Suicide risk in adolescents during the COVID-19 pandemic

BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic created high levels of psychological distress and may have increased suicide risk.
METHODS
We used the 4-item Ask Suicide-Screening Questions (ASQ) to assess suicide risk among all patients 12 to 24 years of age at a children’s hospital. We compared demographics, encounter type (telehealth or face-to-face [F2F]), and screening results from April to June 2020 (T2) to those from April to June 2019 (T1).
RESULTS
Fewer patients were seen at T2 than T1 (17 986 vs 24 863). A greater proportion of visits at T2 were by telehealth (0% vs 43%). The rate of positive suicide screens was higher in T2 than in T1 (12.2% vs 11.1%, adjusted odds ration [aOR], 1.24; 95% confidence interval [CI], 1.15–1.35). The odds of a positive screen were greater for older patients (aOR of 1.12 for age in years; 95% CI, 1.10–1.14), female patients (aOR, 2.23; 95% CI, 2.00–2.48), patients with public versus private insurance (aOR, 1.88; 95% CI, 1.72–2.07), and lower for Black versus White patients (aOR, 0.85; 95% CI, 0.77–0.95). Rates of positive screens were highest among inpatients (20.0%), intermediate for emergency department patients (14.4%), and lowest in outpatient clinics (9.9%) (P < .05).
CONCLUSIONS
Rates of positive suicide risk screens among adolescents rose in the pandemic’s early months with differences related to sociodemographics and visit type. Changes in health care delivery highlight the complexities of assessing and responding to mental health needs of adolescents. Additional research might determine the effects of screening methods and patient populations on screening results.