Abstract

Objective: Suicide has been a leading cause death in adolescents nationally for years; the full effect of COVID-19 pandemic and social isolation on pediatric mental health and subsequent suicidality is not yet fully understood.
Method: This retrospective chart review describes trends in patients 4 to 17 years of age who presented to the emergency room or for hospital admission with suicidal thoughts or acts of self-harm from January 2012 to July 2022. Both change point and auto-regressive moving average (ARMA) models were fit to patient presentation numbers; expected change in presentation rates in pandemic months were compared to pre-pandemic time periods.
Results: There was an increasing pattern of suicidal ideation and self-harm presentations throughout the entire study period, with an average baseline increase of 0.015 patient presentations per week. Change point and ARMA models both demonstrated an increase in patient presentations around April 2020; ARMA modeling estimated 1.67 additional patient presentations per week above pre-pandemic model predictions.
Conclusion: In the pandemic time period, there were significantly more patient presentations for suicidal ideation and intentional self-harm than would have been expected based on pre-pandemic patterns. This volume has continued up to 2 years after the pandemic declaration and has both mental health access and resource implications.
Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group

Learning Points

This paper was really my first foray into change point modeling. The goal of the paper was to idenitfy the evolution of pediatric suicide ideation cases in the Emergency Department at the Oklahoma City Children’s Hospital. The entire time series can be found

The project was seeking to idenitfy if the COVID-19 panedmic influenced these presentation rates. A changepoint model was employed to idenitfy changes in the varaince and autoregressive patterns of these presentations. The model suggested a growth in the autoregresive parameter a month after the lockdown orders, here are the results of the changepoint

Recommended citation: DeLetter, A., Stafford, L., Rosen, A. F. G., Bard, D. E., & DeLeon, S. (2025). Seeking Care for Suicidal Thoughts and Actions: How COVID Affected Our Pediatric Patients. JAACAP Open. https://doi.org/10.1016/j.jaacop.2025.04.009