Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study.

OBJECTIVE: To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. METHOD: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. RESULTS: Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). CONCLUSION: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. DIVERSITY & INCLUSION STATEMENT: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

COVID-19 and suicides in India: Where do we stand?

Introduction1 The Corona Virus Disease 2019 (COVID-19) has ignited many debates and has undoubtedly shaken up the core foundations of the health-care system worldwide. There has been plenty of evidence that pandemic and the effects of lockdown have Studies have resulted in elevated levels of psychological symptoms such as depression, anxiety, phobia, trauma, etc. Concerning the COVID-19 outbreak (since late January 2020 in India), the first case that was reported in India is stated to be due to fear of being infected with COVID-19. Similarly, COVID-19 suicide occurrences were reported as of fear of infection, economic crisis and social boycott in Bangladesh and Pakistan, from the neighbouring countries of India. Though the report of the National Crime Record Bureau (NCRB) was released as last as October’21 this year, many of the incidents were reported by press and over social media platforms. The NCRB Statistics - 20202 A total of 1,53,052 suicides were reported in the country during 2020 showing an increase of 10.0% in comparison to 2019 & the rate of suicides has increased by 8.7% during 2020 over 2019. Majority of suicides were reported in Maharashtra (13.0%) followed by Tamil Nadu (11.0%), Madhya Pradesh (9.5%), West Bengal (8.6%) & Karnataka (8.0%). These 5 States together accounted for 50.1% of the total suicides reported in the country. Family Problems (33.6%) & Illness (18.0%)’ were the major causes of suicides. Drug Abuse/Addiction (6.0%), Marriage Related Issues(5.0%), Love Affairs (4.4%), Bankruptcy or Indebtedness (3.4%), Unemployment (2.3%), Failure in Examination (1.4%) & Poverty (1.2%) were other causes. Daily wage earners accounted for the maximum percentage (24.6%). Hanging’ (57.8%), consuming ‘Poison’ (25.0%), ‘Drowning’ (5.2%) and ‘Fire/Self Immolation’ (3.0%) were the prominent means/mode. Beyond the NCRB Statistics3 The NCRB report has some significant limitations. NCRB underestimates suicide rates due to under- reporting of cases & this data is usually made available after a significant delay of between 12 and 24 months. Furthermore, NCRB releases summary annual data rather than weekly or monthly data to analyse trends (Important during COVID19). NCRB does not keep any record of attempted suicides as well. Analysis of media reports reveals that the rates of suicide and attempted suicide between 24 March to 3 May 2020 compared to the same dates in 2019 showed a 67.7% increase in reported suicides and attempted suicides during the lockdown. More suicides & attempted suicides were by older employed men. Suicides increased in 2020 in states which traditionally have low suicide rates such as Bihar, Uttar Pradesh, Rajasthan, Haryana, and Chandigarh (also economically less developed & inadequate health infrastructure). There were 39 alcohol-related suicides & 7 attempted suicides as compared to no such suicide/ attempted suicide cases in 2019. Conclusion3 The possibility that the pandemic may have increased the risk of suicide as reflected from the media reports has been attested by the recently released NCRB data. However, both the reports are an underestimate of the true figures. The pandemic however has now provided an opportunity for cross- sectoral collaboration for suicide prevention rather than restricting suicide prevention to the health sector Symposium Proposal: Digital Phenotyping in Mental Health This symposium explores the emerging field of digital phenotyping in mental health. Despite developments, psychiatry heavily relies on patients’ interviews and self-reporting to match the diagnostic criteria of the ICD or DSM and is still handicapped by the lack of objective measurements for diagnosis and management. Smartphones and wearables, which have emerged as new tools for health investigation, generate many digital fingerprints that provide insights into human behavior. They collect data in naturalistic settings in-situ, leveraging the lived experiences of patients and no longer confined to clinics or research laboratories. However, such technology with revolutionary p tential is also associated with challenges and controversies. Various legal, ethical, and security issues concern digital phenotyping in mental health. The first presentation by Vijay Gogoi of LGBRIMH sets the scene for what follows1. He discusses the advent and concept of using digital devices and the Internet of Things (IoT) for personal sensing in the context of mental health. Terminologies like computational behavioral analysis, personal sensing, continuous measurement are being applied in similar research approaches. Hence, some researchers also view digital phenotyping as a variant of deep phenotyping, closely aligned with the goals of precision medicine and a new tool for the National Institute of Mental Health’s Research Domain Criteria. Dhrubajyoti Chetia of LGBRIMH then discusses the various research trends in mental health using digital devices2. The features studied as behavioral markers for social context, stress, sleep, mood, and clinical disorders like depression, schizophrenia, and bipolar disorder will be discussed. Changes in location and activity patterns, keyboard interaction dynamics, voice modulation, social communication logs are used to predict depressive and manic states. Proactive screening in online environments and automatic natural language processing of social media posts have been used successfully to identify individuals with evidence of psychological distress. Signals from smartphones and clinical measurements may provide a safety net for patients at risk of self-harm or suicide. The challenges and limitations of using digital technology are highlighted by Sajjadur Rehman of Lady Hardinge Medical College3. Results are not comparable across studies because of varying data collection techniques and research designs. As most research is currently being carried out in small samples as proof of concept studies, replicating the same in a large population is a challenge. Variability from geographical location, characteristics of people, data types, environments, etc., is a barrier. With rapid technological advancements, and people changing their usage, machine learning algorithms are bound to become inaccurate. Finally, as health care professionals, the ethical and security concerns were discussed by Kunal Deb of LGBRIMH4. Accountability for safety and efficacy, usually assessed by government agencies, is still not well developed for digital health technologies. Strict data privacy and protection regulations also need to be in place. The use of various data streams may assist the third party in re-identifying individuals without their knowledge, with the potential impacts of mental health diagnosis and predictions on employment, insurance, litigation, and other contexts. 1.Vijay Gogoi, Associate Professor, Psychiatry, LGBRIMH, Tezpur, Assam 2.Dhrubajyoti Chetia, Associate Professor, LGBRIMH, Tezpur Assam. 3.Sajjadur Rehman, Assistant Professor, Psychiatry, Lady Hardinge Medical College, Delhi 4.Kunal Deb, Assistant Professor, Psychiatry, LGBRIMH, Tezpur, Assam.

