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Background: The COVID-19 pandemic saw changes to the delivery of health services and concerns about psychological morbidity not directly related to COVID infection. We analyzed the effects of the pandemic on our hospital’s program to screen adolescents for suicidality.

Objective: To determine the effect of the COVID-19 pandemic on 1) a hospital-wide screening program for suicidality in teens; and 2) the prevalence of positive screens for suicidality.

Design/Methods: Our study population was all patients > 12yo seen as inpatients or in the ED or clinics at a children’s hospital in Apr-June in 2019 (T1) and 2020 (T2). Eligible pts were screened for suicide risk using the 4-item ASW (Ask Suicide-Screening Questions). A positive response to any ASQ question was defined as positive. Results and de-identified visit characteristics were maintained in a research repository. For T1 and T2, we compared overall visits, number of telemedicine (TM) visits, proportion of eligible patients screened, proportion of positive screens, and the effect of TM. We used generalized linear mixed-effects models to test for statistical significance.

Results: During T1, 24,860 patients had 38,455 visits, of which 15 (0.04%) were by TM. During T2, 16,359 patients had 24,073 visits, of which 3,372 (26.7%) were by TM. A higher percentage of eligible patients were screened at T1 relative to T2 (66.4% vs. 55.8%, z = -26.1, p < 0.001). The rate of screening in TM visits (T2 only, due to paucity of TM at T1) was lower than in in-person visits (39.3% vs 65.1%, z = -39.2, p<0.001). There was a higher percentage of positive screens during T2 than T1 - 12.1% vs. 10.7% (OR 1.15; z = 5.5, p < 0.001). Positive screen rates were lower in TM visits than in-person visits (10.8% vs. 12.8%; z = -3.4, p<0.001).

Conclusion(s): In the early months of the COVID-19 pandemic, patient encounters decreased by >50%. Even with this dimished volume, a lower percentage of eligible patients were screened for suicidality. The rate of positive screens was higher than a year earlier. Screening was lowest in TM visits. The higher rate of positive screens during the pandemic could reflect doctor selection in encouraging higher risk patients to keep appointments, patient self-selection in seeking care, and/or an actual higher rate of suicidality among teens. Any of these explanations is concerning. Fewer screenings and a higher rate of positivity suggest that, during the pandemict teens at risk for suicide may not have been identified, and the prevalence of suicidality may have increased.

Presented at the 2021 PAS Virtual Conference

Publication Date

5-2021

Disciplines

Behavioral Medicine | Bioethics and Medical Ethics | Pediatrics

When and Where Presented

Presented at the 2021 PAS Virtual Conference

The Effect of COVID-19 on the Detection and Prevalence of Suicidality in Adolescents

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