Youth suicide risk and mental health post-COVID: An Australian perspective

Aims: Suicide is a leading cause of death for young people, and rates in Australia are increasing. The Australian city of Melbourne faced the toughest COVID-19 pandemic lockdown restrictions worldwide, which had a major impact on youth mental health. This study aimed to provide a snapshot into the mental health and suicide-related thoughts and behaviours of Australian Adolescents from Melbourne post the lockdowns. Method(s): Participants were 932 young people (Age M = 15.5, 53% female) recruited from high schools in Melbourne, Australia as part of a larger RCT. Participants completed measures of suicidal ideation (SIDAS) and behaviour (recent attempts and current plans), and depressive symptoms (PHQ-9). Result(s): Preliminary results indicate that 28% of participants experienced some level of suicidal ideation with 7% reporting severe suicidal ideation. Suicide attempts in the sample in the last 12 months (13%) and current plans (3%) were less common but still prevalent. In terms of depressive symptoms, the breakdown in the sample was 5% severe, 8% moderately severe, 18% moderate, 25% mild and 43% none to minimal with 1% not reporting. Data related to particular risk factors (e.g., years since the pandemic, gender, school etc.) along with implications for practice and policy will be presented at the conference. Conclusion(s): This study sheds light on the mental health and suiciderelated thoughts and behaviours of school-attending young people following COVID-19-related lockdowns in Australia. The high levels of suicidality and poor mental health in the cohort point to a need for targeted interventions and support for this group.

The effect of intervention using an emotional recognition coaching companion robot on the elderly people with depression

Aims: During the COVID-19 pandemic, care for the elderly in the community was greatly limited. Accordingly, the demand for alternative community care have increased to cope with changing situations. In this study, we tried to find out whether the companion robot improved mood state and related problem in depressive or isolated community dwelling elderly. Method(s): For 186 community dwelling elderly who have received social welfare service due to depression or social isolation, we provided companion robot that could support their daily living. The robot was equipped with special program that could recognize and respond to the participant's own emotion. It was part of behavioural activation techniques which is one of powerful treatment for depression. The self-report questionnaires were used to measure changes in cognitive function, depression, suicidality, loneliness, resilience and satisfaction of life. Outcomes were measured before using companion robot and after 3 months, and we compared them. Result(s): The elderly using companion robot for 3 months showed improved cognitive function, depression (p < .001), suicidality (p < .001), and loneliness (p = .033) in the self-report questionnaire. Resilience (p = .749) and satisfaction of life (p = .246) were also improved but not reached significance. Conclusion(s): These findings showed that the use of companion robot with emotional recognition coaching program could help improve depression, cognitive function, loneliness and suicidal ideation. In particular, this effect was also useful for those who were diagnosed with depression. Also if we can put more techniques of behavioural activation programs into robot, it could be useful in community care for depressive and isolated elderly.

Screening adolescents for psychosocial concerns

Psychosocial issues are cen-'tral to the care of adolescent patients. Pediatricians routinely discuss substance use, sexual health, and accident prevention with adolescents and are likely to see specific mental health concerns in about 20% of their patients. In light of rising suicide rates and the likely consequences of COVID-19, depression is an increasingly common concern. With limited access to mental health clinicians, individual pediatricians must manage patients' mental health needs by enhancing their own skills, collocating mental health personnel in their practices, and building trusted referral networks. Because psychosocial screening is now an expected part of pediatric primary care,1 this article focuses on screening adolescent patients, including choice of tools and follow-up of positive results.

Long-Term Neurologic Sequelae Among Patients with Varying COVID-19 Severity: An Administrative Claims Database Analysis

