis support for persons experiencing mental health-related distress and assists community members who are concerned about persons experiencing a mental health crisis.

Suicide prevention in the covid-19 era.

The COVID-19 pandemic is affecting the health of people all around the world including mental health as social isolation which has been one of the best infection mitigation efforts is strongly associated with anxiety, depression, self-harm and suicide attempts. These feelings are consistent with past pandemics where there was loss of routine and sociability. Suicidality has been on the rise in the United States and it is within this context that the pandemic has struck. With the risk of suicide being increased, preventative measures need to be implemented at the universal, selective and indicated levels. Universal suicide prevention is needed for the population as a whole regardless of their risk of suicide. Selective prevention is for subgroups at an increased risk and lastly indicated prevention corresponds to people at a very high risk, for example those with recent suicide attempts. Telemedicine, informative and responsible media, as well as monetary help from governments, banks and other major institutions can all help with suicide prevention in these during the pandemic. These resources can broadly help the population at large, but more targeted approaches will be needed for high risk individuals including those with psychiatric diagnoses, COVID-19 survivors, frontline healthcare workers and the elderly. Additionally, those with recent suicide attempts should warrant even more attention.

Descriptive analysis of depression among adolescents in Huangshi, China.

BACKGROUND: More adolescents suffered from depressive disorder, and what was worse, the morbidity increased annually. The situation was getting worse during COVID-19 pandemic. The prevalence of depression among adolescents in China has increased a lot due to social and economic development, family-associated reasons, academic stress, interpersonal relationships, and so on. OBJECTIVE: This study aimed to determine the prevalence, gender differences, risk factors, and abnormal illness behaviors of depression among adolescents in Huangshi, China. METHODS: A descriptive analysis was conducted based on the data from clinical interviews and self-reports by the patients. Depression was assessed and diagnosed using the DSM-5 Diagnostic and Statistical Manual of Mental Disorders. RESULTS: Depression was most frequently seen in 674 patients with mental illnesses (282, 41.84%). The male-to-female ratio was 1:2.44, and their age ranged from 9 to 18. The majority of patients are in high school (261/282, 92.55%), and the highest morbidity occurred at 16 years. More cases were diagnosed in urban than in rural areas. Genetic factors, school violence, academic stress, sleep disorders, and family-related factors were essential factors leading to depression among adolescents. Most patients had sleep disorders (84.75%). In family-related factors, left-behind children and unrecognized/misunderstood by their families were prominently diagnosed with depression. A large portion of individuals with depression felt apathetic, solitary, and sluggish and were unable to study, work, and live normally (212/282, 75.18%); they even committed suicide or attempted suicide (228/282, 80.85%) and inflicted self-harm (146/282, 51.77%). CONCLUSIONS: An increasing trend of depression has been observed since 2018, especially in 2021. This depression has led to suicide or suicidal attempts and self-harm, reflecting the severity of mental health among adolescents in Huangshi. Therefore, this study aimed to draw the attention of society, families, and schools to the importance of mental health among adolescents, providing guidance and references for the prevention, diagnosis, and treatment of young depressive disorders in China.

[Suicide attempt before and during the COVID-19 pandemic: A comparative study from the emergency department]. / Intento de suicidio antes y durante la pandemia de covid-19. Estudio comparativo desde el servicio de urgencias.

