The number of times children and adolescents came to hospital emergency rooms after attempting suicide jumped 22% across 18 countries, including the U.S., during the first two years of the COVID-19 pandemic, according to a new study in Lancet Psychiatry.
A second study, written by many of the same researchers and published this week by JAMA Pediatrics, finds that kids in the U.S. and 11 other countries experienced more symptoms of depression during the pandemic, especially girls and youth from higher-income households.
The two papers synthesize the academic research to date on these two issues to answer the ongoing question: Has the pandemic — and the myriad changes at home and school that came with it — really harmed kids’ mental health?
While many earlier studies have suggested more youth experienced depression, attempted suicide and developed other mental health issues after COVID-19 began to spread, some small studies have indicated no change or even improvement.
The two new papers are meta-analyses, or a study of studies on a given topic — a top-tier form of scientific evidence. One represents the findings of 42 studies on attempted suicide and self-harm among young people during the pandemic. The other represents 53 studies examining changes in youth depression and anxiety.
Together, they confirm that child and adolescent mental health worsened in the U.S. and many other countries, the lead author of both papers, clinical psychologist Sheri Madigan, wrote in an email to The Journalist’s Resource.
“The widespread uncertainty, at times severe restrictions, and repeated disruptions during the pandemic might have pushed some youth, especially female individuals and adolescents, beyond their typical stress threshold,” Madigan and her colleagues write in the JAMA Pediatrics paper.
A spike in youth suicide attempts
The researchers examined the rate at which people aged 18 years and younger went to emergency rooms after attempting suicide. They analyzed a total of 11.1 million visits, looking for differences in rates before the pandemic began and two years afterward.
They estimate the rate jumped 27% in the U.S. It rose 22%, on average, across the 18 countries studied: the U.S., Canada, South Korea, Australia, New Zealand, England, Scotland, Ireland, Austria, Germany, Spain, Italy, Hungary, Serbia, Switzerland, Slovenia, Turkey, Oman and the United Arab Emirates.
“Specifically, we found that, on average, in any given emergency department setting, there were 102 child and adolescent visits per month for suicide attempts before the pandemic, which increased to 125 during the months of the pandemic,” Madigan, director of the Determinants of Child Development Lab at the University of Calgary, explained via email.
Madigan added that the rise in visits for attempted suicide is especially noteworthy considering youth emergency room visits, as a whole, dropped during the pandemic, partly because many families delayed care and avoided leaving their homes.
A separate paper forthcoming in The American Journal of Emergency Medicine looks at the decline in all emergency department visits for people of all ages in the U.S. from January 2019 to April 2022. It finds these visits dropped 42% in spring 2020, compared to spring 2019, and remained below pre-pandemic levels until the second quarter of 2021.
Other key findings
Madigan and her colleagues also found “strong evidence” of an increase in depression symptoms for children aged 18 and younger. Because they analyzed changes in depression and anxiety using standardized averages, they do not present the magnitude of changes as percentage increases in their paper. They describe changes, as well as the strength of the evidence, using adjectives such as “strong,” “good” and “slight.”
For that paper, researchers examined data collected on a total of 40,807 kids between 2017 and 2021 in 12 countries: the U.S., Canada, China, Australia, England, Scotland, Ireland, Germany, Italy, Spain, Switzerland and the Netherlands.
Some other main takeaways from the two studies:
- The rate at which emergency rooms treated kids for attempted suicide or suicide ideation — the medical term for thinking about or planning suicide — rose 39% for girls and 6% for boys, on average, in the countries studied.
- Researchers found no change in emergency room visits for self-harm when they looked at data for kids of all ages. But when they focused on older youth — those aged 13 to 18 years — they saw that visits increased an estimated 18% for that group. Meanwhile, visits related to self-harm dropped an estimated 15% for children aged 12 years and younger.
- There is “very good evidence” of an increase in depression symptoms among kids from Europe and “good evidence” of an increase among kids from North America. There also is “good evidence” of a slight change in Asia.
- There is “good evidence” that depression symptoms increased among girls and “slightly increased” among boys. The authors find “some evidence” of increased depression symptoms among kids from middle- to high-income households specifically.
Solving the mental health problem
While neither study attempts to determine what caused the increase in depression symptoms or emergency room visits for attempted suicide, the authors note that kids’ lives changed dramatically during the pandemic.
In the JAMA Pediatrics paper, researchers list some of the changes that could have affected their mental health:
- Social isolation and orders to quarantine.
- Increased screen time.
- Decreased physical activity.
- School closures and disruptions, including switching between online and in-person learning.
- Cancellation of extracurricular activities.
- Parental job loss.
- Other family members experiencing increased anxiety or depression.
- Family violence.
Madigan pointed out that as children and adolescents faced new stressors amid the pandemic, they also lost access to key sources of help when schools closed: guidance counselors, social workers, school psychologists, athletic coaches and the other people on campus they tended to go to for guidance and problem-solving.
“Schools are often a primary location for receiving psychological services, with 80% of children relying on school-based services to address their mental health needs,” she wrote by email.
The next big question needing to be answered, according to Madigan: What should be done to help kids thrive in the aftermath of a pandemic that impacted their mental health?
The findings outlined in the two meta-analyses can inform policymakers’ and public health leaders’ responses to the problem.
“Our results, as well as those of many other scholars, sound a clarion call to policy makers that a response is needed to directly address the mental health crisis being experienced by children and adolescents,” write the authors of the JAMA Pediatrics paper. “The development and widespread availability of timely and evidence-based global mental health prevention and intervention efforts to address childhood mental illness are critical and urgently needed.”
For more details
Changes in Depression and Anxiety Among Children and Adolescents From Before to During the COVID-19 Pandemic: A Systematic Review and Meta-analysis
Sheri Madigan; et al. JAMA Pediatrics, published online May 1, 2023.
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
Sheri Madigan; et al. The Lancet Psychiatry, May 2023.
If you feel suicidal, please talk to somebody. Dial 988 to call the National Suicide Prevention Lifeline. You can call the Trans Lifeline at 877-565-8860 or the Trevor Project at 866-488-7386. You can speak to someone via text message by texting “START” to the Crisis Text Line at 741741. If you don’t like the phone, consider using the Lifeline Chat. The Veterans Crisis Line connects service members veterans in crisis and their family members and friends with qualified Department of Veteran’s Affairs responders through a confidential, toll-free hotline, online chat, or text messaging service. Dial 1-800-273-8255 and Press 1 to talk to someone or send a text message to 838255 to connect with a VA responder. You can also start a confidential, online chat session at Veterans Crisis Chat. This text was adapted from the American Association of Suicideology’s reporting recommendations and the National Institute of Mental Health.