Objectives: Examine the long-term incident neurologic sequelae post COVID recovery and assess relationship with COVID severity using real-world data. Method(s): This retrospective cohort study was conducted using Optum Research Database between 01July2019 to 30Sep2022. Patients included were >=18 years with COVID diagnosis (index date) between 01Jan2020 and 31Oct2020, with continuous enrollment 6 months before and >=12 months after index date, known demographics, not pregnant, and with no baseline neurologic conditions. Patients were stratified into COVID severity cohorts as mild (index diagnosis), moderate (inpatient visit within 15 days of index), or severe (evidence of acute respiratory distress) and followed for a minimum of 12-months post-index. Neurologic sequelae examined were persistent headache, migraine, anosmia, sleep disturbance, cognitive dysfunction, post-traumatic stress disorder, suicidality, anxiety, depression, attention deficit hyperactivity disorder, cerebrovascular disease (CVD), fatigue/myalgia and tremors. Descriptive statistics and incidence rate ratios (IRR) were calculated to assess outcomes. Result(s): Of 534,843 patients, 107,656 (Mild 96,637;Moderate 3,371;Severe 7,648) met the study inclusion criteria. Median follow up time was 750, 774 and 768 days in the mild, moderate and severe cohorts, respectively. About 20% of patients in the mild, 32% in moderate and 35% in the severe cohort experienced >=3 neurologic sequelae during the follow-up period. A significantly higher incidence of any neurologic sequelae was observed in moderate and severe cohorts compared with the mild cohort (IRR 3.1 and 3.0, respectively;p<0.001). Cognitive dysfunction (moderate IRR 5.4, severe IRR 5.7;p<0.001), and CVD (moderate IRR 4.8, severe IRR 4.0;p<0.001) were the most commonly occurring manifestations in moderate and severe cohorts compared with the mild cohort. Conclusion(s): These results highlight the need for long-term monitoring and preventative strategies for neurologic conditions post COVID recovery that might impair quality of life and increase overall healthcare burden in the U.S.Copyright © 2023

Impact of the COVID-19 pandemic on the well-being of the stranded seafarers

PurposeThis study examines the impact of the COVID-19 pandemic on the well-being and mental health of the seafarers who had to overstay on ships after their contracts expired, identifies topics that affect their mental distress and recommends measures to overcome these.Design/methodology/approachFour research questions about the impacts on the seafarers before and during the COVID-19 pandemic were raised. A literature review and a questionnaire survey were conducted to find answers. Ship officers were asked to assess and fill in the questionnaires for the stranded seafarers onboard in order to collect sufficient samples rapidly for this study.FindingsDespite the guidelines provided by the shipping companies being adequate to protect the seafarers from COVID-19, their mental distress levels have been worsened under the pandemic. The crew change crisis causes anxiety and negatively impacts on their working performance;however, the repatriation expectation of the stranded seafarers is of the highest concern. Three topics were identified as having impacts on the mental health of the stranded seafarers: crew change crisis, low vaccination rate and the lack of key worker recognition. While international stakeholders are advocating for support in these issues, the shipping companies and the seafarers need to do their parts to exacerbate the mental distress, and to survive and thrive beyond the pandemic.Originality/valueThe findings of this study will help the shipping companies to navigate the challenges and the seafarers to overcome issues caused by the COVID-19 pandemic.

Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts

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.

Suicidal Behavior in the Trans-Baikal Region: Epidemiological Characteristics, the Impact of the Covid-19 Pandemic and the Implementation of the Who Tool for Improvement of Monitoring Systems

The article provides an analysis of the current epidemiological characteristics of suicidal behavior in the TransBaikal Region, an assessment of the impact of the COVID -19 pandemic on the indicators of suicidal activity of the population, and also presents the first results of self-harm monitoring implemented in the subject based on the WHO tool. It has been established that in Transbaikalia a positive trend continues in a significant decrease in the number of suicides, although the rate of completed suicides in the Territory is 2.5 times higher than the national average and 1.5 times higher than in the Far Eastern Federal District. The spread of a new coronavirus infection COVID -19 and its associated adverse socioeconomic impacts have resulted in a slowdown in the decline in suicide rates and a 1.5-fold increase in the number of suicide attempts among the population of the region in 2020. The monitoring of self-injurious behavior standardized by WHO has allowed a more detailed analysis of the epidemiological features of suicide attempts in the region.

Investigating the moderating role of thwarted belongingness, perceived burdensomeness, and suicidal capability in suicidal behavior

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.

A Rapid Systematic Review of the Prevalence of Suicide and Self-Harm Behaviors in Adolescents During the COVID-19 Pandemic.

