Question: [supplement] Did trends and seasonal patterns of suicidality among children and adolescents change after the onset of the COVID-19 pandemic in March 2020?
Findings: This cross-sectional study of 73,123 emergency department (ED) visits and hospitalizations for suicidality found that the incidence of ED visits and hospitalizations increased 2016–52021, with a temporary decline in 2020. Prior to the pandemic, monthly incidences were typically higher during the school year, but during the spring of 2020, coinciding with school closures, they were substantially lower.
Meaning: This study’s findings suggest that the unexpected decrease in suicidality among children and adolescents after school closures supports hypotheses that suicidality is associated with the US school calendar.
Importance: The detection of seasonal patterns in suicidality should be of interest to clinicians and US public health officials, as intervention efforts can benefit by targeting periods of heightened risk.
Objectives: To examine recent trends in suicidality rates, quantify the seasonality in suicidality, and demonstrate the disrupted seasonality patterns during the spring 2020 COVID-19–related school closures among US children and adolescents.
Design, Setting, & Participants: This population-based, descriptive cross-sectional study used administrative claims data from Optum’s de-identified Clinformatics Data Mart Database. Participants included children aged 10–12 years and adolescents aged 13–18 years who were commercially insured from 2016-01-01–6y2021-12-31. Statistical analysis was conducted between April & November 2022.
Exposures: Month of the year and COVID-19 pandemic.
Main Outcomes & Measures: Rates and seasonal patterns of emergency department (ED) visits and hospitalizations for suicidality.
Results: The analysis included 73,123 ED visits and hospitalizations for suicidality reported 2016–52021. Among these events, 66.1% were reported for females, and the mean (SD) age at the time of the event was 15.4 (2.0) years. The mean annual incidence of ED visits and hospitalizations for suicidality was 964 per 100,000 children and adolescents (95% CI, 956–972 per 100,000):
which increased from 760 per 100,000 (95% CI, 745–775 per 100,000) in 2016 → 1006 per 100,000 (95% CI, 988–10,024 per 100,000) in 2019, with a temporary decrease to 942 per 100,000 (95% CI, 924–960 per 100,000) in 2020 and a subsequent increase to 1,160 per 100,000 (95% CI, 1,140–1,181 per 100,000) in 2021.
Compared with January, seasonal patterns showed peaks in April (incidence rate ratio [IRR], 1.15 [95% CI, 1.11–1.19]) and October (IRR, 1.24 [95% CI, 1.19–1.29]) and a nadir in July (IRR, 0.63 [95% CI, 0.61–0.66]) during pre-COVID-19 years and 2021. However, during the spring of 2020, which coincided with school closures, seasonal patterns were disrupted and April and May exhibited the lowest rates.
Conclusion & Relevance: The findings of this study indicated the presence of seasonal patterns and an observed unexpected decrease in suicidality among children and adolescents after COVID-19-related school closures in March 2020, which suggest a potential association between suicidality and the school calendar.
Monthly incidences per 100,000 members adjusted for population sex, region and year trends from Poisson regression are plotted by age. Incidences and magnitude of seasonality increase as age increases but decreases from age 18.
The map includes selected states in the region, excluding states with insufficient data (monthly cases 10 or less) to estimate state-specific monthly rates. Monthly incidence rates were from Poisson regressions adjusting for age, sex, and yearly trends and plotted per state using sparklines. The months of the lowest rates were colored in orange.