Pediatric ED visits, hospitalizations for self-harm up during pandemic, especially in adolescent females; "Less is better" is the best message when talking to patients about alcohol

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Pediatric ED visits and hospitalizations for self-harm, suicidal thoughts increased in Canada during pandemic, especially in young adolescent females "Less is better" is the best message when talking to patients about alcohol Pediatric ED visits and hospitalizations for self-harm, suicidal thoughts increased in Canada during pandemic, especially in young adolescent females

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.

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"Hospital admissions for suicidal ideation, self-poisoning, and self-harm increased significantly in the first 2 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%, from 5293 visits per quarter in the prepandemic period to 6060 visits per quarter during the pandemic. All-cause ED visits decreased 25%, 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%, 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 prepandemic period. The study included data from ICES and CIHI from January 2017 to June 2022.

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Some findings:

Emergency department visits and hospital admissions for self-harm increased 29% and 72%, 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% 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.

Post-publication link: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220507

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

Post-publication link: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.230127

Media contact for Dr. Naveen Poonai (pan-Canadian study):

Amanda Taccone, Communications, Lawson Health Research Institute, amanda.taccone@lawsonresearch.com

Media contact for Dr. Natasha Saunders (Ontario study):

Sarah Warr, SickKids, sarah.warr@sickkids.ca 

"Less is better" is the best message when talking to patients about alcohol

What are safe alcohol consumption levels for Canadians? "Less is better," write the authors of an editorial published in CMAJ (Canadian Medical Association Journal), referencing the alcohol consumption guideline published in early 2023 by the Canadian Centre on Substance Use and Addiction (CCSA).

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The CCSA guideline, which recommends a much lower threshold of 3 drinks per week for safe consumption, compared with the previous guidance of 10 drinks for females and up to 15 for males, has sparked confusion and debate around safe thresholds for alcohol consumption.

"Ultimately, clinicians should communicate to patients that alcohol consumption, at even low levels, has adverse effects on health; many patients are likely unaware of the carcinogenic effects of alcohol," write Drs. Savita Rani, outgoing CMAJ editorial fellow and a senior resident in public health, and Andreas Laupacis, CMAJ senior deputy editor.

As a carcinogen, alcohol is linked to many types of cancer. It can also increase the risk of liver disease, mental health disorders and other diseases.

"Patients who have alcohol-related diseases or risk factors for those diseases will benefit the most from a reduction in alcohol consumption. Patients who do not should be counselled that less alcohol is better in terms of overall health and encouraged to balance any benefits they may derive from alcohol consumption with its negative health effects," they conclude.

"'Less is better' is the best message when talking to patients about alcohol" is published September 18, 2023.

MEDIA NOTE: Please use the following public link after the embargo lift:

Editorial: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.231238

General media contact: Kim Barnhardt, CMAJ, kim.barnhardt@cmaj.ca

Please credit CMAJ, not the Canadian Medical Association (CMA). CMAJ is an independent medical journal; views expressed do not necessarily reflect those of its owner, CMA Impact Inc., a CMA company, or CMA.

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