Background: COVID-19 has caused psychological, social, and physical isolation in adolescents resulting in varying rates of suicidal behavior and self-harm. Aims: We investigated the pandemic's impact on adolescent suicidal behavior and self-harm by reviewing the existing literature. Methods: We searched PubMed using keywords: adolescent, suicide, suicidal behavior, self-harm, prevalence, and COVID-19 and included studies reporting primary data only. Results: Of the 551 studies identified, we included 39 studies in the final analysis. Two of the six high-quality population-based suicide registry studies reported increased suicide rates during the pandemic. Seven of fifteen emergency department-based studies out of which four were of high quality and three high-quality population-based health registry studies reported increased self-harm. A few school and community-based surveys and national helpline data also reported an increase in suicidal behavior or self-harm. Limitations: Methodological heterogeneity of the included studies. Conclusions: There is wide variation in study methodology, population, settings, and age groups in the included studies. Suicidal behavior and self-harm were increased in specific study settings and adolescent populations during the pandemic. More methodologically rigorous research is needed to evaluate the impact of COVID-19 on adolescent suicidal behavior and self-harm.

A Rose by Any Other Name: Gender-Affirming Care and Severe Mental Illness

The transgender population has higher rates of psychiatric disorders and stigma within medical settings. Literature suggests that gender-affirming care is the standard when working with such patients. There are limited studies regarding treating these patients with severe mental illness (SMI). This article explores how to treat SMI that impacts patients' reality to the point where their assigned sex cannot be acknowledged. The case presented is that of a transgender woman, where clarification of her natal sex was crucial to treatment. The patient denied her natal sex, endorsing a history of miscarriage. Studies on treatment of transgender SMI patients are limited. Gender-affirming treatment is the standard of care for these patients. Training how to ask pertinent questions and communicate effectively is necessary to prevent misdiagnosis, unnecessary treatment, and agitation. [Psychiatr Ann. 2023;53(5):221–223.]

Characteristics of patients treated for suicidal behavior during the pandemic in a psychiatric emergency department in a Spanish province

Introduction: Different studies have suggested that psychological, social and economic factors could contribute to an increase in the suicide. That is why the scientific community fear an epidemic of suicides secondary to this crisis. The objective is to evaluate the variables related to suicidal behavior during the two states of alarm and to review if there were sociodemographic or clinical differences with respect to periods prior to the COVID-19 pandemic. Material(s) and Method(s): We compared visits to the emergency room and their characteristics of all patients with suicidal behavior before and after the pandemic in Lerida. Information on sociodemographic status, reason for consultation, diagnosis and characteristics of suicidal behavior was obtained from the electronic medical record. Result(s): No differences were observed in the percentage of suicidal ideation or attempts in the three periods (p = 0.201). The characteristics in the multiple logistic regression associated with suicidal behavior are: being a woman (OR: 1.81 [1.27-2.56]), living with relatives (OR: 1.55 [1.05-2.32]) and have a diagnosis of non-alcohol related substance use disorder (OR: 1.94 [1.09-3.42]). As protective factors, being visited in the emergency room during the second state of alarm (OR: 0.68 [0.48-0.96]) and having depression (OR: 0.67 [0.47-0.96]). Conclusion(s): Emergency care for suicidal behavior did not increase during the pandemic and, in fact, in 2020 completed suicides decreased by almost half in the province. Risk factors for suicide attempt were female gender, living with relatives, and having a substance use disorder diagnosis. Instead, depression was a protective factor.Copyright © 2022

The Suicidal Ideation Attributes Scale-Modified (SIDAS-M): Development and preliminary validation of a new scale for the measurement of suicidal ideation in autistic adults.

LAY ABSTRACT: Autistic people may be at higher risk of suicidal behavior than people in the general population. Suicidal behavior may include thinking about suicide or attempting to end one's own life by suicide. It is important to identify autistic people who may be thinking about suicide. People who are at risk of suicidal behavior can be identified by asking questions about whether they have been thinking about suicide. A specially designed questionnaire, or screening instrument, can help someone ask the best questions to find out if someone has been thinking about suicide. This information can help to identify supports to be put in place to prevent suicidal behavior, such as a suicide attempt. However, autistic people may interpret questions differently than non-autistic people. It is important to use screening tools that have been designed with, and for autistic people. In this study, we examined the Suicidal Ideation Attributes Scale (SIDAS). The SIDAS is an existing tool that was developed to screen for suicidal thinking in the general population. We modified SIDAS for use with autistic adults. We involved autistic people in the process of modifying SIDAS. We called the modified instrument the SIDAS-M. The results of our study showed SIDAS-M may be useful for screening for suicidal thinking in autistic adults who do not have an intellectual disability.

