Suicide and Self-Harm in Adolescents During the COVID-19 Pandemic: A U.S. Virtual Pediatric Systems, LLC, Database Study of PICU Admissions, 2016-2021.

OBJECTIVES: To characterize the epidemiology of suicide and self-harm among adolescents admitted to PICUs during the first 2 years of the COVID-19 pandemic in the United States. DESIGN: Descriptive analysis of a large, multicenter, quality-controlled database (Virtual Pediatric Systems [VPS]), and of a national public health dataset (U.S. Centers for Disease Control and Prevention web-based Wide-ranging ONline Data for Epidemiology Research [CDC WONDER]). SETTING: The 69 PICUs participating in the VPS database that contributed data for the entire the study period, January 1, 2016, to December 31, 2021. PATIENTS: Adolescents older than 12 years to younger than 18 years old admitted to a participating PICU during the study period with a diagnosis involving self-harm or a suicide attempt (VPS sample), or adolescent suicide deaths over the same period (CDC WONDER sample). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified 10,239 suicide deaths and 7,692 PICU admissions for self-harm, including 5,414 admissions in the pre-pandemic period (Q1-2016 to Q1-2020) and 2,278 in the pandemic period (Q2-2020 to Q4-2021). Compared with the pre-pandemic period, there was no increase in the median (interquartile range) number of suicide deaths per quarter (429 [399-453] vs. 416 [390-482]) or PICU admissions for self-harm per quarter (315 [289-353] vs. 310 [286-387]) during the pandemic period, respectively. There was an increase in the ratio of self-harm PICU admissions to all-cause PICU admissions per quarter during the pandemic (1.98 [1.43-2.12]) compared with the pre-pandemic period per quarter (1.59 [1.46-1.74]). We also observed a significant decrease in all-cause PICU admissions per quarter early in the pandemic compared with the pre-pandemic period (16,026 [13,721-16,297] vs. 19,607 [18,371-20,581]). CONCLUSIONS: The number of suicide deaths and PICU admissions per quarter for self-harm remained relatively constant during the pandemic, while the number of all-cause PICU admissions per quarter decreased compared with the pre-pandemic period. The resultant higher ratio of self-harm admissions to all-cause PICU admissions may have contributed to the perception that more adolescents required critical care for mental health-related conditions early in the pandemic.

Commentary: School closures, the pandemic, and pediatric mental health: Scrutinizing the evidence.

The COVID-19 pandemic arrived with significant hardship. The secondary impacts of the pandemic and our response with respect to pediatric mental health has been a subject of significant discussion in the lay public, media, and decision-maker groups. The initiatives to control SARS-CoV-2 have become politicized. A narrative emerged early that strategies to mitigate the spread of the virus were harming children's mental health. Position statements from professional organizations in Canada have been used to support this claim. The aim of this commentary is to provide a reanalysis of some of the data and research methodology used to support these position statements. Some of the direct claims such as "online learning is harmful," should be supported by a strong evidence base with significant consensus that speaks directly to causality. We find that the quality of the studies and the heterogeneity of the results does not support the strength of the unequivocal claims made by these position statements. In a sample of the current literature examining the issue, we find that outcomes range from improvements to deteriorations. Earlier studies relying on cross-sectional surveys typically have shown stronger negative effects than longitudinal cohort studies, which often have also shown groups of children experiencing no changes to measured mental health characteristics or groups that have experienced improvements. We argue it is imperative that policymakers use the highest quality evidence in making the best decisions. We as professionals must avoid discussing only one side of heterogeneous evidence.

La pandémie de la COVID-19 est arrivée avec des difficultés importantes. Les effets secondaires de la pandémie et notre réponse à l'égard de la santé mentale pédiatrique ont constitué un sujet de discussion significatif dans le public profane, les médias et les groupes de décideurs. Les initiatives de contrôle du SRAS-CoV-2 sont devenues politisées. Une histoire a émergé tôt disant que les stratégies pour atténuer la propagation du virus nuisaient à la santé mentale des enfants. Des énoncés de position des organisations professionnelles du Canada ont été utilisés pour soutenir cette revendication. Le présent commentaire vise à offrir une ré-analyse de certaines données et méthodologies de recherche utilisées pour soutenir ces énoncés de position. Certaines revendications directes comme « l'apprentissage en ligne est nuisible ¼ devraient être appuyées par une forte base de données probantes et un consensus significatif qui s'adresse directement à la causalité. Nous croyons que la qualité des études et l'hétérogénéité des résultats ne soutiennent pas la force des revendications sans équivoque faites par ces énoncés de position. Dans un échantillon de la littérature actuelle qui examine la question, nous constatons que les résultats vont des améliorations aux détériorations. Des études précédentes s'appuyant sur des sondages transversaux ont typiquement montré des effets négatifs plus forts que les études de cohorte longitudinales, qui ont aussi souvent montré des groupes d'enfants qui ne connaissent aucun changement des caractéristiques mesurées de la santé mentale ou des groupes qui ont connu des améliorations. Nous défendons qu'il est impératif que les décideurs utilisent les données probantes de la plus grande qualité en prenant les meilleures décisions. Nous, comme professionnels, devons éviter de ne discuter que d'un côté des données probantes hétérogènes.