Even though pediatric emergency department visits decreased greatly overall during the COVID-19 pandemic, a newly published study led out of the University of Calgary shows there was also a sharp increase in emergency department visits for attempted suicide and suicide ideation among children and adolescents in that same period of social isolation.

Dr. Sheri Madigan, a clinical psychologist in the Department of Psychology, is the lead author on the study, published today (March 9) in The Lancet Psychiatry, which provides a meta-analysis of 42 studies representing over 11 million pediatric emergency department visits across 18 countries, comparing the data on visits prior to the pandemic with those that took place during the pandemic, up to July 2021.

The numbers show that while there was a 32% reduction in pediatric emergency department visits for any health-related reasons during the pandemic, there was still a 22% increase in children and adolescents going to emergency departments for suicide attempts, and an 8% increase in visits for suicide ideation.

Madigan says, "What this 22% increase means is that in an average emergency department setting, there were 102 child and adolescent visits per month for suicide attempts before the COVID-19 pandemic, which increased to 125 per month during the pandemic."

While Madigan is, of course, troubled by these findings, they don't necessarily come as a shock. In the summer of 2021, her research team led a study which found that depression and anxiety symptoms had doubled in children and adolescents during the first year of the pandemic, and she cautioned it was a global mental health crisis.

These new concerning findings seem to bear witness to that warning.

"In our earlier work on mental health in the pandemic, we determined that kids were in crisis, and that we needed to bolster services and resources, or it was going to get worse," says Madigan, who is a Canada Research Chair in Determinants of Child Development. "There's been a debate during the pandemic as to whether the kids are all right or not all right. Now that more data have been published and analyzed, we can more precisely answer that question. The kids are, in fact, not all right."

At face value, there seems to be a confusing discrepancy between the overall reduction in pediatric emergency department visits during the pandemic, on the one hand, and the spike in visits associated with suicide attempts and suicide ideation, on the other. But, beneath the surface, it makes perfect sense, says Madigan, who co-authored The Lancet Psychiatry study with researchers from The Hospital for Sick Children (SickKids) in Toronto, the University of Ottawa, and University College Dublin.

Fear of COVID-19 infection and other factors kept people away from emergency departments for most health conditions during the pandemic. But in that same period, the proven risk factors for mental illness for children and adolescents increased dramatically. Children's screen time rose greatly during the pandemic as physical activity levels dwindled. Many families were in turmoil as jobs were lost, family violence increased, and the mental health of parents deteriorated.

"These are all accelerants to mental distress," says Madigan. "Children have an ability to show resilience in difficult times, but they were pushed past what is tolerable, beyond their capacity-to-cope threshold. And now, far more kids and teens are in crisis then was the case before the pandemic."

The researchers included studies published between January 2020 and July 2021 that contained data on pediatric emergency department visits before and during the COVID-19 pandemic, up to the summer of 2021.

Because ongoing studies on the more recent administrative health data have yet to be published, Madigan says The Lancet Psychiatry article findings provide the clearest snapshot of the pandemic up to about July 2021. Madigan says, "We will continue to monitor the incoming data to see if this trend of increasing emergency department visits for suicide attempts and suicide ideation among children and adolescents continues to climb as the pandemic changes and evolves."

Before the pandemic, says Madigan, about one in five children worldwide were experiencing some form of mental illness, but only 25% in serious need of treatment received it. As mental health stressors escalated overwhelmingly during the pandemic, the need for mental health resources increased in kind, and services and supports are still insufficient to meet the overwhelming demand for mental health treatment.

"We can't ignore that the mental health of children and adolescents is in crisis," Madigan says. "We need to prioritize the creation of mental health resources, supports, and services now, to help children shift from languishing to flourishing." To do so, she suggests that governments need to invest in community resources and infrastructure to support the identification and treatment of mental illness, as well as school programs that focus on prevention and mental health literacy.