A Computational Platform to Support the Detection, Follow-up, and Epidemiological Surveillance of Mental Health and Substance Use Disorders: Protocol for a Development and Evaluation Study.

BACKGROUND: According to the World Health Organization, approximately 15% of the global population is affected by mental health or substance use disorders. These conditions contribute significantly to the global disease burden, which has worsened because of the direct and indirect effects of COVID-19. In Mexico, a quarter of the population between the ages of 18 and 65 years who reside in urban areas present a mental health condition. The presence of a mental or substance abuse disorder is behind a significant percentage of suicidal behaviors in Mexico, where only 1 in 5 of those who have these disorders receive any treatment. OBJECTIVE: This study aims to develop, deploy, and evaluate a computational platform to support the early detection and intervention of mental and substance use disorders in secondary and high schools as well as primary care units. The platform also aims to facilitate monitoring, treatment, and epidemiological surveillance ultimately helping specialized health units at the secondary level of care. METHODS: The development and evaluation of the proposed computational platform will run during 3 stages. In stage 1, the identification of the functional and user requirements and the implementation of the modules to support the screening, follow-up, treatment, and epidemiological surveillance will be performed. In stage 2, the initial deployment of the screening module will be carried out in a set of secondary and high schools, as well as the deployment of the modules to support the follow-up, treatment, and epidemiological surveillance processes in primary and secondary care health units. In parallel, during stage 2, patient applications to support early interventions and continuous monitoring will also be developed. Finally, during stage 3, the deployment of the complete platform will be performed jointly with a quantitative and qualitative evaluation. RESULTS: The screening process has started, and 6 schools have been currently enrolled. As of February 2023, a total of 1501 students have undergone screening, and the referral of those students presenting a risk in mental health or substance use to primary care units has also started. The development, deployment, and evaluation of all the modules of the proposed platform are expected to be completed by late 2024. CONCLUSIONS: The expected results of this study are to impact a better integration between the different levels of health care, from early detection to follow-up and epidemiological surveillance of mental and substance use disorders contributing to reducing the gap in the attention to these problems in the community. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44607.

Impact of the COVID-19 Pandemic on the Suicidal Behavior in Romania.

Suicide rates reflect the mental health status in certain countries or regions. As the COVID-19 infection developed as a pandemic and governments imposed certain measures to stop the spread of the virus, mental health was affected worldwide. Romania was no exception as the government issued a complete lockdown with restriction regarding travels, social gatherings, transition to working from home and others. The increase in the rate of unemployment, the difficulties in accessing the health services and the social distancing generated by the restrictions had a major impact on lifestyle with a potential surge of psychiatric disorders, with or without history of illness. In this study, we analyzed the changes in regard to the number of suicides and suicide attempts as well as the methods employed and the underlying psychiatric pathology in Cluj County, Romania, throughout the first year of the pandemic. The results had not revealed changes in the overall suicide rate, but in the case of mild cognitive disorders and dementia the suicide figures increased, while a decrease was observed in the number of suicides related to substance use disorders. The long-term effects of the pandemic remain unknown, but there is a clear impact on mental health and measures should be taken in order to prevent suicides.

Mental health of patients with psoriasis during the COVID-19 pandemic: a cross-sectional study in a tertiary setting

