Self-Harm in Children and Adolescents who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

Ben Hoi-Ching Wong; Samantha Cross; Patricia Zavaleta-Ramírez; Ines Bauda; Pamela Hoffman; Patricia Ibeziako; Laura Nussbaum; Gregor E. Berger; Hossein Hassanian-Moghaddam; Krisztina Kapornai; Tauseef Mehdi; Jovanka Tolmac; Elizabeth Barrett; Liana Romaniuk; Chiara Davico; Omer S. Moghraby; Giedra Ostrauskaite; Sulagna Chakrabarti; Sara Carucci; Gyula Sofi; Haseena Hussain; Alexandra S.K. Lloyd; Fiona McNicholas; Ben Meadowcroft; Manish Rao; Györgyi Csábi; Gabriel Gatica-Bahamonde; Hakan Öğütlü; Eirini Skouta; Rachel Elvins; Isabel Boege; Dulangi M.A. Dahanayake; Marija Anderluh; Miyuru Chandradasa; Braulio M. Girela-Serrano; Sara Uccella; Dejan Stevanovic; Marco Lamberti; Amy Piercey; Peter Nagy; Varun S. Mehta; Yasodha Rohanachandra; Jie Li; Ali Evren Tufan; Hassan Mirza; Farah Rozali; Benjamin J. Baig; Izabela Pilecka; Ioannis Bakolis; Dennis Ougrin

doi:10.1016/j.jaac.2022.11.016

Self-Harm in Children and Adolescents who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

Ben Hoi-Ching Wong, Samantha Cross, Patricia Zavaleta-Ramírez, Ines Bauda, Pamela Hoffman, Patricia Ibeziako, Laura Nussbaum, Gregor E. Berger, Hossein Hassanian-Moghaddam, Krisztina Kapornai, Tauseef Mehdi, Jovanka Tolmac, Elizabeth Barrett, Liana Romaniuk, Chiara Davico, Omer S. Moghraby, Giedra Ostrauskaite, Sulagna Chakrabarti, Sara Carucci, Gyula SofiHaseena Hussain, Alexandra S.K. Lloyd, Fiona McNicholas, Ben Meadowcroft, Manish Rao, Györgyi Csábi, Gabriel Gatica-Bahamonde, Hakan Öğütlü, Eirini Skouta, Rachel Elvins, Isabel Boege, Dulangi M.A. Dahanayake, Marija Anderluh, Miyuru Chandradasa, Braulio M. Girela-Serrano, Sara Uccella, Dejan Stevanovic, Marco Lamberti, Amy Piercey, Peter Nagy, Varun S. Mehta, Yasodha Rohanachandra, Jie Li, Ali Evren Tufan, Hassan Mirza, Farah Rozali, Benjamin J. Baig, Izabela Pilecka, Ioannis Bakolis, Dennis Ougrin

Research output: Contribution to journal › Article › peer-review

18 Citations (Scopus)

Abstract

Objective: To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. Method: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. Results: Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). Conclusion: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Original language	English
Pages (from-to)	998-1009
Number of pages	12
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	62
Issue number	9
DOIs	https://doi.org/10.1016/j.jaac.2022.11.016
Publication status	Published - Sept 2023

Keywords

self-injurious behavior
emergency psychiatric services
COVID-19 pandemic
child psychiatry
adolescent psychiatry

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jaac.2022.11.016

https://www.sciencedirect.com/science/article/pii/S089085672300062X

Cite this

Hoi-Ching Wong, B., Cross, S., Zavaleta-Ramírez, P., Bauda, I., Hoffman, P., Ibeziako, P., Nussbaum, L., Berger, G. E., Hassanian-Moghaddam, H., Kapornai, K., Mehdi, T., Tolmac, J., Barrett, E., Romaniuk, L., Davico, C., Moghraby, O. S., Ostrauskaite, G., Chakrabarti, S., Carucci, S., ... Ougrin, D. (2023). Self-Harm in Children and Adolescents who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study. Journal of the American Academy of Child and Adolescent Psychiatry, 62(9), 998-1009. https://doi.org/10.1016/j.jaac.2022.11.016

@article{ccfb5d5501fe4bea9d5d8d15523d5e85,

title = "Self-Harm in Children and Adolescents who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study",

abstract = "Objective: To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. Method: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. Results: Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). Conclusion: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.",

keywords = "self-injurious behavior, emergency psychiatric services, COVID-19 pandemic, child psychiatry, adolescent psychiatry",

author = "{Hoi-Ching Wong}, Ben and Samantha Cross and Patricia Zavaleta-Ram{\'i}rez and Ines Bauda and Pamela Hoffman and Patricia Ibeziako and Laura Nussbaum and Berger, {Gregor E.} and Hossein Hassanian-Moghaddam and Krisztina Kapornai and Tauseef Mehdi and Jovanka Tolmac and Elizabeth Barrett and Liana Romaniuk and Chiara Davico and Moghraby, {Omer S.} and Giedra Ostrauskaite and Sulagna Chakrabarti and Sara Carucci and Gyula Sofi and Haseena Hussain and Lloyd, {Alexandra S.K.} and Fiona McNicholas and Ben Meadowcroft and Manish Rao and Gy{\"o}rgyi Cs{\'a}bi and Gabriel Gatica-Bahamonde and Hakan {\"O}ğ{\"u}tl{\"u} and Eirini Skouta and Rachel Elvins and Isabel Boege and Dahanayake, {Dulangi M.A.} and Marija Anderluh and Miyuru Chandradasa and Girela-Serrano, {Braulio M.} and Sara Uccella and Dejan Stevanovic and Marco Lamberti and Amy Piercey and Peter Nagy and Mehta, {Varun S.} and Yasodha Rohanachandra and Jie Li and Tufan, {Ali Evren} and Hassan Mirza and Farah Rozali and Baig, {Benjamin J.} and Izabela Pilecka and Ioannis Bakolis and Dennis Ougrin",