OBJECTIVES: To study the prevalence and characteristics of the patients who consulted in the emergency department for attempted suicide in 2021 and to compare them with those carried out in the pre-Covid period in 2019. METHODS: Retrospective cross-sectional study between January 1 and December 31, 2019 and 2021. Demographic, clinical variables (history, psychiatric medication, toxic abuse, mental health follow-up, and previous suicide attempt) and characteristics of the current suicide episode (mechanism, triggering reason, and patient destination) were included. RESULTS: They consulted 125 patients in 2019 and 173 in 2021, mean age 38.8±15.2 and 37.9±18.5 years, women 56.8% and 67.6%. They presented: previous suicide attempt, men 20.4% and 19.6%, women 40.8% and 31.6%; substance use disorder, men 51.8% and 46.4%, women 39.4% and 17.1%, due to alcohol, men 78.6% and 88.5%, women 82.1% and 70%. Characteristics of the autolytic episode: pharmacological cause, 68.8% in 2019, 70.5% in 2021, benzodiazepines (81.3% and 70.2%); toxic (30.4% and 16.8%), alcohol (78.9% and 86.2%), medication more associated with alcohol (benzodiazepines, 56.2% and 59.1%); self-harm (11.2% and 8.7%). Destination of the patients: outpatient psychiatric follow-up (84% and 71.7%), hospital admission (8.8% and 11%). CONCLUSIONS: There was an increase in consultations of 38.4%, the majority were women, who also presented a higher prevalence of previous suicide attempt; men presented more substance use disorder. The most frequent autolytic mechanism was drugs, especially benzodiazepines. The most used toxicant was alcohol, most of the time associated with benzodiazepines. Upon discharge, most patients were referred to the mental health unit.

Trends in emergency department visits for suicide attempts before and during the COVID-19 pandemic in Korea: A nationwide study, 2016-2021.

BACKGROUND: There is increasing concern that the effects of the COVID-19 pandemic will result in excess suicides by increasing known risk factors, such as suicide attempts. However, evidence on the long-term impacts of COVID-19 on suicide attempts is lacking. We aimed to assess the short- and long-term effects of the COVID-19 pandemic on patients with suicide attempts in emergency departments (EDs) and to evaluate age- and sex-specific differences. METHOD: We conducted nationwide cross-sectional study among patients with suicide attempts in the ED from 2016 to 2021. The trend test were used to determine whether study subjects were affected by changes in ED visits for suicide attempts. We estimated the average annual percentage change (APC) stratified by sex and age groups. RESULTS: The number of ED visits related to suicide attempts increased from 27,581 in 2016 to 37,719 in 2021. In particular, it decreased immediately after the COVID-19 pandemic but increased again in 2021. We identified that the average APC increased by 6.8 % overall, 1.6 % among males, and 10.8 % among females. Moreover, the APC of trend sharply increased in patients aged 10s and 20s. The in-hospital mortality was 3.6 % for females, compared to 9.5 % for males, which showed sex differences. LIMITATIONS: This study was limited to confirming causal relationship based on a descriptive study. CONCLUSIONS: The incidence of suicide attempts in ED has increased in Korea. In particular, there was a sharp increase among women, adolescents and young adults. Patient-tailored treatment and preventive medical system for suicide attempts is important.

National trends in suicide-related behaviors among youths between 2005-2020, including COVID-19: a Korean representative survey of one million adolescents.

OBJECTIVE: It is difficult to conclude that COVID-19 is associated with a decrease in the suicide attempts rate by comparing only a short-term period. Therefore, it is necessary to examine attempted suicide rates through a trend analysis over a longer period. This study aimed to investigate an estimated long-term trend regarding the prevalence of suicide-related behaviors among adolescents in South Korea from 2005 to 2020, including COVID-19. SUBJECTS AND METHODS: We sourced data from a national representative survey (Korea Youth Risk Behavior Survey) and analyzed one million Korean adolescents aged 13 to 18 years (n=1,057,885) from 2005 to 2020. The 16-year trends regarding the prevalence of sadness or despair and suicidal ideation and attempt and the trend changes before and during COVID-19. RESULTS: Data of 1,057,885 Korean adolescents was analyzed (weighted mean age, 15.03 years; males, 52.5%; females, 47.5%). Although the 16-year trend in the prevalence of sadness or despair and suicide ideation and attempt consistently decreased (prevalence of sadness or despair between 2005-2008, 38.0% with 95% confidence interval [CI], 37.7 to 38.4 vs. prevalence in 2020, 25.0% [24.5 to 25.6]; suicide ideation between 2005-2008, 21.9% [21.6 to 22.1] vs. prevalence in 2020, 10.7% [10.3 to 11.1]; and suicide attempt between 2005-2008, 5.0% [4.9 to 5.2] vs. prevalence in 2020, 1.9% [1.8 to 2.0]), the downward slope decreased during COVID-19 (ßdiff in sadness, 0.215 with 95% CI 0.206 to 0.224; ßdiff in suicidal ideation, 0.245 [0.234 to 0.256]; and ßdiff in suicide attempt, 0.219 [0.201 to 0.237]) compared with pre-pandemic period. CONCLUSIONS: This study found that the observed risk of suicide-related behaviors during the pandemic was higher than expected through long-term trend analysis of the prevalence of sadness/despair and suicidal ideation and attempts among South Korean adolescents. We need a profound epidemiologic study of the change in mental health due to the pandemic's impact and the establishment of prevention strategies for suicide ideation and attempt.