Patients with psoriasis are at increased risk of depression. Furthermore, psoriasis is linked to social isolation, stress-related disorders and suicidality. The COVID-19 pandemic and social distancing represent potential stressors for patients, which may disproportionately affect the wellbeing of this vulnerable population. Our aim was to investigate whether the pandemic increased the affective burden of patients with psoriasis. We surveyed 194 patients with dermatologist-confirmed psoriasis attending our tertiary service. Ninety-three patients had completed questionnaires [Hospital Anxiety and Depression Scale (HADS);Quick Inventory of Depressive Symptomatology Self- Report (QIDS-SR);Sheehan Suicidality Tracking Scale;Dermatology Life Quality Index (DLQI)] before March 2020 in a pre-existing study. From May to October 2020, we recruited a different patient sample (n = 101) who completed the same questionnaires. We analysed separately data from 22 patients, who completed the survey both before and during the pandemic. Cases of depression and anxiety were defined as having a HADS subscale score of >= 8. Analysis was performed in R. Ninety-three patients completed the survey before the pandemic [49 5% female;mean (SD) age 42 (18) years] and 101 during the pandemic [38% female;mean (SD) age 52 (16) years;74% shielding]. Patient proportions across treatment groups did not differ before vs. during the pandemic (73 1% vs. 78 2% on biologics;P = 0 8). Depression, anxiety and suicidality were highly prevalent at both timepoints. However, there were no significant differences in depression [31% vs. 40%;adjusted odds ratio (aOR) 1 2, 95% confidence interval (CI) 0 6-2 5], anxiety (39% vs. 47 5%;aOR 1 7, 95% CI 0 8-3 5) or suicidal ideation prevalence (13% vs. 20%;aOR 2 19, 95% CI 0 8-5 9] before vs during the pandemic. During the pandemic, depression was not associated with living alone (P = 0 45) or shielding (P = 0 13). In the paired analysis, depression scores did not differ during compared with before the pandemic (QIDS-SR 9 4 x 5 8 vs. 8 8 x 6 1;P = 0 56). DLQI changes did not correlate with changes in QIDS-SR (r = 0 08, P = 0 7). At follow-up, three patients (14%) reported 12-month passive suicidal ideation;no patient reported 12- month active suicidality. Depression and the prevalence of anxiety are high in patients with psoriasis. Suicidal ideation rates appear to be higher than the rates in the general population during the COVID-19 pandemic. However, we did not observe a significant increase in the psychological burden or shielding of our patients during the pandemic compared with previous levels. Our findings are consistent with recent research on psoriasis-related quality of life during the COVID- 19 pandemic and may reflect population-specific resilience mechanisms. They also highlight the importance of continued monitoring of psychiatric comorbidity in this population, independently of acute stressors. Future research should address the long-term pandemic impact on patients.

Analysis of the mental state and job satisfaction of medical staff during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic is a threat to the physical and mental health of the global population. The healthcare workers are at high risk of mental health disorders. They are the main link to ensure the health safety for patients. Therefore, it is necessary to monitor their mental state to protect them from the negative effects of the pandemic. Material(s) and Method(s): The study included 316 healthcare workers and 302 non-medical controls. The following diagnostic methods were used: Satisfaction with Job Scale, Psychache Scale, Depression, Anxiety and Stress Scale (DASS-21) and Suicidal Behaviors Questionnaire-Revised (SBQ-R). The study was conducted with online questionnaire. Result(s): The medical subjects reveal higher levels of depression, anxiety, stress, and psychache than the controls. The highest results are shown in the group of nursing staff. At the same time, nurses are at lower suicide risk and they disclose lower likelihood of suicidal behavior in the future than other medical professionals and have had lower frequency of suicidal ideation over the past 12 months than the control group. The COVID-19 pandemic caused negative changes in professional life in most medical subjects, especially in the group of nurses. Conclusion(s): The results confirmed the importance of providing psychological support to medical staff as they reveal higher level of negative mental health consequences than the general population. The line of further research is to identify the causes of lower suicidal tendencies among nurses despite the strongest deterioration in their mental state.Copyright © 2022 Via Medica. All rights reserved.