note = "Funding Information: The Comparison of Effectiveness and Cost-Effectiveness of Intensive Community Care Services versus Usual Inpatient Care for Young People with Psychiatric Emergencies (IVY) network has received funding from the NIHR ( https://www.fundingawards.nihr.ac.uk/award/NIHR127408 ). The European College of Neuropsychopharmacology network is funded through membership fees, royalties, and interest payments. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: {\textcopyright} 2023 American Academy of Child and Adolescent Psychiatry",

year = "2023",

month = sep,

doi = "10.1016/j.jaac.2022.11.016",

language = "English",

volume = "62",

pages = "998--1009",

journal = "Journal of the American Academy of Child and Adolescent Psychiatry",

issn = "0890-8567",

publisher = "Elsevier Limited",

number = "9",

}

Hoi-Ching Wong, B, Cross, S, Zavaleta-Ramírez, P, Bauda, I, Hoffman, P, Ibeziako, P, Nussbaum, L, Berger, GE, Hassanian-Moghaddam, H, Kapornai, K, Mehdi, T, Tolmac, J, Barrett, E, Romaniuk, L, Davico, C, Moghraby, OS, Ostrauskaite, G, Chakrabarti, S, Carucci, S, Sofi, G, Hussain, H, Lloyd, ASK, McNicholas, F, Meadowcroft, B, Rao, M, Csábi, G, Gatica-Bahamonde, G, Öğütlü, H, Skouta, E, Elvins, R, Boege, I, Dahanayake, DMA, Anderluh, M, Chandradasa, M, Girela-Serrano, BM, Uccella, S, Stevanovic, D, Lamberti, M, Piercey, A, Nagy, P, Mehta, VS, Rohanachandra, Y, Li, J, Tufan, AE, Mirza, H, Rozali, F, Baig, BJ , Pilecka, I , Bakolis, I & Ougrin, D 2023, 'Self-Harm in Children and Adolescents who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 62, no. 9, pp. 998-1009. https://doi.org/10.1016/j.jaac.2022.11.016

Self-Harm in Children and Adolescents who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study. / Hoi-Ching Wong, Ben; Cross, Samantha; Zavaleta-Ramírez, Patricia et al.
In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 62, No. 9, 09.2023, p. 998-1009.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Self-Harm in Children and Adolescents who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

AU - Hoi-Ching Wong, Ben

AU - Cross, Samantha

AU - Zavaleta-Ramírez, Patricia

AU - Bauda, Ines

AU - Hoffman, Pamela

AU - Ibeziako, Patricia

AU - Nussbaum, Laura

AU - Berger, Gregor E.

AU - Hassanian-Moghaddam, Hossein

AU - Kapornai, Krisztina

AU - Mehdi, Tauseef

AU - Tolmac, Jovanka

AU - Barrett, Elizabeth

AU - Romaniuk, Liana

AU - Davico, Chiara

AU - Moghraby, Omer S.

AU - Ostrauskaite, Giedra

AU - Chakrabarti, Sulagna

AU - Carucci, Sara

AU - Sofi, Gyula

AU - Hussain, Haseena

AU - Lloyd, Alexandra S.K.

AU - McNicholas, Fiona

AU - Meadowcroft, Ben

AU - Rao, Manish

AU - Csábi, Györgyi

AU - Gatica-Bahamonde, Gabriel

AU - Öğütlü, Hakan

AU - Skouta, Eirini

AU - Elvins, Rachel

AU - Boege, Isabel

AU - Dahanayake, Dulangi M.A.

AU - Anderluh, Marija

AU - Chandradasa, Miyuru

AU - Girela-Serrano, Braulio M.

AU - Uccella, Sara

AU - Stevanovic, Dejan

AU - Lamberti, Marco

AU - Piercey, Amy

AU - Nagy, Peter

AU - Mehta, Varun S.

AU - Rohanachandra, Yasodha

AU - Li, Jie

AU - Tufan, Ali Evren

AU - Mirza, Hassan

AU - Rozali, Farah

AU - Baig, Benjamin J.

AU - Pilecka, Izabela

AU - Bakolis, Ioannis

AU - Ougrin, Dennis

N1 - Funding Information: The Comparison of Effectiveness and Cost-Effectiveness of Intensive Community Care Services versus Usual Inpatient Care for Young People with Psychiatric Emergencies (IVY) network has received funding from the NIHR ( https://www.fundingawards.nihr.ac.uk/award/NIHR127408 ). The European College of Neuropsychopharmacology network is funded through membership fees, royalties, and interest payments. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2023 American Academy of Child and Adolescent Psychiatry

PY - 2023/9

Y1 - 2023/9

N2 - Objective: To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. Method: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. Results: Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). Conclusion: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

AB - Objective: To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. Method: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. Results: Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). Conclusion: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

KW - self-injurious behavior

KW - emergency psychiatric services

KW - COVID-19 pandemic

KW - child psychiatry

KW - adolescent psychiatry

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U2 - 10.1016/j.jaac.2022.11.016

DO - 10.1016/j.jaac.2022.11.016

M3 - Article

SN - 0890-8567

VL - 62

SP - 998

EP - 1009

JO - Journal of the American Academy of Child and Adolescent Psychiatry

JF - Journal of the American Academy of Child and Adolescent Psychiatry

IS - 9

ER -

Self-Harm in Children and Adolescents who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

Abstract

Keywords

UN SDGs

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