COVID-19 related mental health issues: a narrative review of psychometric properties of scales and methodological concerns in scale development.

OBJECTIVES: The global crisis of COVID-19 and its consequential strict public health measures placed around the world have impacted mental health. New scales and tools have been developed to measure these mental health effects. This narrative review assesses the psychometric properties of these scales and tools and methodological aspects of their development. METHODS: PubMed, PubMed Central, and Google Scholar were searched for articles published from 15 May 2020 to 15 August 2020. This search used three groups of terms ("tool" OR "scale" AND "mental" OR "psychological"; AND "COVID-19" OR "coronavirus"). The identified scales were further evaluated for their psychometric properties and methodological aspects of their development. RESULTS: Though the studies developing these scales (n = 12) have demonstrated their robust psychometric properties, some methodological concerns are noteworthy. Most of the scales were validated using internet-based surveys, and detailed descriptions of the mode of administration, sampling process, response rates, and augmentation strategies were missing. CONCLUSIONS: The heterogeneous and inadequate reporting of methods adopted to evaluate the psychometric properties of the identified scales can limit their utility in clinical and research settings. We suggest developing guidelines and checklists to improve the design and testing, and result in reporting of online-administered scales to assess the mental health effects of the COVID-19 pandemic.

CT Scans Obtained for Nonpulmonary Indications: Associated Respiratory Findings of COVID-19.

Background Atypical manifestations of coronavirus disease 2019 (COVID-19) are being encountered as the pandemic unfolds, leading to non-chest CT scans that may uncover unsuspected pulmonary disease. Purpose To investigate patients with primary nonrespiratory symptoms who underwent CT of the abdomen or pelvis or CT of the cervical spine or neck with unsuspected findings highly suspicious for pulmonary COVID-19. Materials and Methods This retrospective study from March 10, 2020, to April 6, 2020, involved three institutions, two in a region considered a hot spot (area of high prevalence) for COVID-19. Patients without known COVID-19 were included who presented to the emergency department (ED) with primary nonrespiratory (gastrointestinal or neurologic) symptoms, had lung parenchymal findings suspicious for COVID-19 at non-chest CT but not concurrent chest CT, and underwent COVID-19 testing in the ED. Group 1 patients had reverse transcription polymerase chain reaction (RT-PCR) results obtained before CT scan reading (COVID-19 suspected on presentation); group 2 had RT-PCR results obtained after CT scans were read (COVID-19 not suspected). Presentation and imaging findings were compared, and outcomes were evaluated. Descriptive statistics and Fisher exact tests were used for analysis. Results Group 1 comprised 62 patients (31 men, 31 women; mean age, 67 years ±17 [standard deviation]), and group 2 comprised 57 patients (28 men, 29 women; mean age, 63 years ± 16). Cough and fever were more common in group 1 (37 of 62 [60%] and 29 of 62 [47%], respectively) than in group 2 (nine of 57 [16%] and 12 of 57 [21%], respectively), with no significant difference in the remaining symptoms. There were 101 CT scans of the abdomen or pelvis and 18 CT scans of the cervical spine or neck. In group 1, non-chest CT findings provided the initial evidence of COVID-19-related pneumonia in 32 of 62 (52%) patients. In group 2, the evidence was found in 44 of 57 (77%) patients. Overall, the most common CT findings were ground-glass opacity (114 of 119, 96%) and consolidation (47 of 119, 40%). Major interventions (vasopressor medication or intubation) were required for 29 of 119 (24%) patients, and 27 of 119 (23%) died. Patients who underwent CT of the cervical spine or neck had worse outcomes than those who underwent abdominal or pelvic CT (P = .01). Conclusion In a substantial percentage of patients with primary nonrespiratory symptoms who underwent non-chest CT, CT provided evidence of coronavirus disease 2019-related pneumonia. © RSNA, 2020.