Cross-national presence and sociodemographic correlates of the suicide crisis syndrome.

BACKGROUND: The Suicide Crisis Syndrome (SCS) has been proposed as an acute, pre-suicidal mental state that precedes imminent suicidal behavior; however, its cross-national applicability and sociodemographic correlates have not yet been determined. The present study assessed the presence and severity of the SCS in ten countries and examined several potential sociodemographic correlates (i.e., age, gender, marital status, race/ethnicity) of the SCS. METHODS: 5528 community-based adults across 10 participating countries provided information on their SCS symptoms and sociodemographic characteristics in an anonymous online survey obtained via convenience sampling during the first year of the COVID-19 pandemic. RESULTS: The SCS occurred cross-nationally, with rates ranging from 3.6% (Israel) to 16.2% (Poland). Those in the United States, South Korea, Poland, and Turkey had the highest severity of symptoms. Participants who were older, identified as cisgender men, and married tended to have lower rates of the SCS than their respective counterparts. There were minimal differences in the SCS by race/ethnicity. LIMITATIONS: These data were both cross-sectional and collected via convenience sampling, limiting generalizability of findings and information about the SCS's predictive utility. CONCLUSIONS: These findings support the cross-national presence of the SCS during the COVID-19 pandemic. Sociodemographic correlates aligned with those of suicidal behavior more generally, providing additional evidence for the concurrent/predictive validity of the SCS.

Increased suicidal ideation and suicide attempts in COVID-19 patients in the United States: Statistics from a large national insurance billing database.

Emerging research suggests suicidality may have increased during the COVID-19 pandemic. This cross-sectional study aimed to advance understanding of suicide risk during the pandemic through novel use of a large insurance database. Using logistic regression across time-points, we estimated the effect of exposure to SARS-CoV-2 infection on rates of suicidal ideation and suicide attempts in infected individuals versus uninfected controls during the pandemic (March 2020 - September 2021). In uninfected individuals, we estimated the effect of exposure to the pandemic period versus the pre-pandemic control period (January 2017 to February 2020) on suicidality rates. We also investigated within-pandemic temporal patterns of suicidality. All patients with data in the UnitedHealth Group claims during those intervals were included. ICD-10 codes defined suicidality measures. There were 525,312,717 (62.3% over age 45, 57.7% female) included encounters. From the pandemic subsample (32.8%), 1.7% were COVID+. Adjusted odds ratios showed that COVID+ patients were significantly more likely to have suicidal ideation and suicide attempts than COVID- patients. Among COVID- patients, adjusted odds of suicidality were significantly lower during versus prior to the pandemic. Results were unfortunately limited by the absence of data on deaths by suicide. Further research should examine how SARS-CoV-2 infection may influence suicidality.

Effectiveness of a targeted brief intervention for recent suicide attempt survivors: a randomised controlled trial protocol.

