The COVID-19 pandemic had an outsized impact on the mental health of adolescents, especially young adolescent females, with a higher-than-expected number of emergency department (ED) visits and hospitalizations for self-harm and suicidal ideation, according to two new research studies published in CMAJ (Canadian Medical Association Journal).

Pan-Canadian study

Researchers from the Pediatric Emergency Research Canada (PERC) network, a network of health care researchers from 15 children’s hospitals, looked at emergency department visits and hospitalizations across Canada for adolescents aged 10–18 years to determine if visits and admissions increased during the pandemic.

“Hospital admissions for suicidal ideation, self-poisoning, and self-harm increased significantly in the first two years of the COVID-19 pandemic among adolescent females,” said Dr. Naveen Poonai, a scientist at Lawson Health Research Institute, a pediatric emergency medicine physician at Children’s Hospital at London Health Sciences Centre, and associate professor at Schulich School of Medicine & Dentistry, Western University, London, Ontario. “What came as a surprise to us is that the greatest increase was among younger adolescent females, a demographic that is often overlooked.”    

The study included data from the Canadian Institute for Health Information (CIHI) from April 2015 to March 2022.

Some findings:

• Emergency department visits for suicidal ideation, self-harm and self-poisoning increased 14.5 per cent, from 5293 visits per quarter in the prepandemic period to 6060 visits per quarter during the pandemic.

• All-cause ED visits decreased 25 per cent, from 230 080 visits in the prepandemic period to 172 180 visits during the pandemic.

• Hospital admissions for suicidal ideation, self-poisoning and self-harm increased 11 per cent, from 1590 admissions per quarter in the prepandemic period to 1770 per quarter during the pandemic.

Ontario study

A large study on self-harm in Ontario during the first 28 months of the pandemic found similar results to the pan-Canadian study. Researchers from The Hospital for Sick Children (SickKids), ICES, Sunnybrook Health Sciences Centre and others found that the number of acute care visits for self-harm was higher than expected among 1.3 million adolescents aged 10–17 years, particularly in females, during the pandemic than during the pre-pandemic period. The study included data from ICES and CIHI from January 2017 to June 2022.

Some findings:

• Emergency department visits and hospital admissions for self-harm increased 29 per cent and 72 per cent, respectively, above expected levels during the pandemic.

• The increases were greatest among females, especially those aged 10–13 years, in whom ED visits increased 62 per cent above expected levels and hospitalizations were 3.5 times greater than expected levels.

• The increases in acute care visits for young females were observed in both those who had never previously received physician-based mental health care and those who had recently received care from a physician.

Although neither study could determine what caused the increases in visits for self-harm in this vulnerable age group, the authors suggest the disruptions of the pandemic may have been a factor.

“Findings may reflect the prolonged and cumulative effects of pandemic-related stressors on this younger age group such as social isolation, loss of routines, missed milestones, changing learning environments, familial stress, inadequately treated psychiatric conditions, substance misuse or changing patterns of mental health service use at a critical point in their developmental trajectory,” writes Dr. Natasha Saunders, a pediatrician and clinician-investigator at SickKids and an adjunct scientist at ICES, Toronto, Ontario, with coauthors.

The authors of both studies urge action on this critical issue.

“Our findings underscore an urgent need for public health policies to mitigate the impact of the COVID-19 pandemic and future pandemics on the mental health of adolescents,” said Dr. Poonai, “including developmentally appropriate screening programs for suicide risk that include younger
adolescents.”

“Beyond the pandemic, it will be important to understand the factors driving the observed upward trend in self-harm among youth,” said Dr. Saunders. “Long-term suicide prevention strategies among youth should be age-, sex- and gender-specific; include upstream interventions; and target pandemic-associated stressors. In the short term, accessible and intensive mental health supports are needed for this segment of the pediatric
population.”

“Emergency department visits and hospital admissions for suicidal ideation, self-poisoning and self-harm among adolescents in Canada during the COVID-19 pandemic” is
published September 18, 2023.

“Self-harm among youth during the first 28 months of the COVID-19 pandemic in Ontario, Canada: a population-based study” was published September 18, 2023.