Self-Harm and suicidality in child and adolescent psychiatric emergencies

Pedro Carvalho e Marques, Child and Adolescent Psychiatry Department, Unidade Local de Saúde de Santo António, Porto, Portugal
Otília Queirós, Child and Adolescent Psychiatry Department, Unidade Local de Saúde de Santo António, Porto, Portugal

Introduction and objectives: Suicidal ideation (SI), suicide attempts (SA) and non-suicidal self-injuries (NSSI) are frequent causes of admissions to pediatric emergency departments (ED). We aim to evaluate the trends of self-harm and suicidality in children and adolescents in a mental health ED between 2019 and 2021 and compare it with similar data extracted from two previous studies carried out in our department in 2008 and 2016. We also analyze the impact of the COVID-19 pandemic in admissions for these causes. Methods: We performed a retrospective, descriptive analysis of all patients admitted to our ED for NSSI, SI and SA during 2008, 2016 and from March 2019 to May 2021. To analyze the impact of the COVID-19 pandemic, we compared the number of admissions between March and May 2021 (post-pandemic) with the same period in 2019 (pre-pandemic). Results: The number of SA was significantly higher in 2008 (18.7%, p = 0.038), SI (6.4%, p = 0.001) and NSSI (7%, p = 0.001) were higher between March 2019 and February 2020. We observed an increase of almost double (98.43%, p < 0.001) the number of episodes in March-May 2021 (compared to the pre-pandemic period), with higher SA (p < 0.001), SI (p = 0.008) and NSSI (p < 0.001). Discussion: We found a rise in self-harm-related ED admissions in recent years due to an increase of NSSI and SI. We did not find an increase in SA. After the initial period of the COVID-19 pandemic, there was an increase of self-harm admissions. Our findings are in line with trends reported in the literature.

Keywords: Self-injurious behavior. Suicide. Attempted. Suicidal ideation. Adolescent psychiatry. Pediatric emergency medicine.