INTRODUCTION: Effective, brief, low-cost interventions for suicide attempt survivors are essential to saving lives and achieving the goals of the National Strategy for Suicide Prevention and Zero Suicide. This study aims to examine the effectiveness of the Attempted Suicide Short Intervention Program (ASSIP) in averting suicide reattempts in the United States healthcare system, its psychological mechanisms as predicted by the Interpersonal Theory of Suicide, and the potential implementation costs, barriers and facilitators for delivering it. METHODS AND ANALYSIS: This study is a hybrid type 1 effectiveness-implementation randomised controlled trial (RCT). ASSIP is delivered at three outpatient mental healthcare clinics in New York State. Participant referral sites include three local hospitals with inpatient and comprehensive psychiatric emergency services, and outpatient mental health clinics. Participants include 400 adults who have had a recent suicide attempt. All are randomised to 'Zero Suicide-Usual Care plus ASSIP' or 'Zero Suicide-Usual Care'. Randomisation is stratified by sex and whether the index attempt is a first suicide attempt or not. Participants complete assessments at baseline, 6 weeks, and 3, 6, 12 and, 18 months. The primary outcome is the time from randomisation to the first suicide reattempt. Prior to the RCT, a 23-person open trial took place, in which 13 participants received 'Zero Suicide-Usual Care plus ASSIP' and 14 completed the first follow-up time point. ETHICS AND DISSEMINATION: This study is overseen by the University of Rochester, with single Institutional Review Board (#3353) reliance agreements from Nathan Kline Institute (#1561697) and SUNY Upstate Medical University (#1647538). It has an established Data and Safety Monitoring Board. Results will be published in peer-reviewed academic journals, presented at scientific conferences, and communicated to referral organisations. Clinics considering ASSIP may use a stakeholder report generated by this study, including incremental cost-effectiveness data from the provider point of view. TRIAL REGISTRATION NUMBER: NCT03894462.

Pediatric Suspected Suicides and Nonfatal Suicide Attempts Reported to United States Poison Control Centers Before and During the COVID-19 Pandemic.

INTRODUCTION: This study investigated the characteristics and compared the trends of pediatric suspected suicide and nonfatal suicide attempts reported to United States (US) poison control centers (PCCs) before and during the first year of the COVID-19 pandemic. METHODS: An interrupted time series analysis using an ARIMA model was conducted to evaluate the trends of suspected suicides and nonfatal suicide attempts among children 6-19 years old reported to the National Poison Data System during March 2020 through February 2021 (pandemic period) compared with March 2017 through February 2020 (pre-pandemic period). RESULTS: The annual number of cases of suspected suicides and nonfatal suicide attempts increased by 4.5% (6095/136,194) among children 6-19 years old during March 2020 through February 2021 compared with the average annual number during the previous three pre-pandemic years. There were 11,876 fewer cases than expected from March 2020 to February 2021, attributable to a decrease in cases during the initial three pandemic months. The average monthly and average daily number of suspected suicides and nonfatal suicide attempts among children 6-12 years old and 13-19 years old was higher during school months than non-school months and weekdays than weekends during both the pre-pandemic and pandemic periods. CONCLUSIONS: There was a greater than expected decrease in the number of suspected suicides and nonfatal suicide attempts among children 6-19 years old reported to US PCCs during the early pandemic months, followed by an increase in cases. Recognizing these patterns can help guide an appropriate public health response to similar future crises.

Comparison of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation before and during the COVID-19 pandemic: a systematic review and meta-analysis.

