Study: COVID increased mental distress, even attempted suicide for kids under 19
A newly-published study, published in the British Medical Journal (BMJ) and led by the University of Calgary, shows the pandemic increased mental distress for kids, leading to a sharp increase in emergency department visits for attempted suicide and suicide ideation among children and adolescents under the age of 19 years old.
Nicole Racine, a clinical psychologist and assistant professor in the School of Psychology at the University of Ottawa, said she believes children were forgotten about during the pandemic and they are one of the vulnerable groups that suffered the most from lockdowns.
They were out of school for long periods of time and there were a lot of closures. And we know that their environments — for many of them who were more vulnerable — were in households, perhaps with increased violence, stress and substance use by parents,” she explained.
Racine is one of the co-authors of the University of Calgary study that was published last week in Lancet Psychiatry, which examined 11 million pediatric emergency department visits across 18 countries between January 2020 and July 2021.
The study found a 22-per cent increase in the number of children and adolescents going to emergency rooms for suicide attempts and an eight-per cent increase in visits for suicide ideation during the pandemic.
This is a stark contrast to the BMJ study also published last week showing the pandemic may not have significantly affected most people’s mental health.
The BMJ study reviewed 137 studies from around the world that measured people’s overall mental health, as well as depression and anxiety levels, before the pandemic and then again during 2020.
The authors found there was a minimal overall mental health change at a population level, and that many people were resilient during the pandemic.
However, the authors acknowledged that children were not well represented in the study, leaving some experts, like Racine, questioning the methodology of the study. The authors of the BMJ study said some data was collected from adolescents aged 10-19 years old and a mixture of children under the age of nine. However, not one study focused only on children.
“The problem is you have to dig deeper,” Racine argued.
“If you collapse across groups and you look at the general population and don’t try to understand what’s happening with subgroups, especially more vulnerable groups, the takeaway you may have is, ‘Oh, actually the pandemic didn’t have an impact on people’s mental health.’”
Racine and her colleagues wrote to the authors of the BMJ study arguing there was “heterogeneity in the data and that the media headline that COVID-19 didn’t have an impact on general mental health was misleading.”
Dr. Shimi Kang, a Vancouver-based psychiatrist and parenting author, said although the two studies show different results, they are still both important from a scientific perspective and they do not have to be “contradictory.”
“One is more focused and looking at actual behaviour and mental health, like showing up in the emergency room,” she explained. “The other one was more of a self-reported study and is broader. So those are very different methodologies. But both studies are important, and both do give us some information about the pandemic and mental health.”
Kang believes the reason the “general population” seemed to mentally be okay during the pandemic and not children is because the makeup of a kid’s brain is so different from an adult’s.
“We are very social and always need human connection,” she said. “And the teenage brain needs that even more…it’s driven to connect with peer group and form its own tribe so it can eventually leave the tribe and have its own family in future.”
Any disruption of that social life, such as lockdowns, social distancing and school closures, would have a “greater impact for those under the age of 24,” she explained.
Combine a global pandemic with increased use of technology and social media and this just exacerbated mental health issues, Kang added.
Dr. Sheri Madigan, a professor of clinical psychology at the University of Calgary, said before the pandemic a majority of children were getting their mental health resources from their schools. But as many schools closed down those services were no longer available.
“So we actually saw kids that were going to the emergency department in greater volumes for suicide attempts, but a lot of the risk factors for mental health generally were on the rise during the pandemic. So what we might be seeing here is just an accumulation of those pandemic stressors over time and kids really being pushed beyond what their stress thresholds could tolerate.”
Madigan, who was also a co-author of the University of Calgary study, said if the data showed an increase in suicide attempts during the pandemic then more kids are struggling now than they were before COVID-19.
“We really need to pour some resources into kids’ mental health. So many of the kids who are actually going to the emergency department, there’s research to suggest that only about a third of them get any type of services after they leave the emergency department,” she said.
“And while we really need some intervention supports to help kids who are struggling right now, we need to think really critically about prevention supports so we can help optimize kid’s mental health and hopefully mitigate the risk of them having these suicide attempts in the future.
A research team also conducted a recent systematic review, published in Lancet Psychiatry, of the literature on 11.1 million children’s and adolescents’ emergency department visits in 18 countries. In the study, they compared the rate of children’s and adolescents’ emergency department visits for suicide attempts that occurred before the pandemic, with the rate that occurred during the pandemic. In doing so, they provide the most rigorous test to date of whether the number of children and adolescents presenting to the emergency department for suicide attempts has increased, decreased or stayed the same during the pandemic.
They found that the rate of suicide attempts for children and adolescents increased by 22 per cent during the pandemic compared with before the pandemic. 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.
When looking deeper into who was more likely to show increases in suicidal behaviour, the researchers found that the rate of emergency department visits during the pandemic increased by 39 per cent for girls, and by six per cent for boys.
This crisis requires immediate attention from governments and policymakers. The needs of children and adolescents must be central in health-care decision-making.
Part of the article was reported by Global News.