Patient questionnaire-based triage improves outcomes for psoriasis referrals

COVID-19 has placed additional demands on a healthcare system that is already overstrained. While the National Health Service has coped extremely well in the face of new pressures, much of the pressure has transferred to a growing backlog of non-COVID outpatient care. Waiting lists have become unwieldy and new dermatology waiting times can be in excess of 18 months. We have developed a novel system to enable our tertiary referral dermatology department to triage rapidly and manage new patients with psoriasis, returning to target levels of activity, with minimum impact on patient care. Newly referred patients with psoriasis were sent a questionnaire, including the Dermatology Life Quality Index (DLQI), to direct their management appropriately. Patients were asked to estimate their affected body surface area using the palm measurements and affected body sites. Patients were also asked which treatment types they would be prepared to accept if offered (phototherapy, systemic therapy), as well as the type of clinic they would find acceptable. The latter included faceto- face only, telephone/video consultation or using a secure skin mobile phone app (MySkinSelfie), whereby photos are securely uploaded for viewing by the doctor but are still controlled by the patient. Of 265 patients, 222 responded (average response time 7 days). In total, 217 were offered an appointment. Thirty-one per cent were seen acutely (2 weeks) and the remainder in routine clinics. Two patients no longer wanted an appointment. An algorithm was used to place patients in appropriate clinics according to their responses. Patients who did not respond to the questionnaire within 4 weeks were sent a reminder letter and then discharged if there was still no reply (17%). Median DLQI was 15, with 63% of patients happy to have a telephone/video consultation, 72% were open to phototherapy, 80% were happy to use the MySkinSelfie App and 34% requested faceto- face appointments only. During the COVID-19 pandemic many dermatology units have had to limit the focus of their work on skin cancer, leaving little time for all but the most urgent patients with inflammatory disease. A previous systematic review and meta-analysis (Singh S, Taylor C, Kornmehl H, Armstrong AW. Psoriasis and suicidality: a systematic review and meta-analysis. J Am Acad Dermatol 2017;77: 425-40) of 1.7 million patients with psoriasis confirmed an increased risk of suicidal ideation [odds ratio (OR) 2.05] and suicidal behaviour (OR 1.26;Singh et al.), highlighting the importance of managing these patients in a timely manner. General practitioner letters can lack sufficient information on disease severity/ urgency, but our simple model allows the department to streamline referrals quickly, ensures that the patient still wants to be seen and minimizes unnecessary hospital visits. We propose that this approach is considered by other dermatology departments to streamline outpatient waiting lists and accelerate a return to normal activity during the pandemic.

Effect of COVID-19 Pandemic on Major Trauma Treated at a Level I Trauma Centre.

PURPOSE OF THE STUDY The paper aims to evaluate the effect of COVID-19 pandemic on a change in the number of major trauma cases, their mechanism and length of hospital stay as seen by a Level I Trauma Centre. MATERIAL AND METHODS The retrospective study included a total of 755 major trauma patients (ISS >= 16) treated at our Level I Trauma Centre in the period 2018-2019 ("pre-COVID-19 time") and 2020-2021 ("COVID-19 time"). The effect of COVID-19 infection on the change in the number and nature of major trauma, mechanism of injury, length of treatment during prehospital care, length of hospital stay, and mortality. RESULTS Of the total number of 755 patients with major trauma, in the "pre-COVID-19 time" 399 patients were treated, while in the "COVID-19 time" it was 356 patients (p = 0.10). The mechanism of major trauma did not change, road traffic accidents prevailed (61% vs. 56%, p = 0.25), the proportion of injuries due to falls from height increased (25% vs. 32.5%, p = 0.08), a significant decrease was observed in the category of severe skiing injuries (7 vs. 2, p = 0.003). The severity of injuries evaluated by Injury Severity Score remained unchanged (25 vs. 25, p = 0.08), but an increased number of patients with trau-matic brain injury (TBI) marked by the Abbreviate Injury Score (AIS) >= 4 was observed (38 vs. 56, p = 0.03). The total length of a hospital stay shortened (18 vs. 15 days, p = 0.04), but the mortality rate spiked (52 vs. 73 patients, p = 0.08). DISCUSSION In the "COVID-19 time", the total number of major trauma cases dropped just like in the other European countries. Despite restrictive measures imposing mobility restrictions, no change was reported in the mechanism of injury, with traffic accidents still prevalent, except for skiing injuries. Unlike the US, we did not see an increase in penetrating injuries due to interpersonal violence or suicidal behaviour. However, there was an increase in the percentage of patients with an isolated TBI as a result of a fall from height. An increase in mortality was reported due to an increase in severe TBI. The length of hospital stay was reduced as a result of efforts to maintain hospital bed availability. CONCLUSIONS During the COVID-19 pandemic, compared to the two years immediately preceding, no significant decrease in the number of major trauma cases was reported, despite the introduction of restrictive measures. The proportion of road traffic injuries remained the same, whereas the number of falls from height slightly increased, which consequently led to an increase in the number of severe TBI. The number of penetrating injuries due to acts of violence did not increase, but due to the lockdown there was a significant decrease in severe skiing-related injuries. The anti-epidemic measures in place did not prolong the pre-hospital care for severely injured patients.Copyright © 2022, Galen s.r.o.. All rights reserved.

Effect of Alcohol Intoxication in the Emergency Department on Suicide Mortality

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.