BACKGROUND: There is a lack of consensus about the effect of the COVID-19 pandemic on the mental health of children and adolescents. We aimed to compare rates of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation during the pandemic with those before the pandemic. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO for studies published between Jan 1, 2020, and Dec 19, 2022. Studies published in English with data on paediatric (ie, those aged <19 years) emergency department visits before and during the COVID-19 pandemic were included. Case studies and qualitative analyses were excluded. Changes in attempted suicide, self-harm, suicidal ideation, and other mental-illness indicators (eg, anxiety, depression, and psychosis) were expressed as ratios of the rates of emergency department visits during the pandemic compared with those before the pandemic, and we analysed these with a random-effects meta-analysis. This study was registered with PROSPERO, CRD42022341897. FINDINGS: 10 360 non-duplicate records were retrieved, which yielded 42 relevant studies (with 130 sample-estimates) representing 11·1 million emergency department visits for all indications of children and adolescents across 18 countries. The mean age of the samples of children and adolescents across studies was 11·7 years (SD 3·1, range 5·5-16·3), and there were on average 57·6% girls and 43·4% boys as a proportion of emergency department visits for any health reasons (ie, physical and mental). Only one study had data related to race or ethnicity. There was good evidence of an increase in emergency department visits for attempted suicide during the pandemic (rate ratio 1·22, 90% CI 1·08-1·37), modest evidence of an increase in emergency department visits for suicidal ideation (1·08, 0·93-1·25), and good evidence for only a slight change in self-harm (0·96, 0·89-1·04). Rates of emergency department visits for other mental-illness indications showed very good evidence of a decline (0·81, 0·74-0·89), and paediatric visits for all health indications showed strong evidence of a reduction (0·68, 0·62-0·75). When rates for attempted suicide and suicidal ideation were combined as a single measure, there was good evidence of an increase in emergency department visits among girls (1·39, 1·04-1·88) and only modest evidence of an increase among boys (1·06, 0·92-1·24). Self-harm among older children (mean age 16·3 years, range 13·0-16·3) showed good evidence of an increase (1·18, 1·00-1·39), but among younger children (mean age 9·0 years, range 5·5-12·0) there was modest evidence of a decrease (0·85, 0·70-1·05). INTERPRETATION: The integration of mental health support within community health and the education system-including promotion, prevention, early intervention, and treatment-is urgently needed to increase the reach of mental health support that can mitigate child and adolescent mental distress. In future pandemics, increased resourcing in some emergency department settings would help to address their expected increase in visits for acute mental distress among children and adolescents. FUNDING: None.

Suicide Attempts in Children Aged 10-14 Years During the First Year of the COVID-19 Pandemic.

PURPOSE: To determine if suicide attempts increased during the first year of the pandemic among young adolescents in Quebec, Canada. METHODS: We analyzed children aged 10-14 years who were hospitalized for a suicide attempt between January 2000 and March 2021. We calculated age-specific and sex-specific suicide attempt rates and the proportion of hospitalizations for suicide attempts before and during the pandemic and compared rates with patients aged 15-19 years. We used interrupted time series regression to measure changes in rates during the first (March 2020 to August 2020) and second (September 2020 to March 2021) waves and difference-in-difference analysis to determine if the pandemic had a greater impact on girls than boys. RESULTS: Suicide attempt rates decreased for children aged 10-14 years during the first wave. However, rates increased sharply during the second wave for girls, without changing for boys. Girls aged 10-14 years had an excess of 5.1 suicide attempts per 10,000 at the start of wave 2, with rates continuing to increase by 0.6 per 10,000 every month thereafter. Compared with the prepandemic period, the increase in the proportion of girls aged 10-14 years hospitalized for a suicide attempt was 2.2% greater than that of boys during wave 2. The pattern seen in girls aged 10-14 years was not present in girls aged 15-19 years. DISCUSSION: Hospitalizations for suicide attempts among girls aged 10-14 years increased considerably during the second wave of the pandemic, compared with boys and older girls. Young adolescent girls may benefit from screening and targeted interventions to address suicidal behavior.

Time series analysis of the suicide attempts assisted by firefighters from 2017 to 2021 in São Paulo, Brazil.

OBJECTIVE: This study aimed to analyze the time trends of suicide attempts assisted by the Fire Department of the Military Police of the State of São Paulo (Corpo de Bombeiros da Polícia Militar do Estado de São Paulo - CBPMESP) from 2017 to 2021, between sexes. METHODS: This is an ecological study of 11,435 suicide attempts assisted by CBPMESP calls from January 2017 to December 2021. Three seasonal auto-regressive integrated moving average with exogenous (SARIMAX) models were adjusted considering total population, only men, and only women. RESULTS: The total occurrences of suicide attempts were stationary in the prepandemic period but had an increased growth pattern after the pandemic began. This trend was higher among men, due to (1) lower assistance of suicide attempts during early pandemic than in the prepandemic period and (2) significant increased assistance after the beginning of vaccination against COVID-19, followed by a decrease, but with a tendency to increase, in the long-term pandemic. CONCLUSION: Our results indicate a growth in the long-term suicide attempts during COVID-19. The beginning of vaccination was not considered significant in the reduction of CBPMESP attendances. These results corroborate the need for a multisectoral national suicide prevention strategy to mitigate the effects of the pandemic on mental health in the State of São Paulo.