key: cord-0943101-lx15bfl3
authors: Mourouvaye, Maymouna; Bottemanne, Hugo; Bonny, Guillaume; Fourcade, Lola; Angoulvant, Francois; Cohen, Jérémie F; Ouss, Lisa
title: Association between suicide behaviours in children and adolescents and the COVID-19 lockdown in Paris, France: a retrospective observational study
date: 2020-12-22
journal: Arch Dis Child
DOI: 10.1136/archdischild-2020-320628
sha: a0789cc10fe4c4a8414b14a8b5b733b9fa98dd3e
doc_id: 943101
cord_uid: lx15bfl3

This retrospective observational study conducted in Necker Hospital for Sick Children, France (January 2018–June 2020) evaluated a potential temporal association between admissions for suicide behaviours in children and adolescents and the national COVID-19 lockdown (March–May 2020). During the study period, 234 patients were admitted for suicide behaviours (28% male; mean age 13.4 years). Using Poisson regression, we found a significant decrease in the incidence of admissions for suicide behaviour during the lockdown (adjusted incidence rate ratio: 0.46; 95% CI 0.24 to 0.86). This association might result from reduced help-seeking and decreased hospital admission rates during the lockdown, as well as cognitive and environmental factors. Further multicentre studies should be conducted to confirm these findings and investigate whether a compensatory rise in admissions for suicide behaviour occurred in the postlockdown period.

During the last decade, the prevalence of suicide attempts has significantly increased in children and adolescents, turning out to be a pervasive public health concern. 1 Besides, global health, social and economic crisis may constitute important stressing factors. The outbreak of the SARS-CoV-2 (or COVID-19) has affected all countries around the world. During the current COVID-19 pandemic, the lockdown may have influenced mental well-being. 2 Notably, the lockdown may have had an impact on suicidal behaviour in children and adolescents. 3 However, little is known about the psychiatric consequences of lockdown. One study suggested that the COVID-19 pandemic in Japan has not affected suicide rates among children and adolescents. 4 We evaluated a potential temporal association between admissions for suicide behaviours and the COVID-19 lockdown in a paediatric hospital in Paris, France.

We conducted a retrospective observational study at Necker-Enfants Malades Hospital, a large university hospital in Paris, France. We included patients aged 7-17 years old admitted for suicidal behaviour between 1 January 2018 and 1 June 2020 in paediatric and emergency paediatric units. All patients received a psychiatric examination. The follow-up was jointly made by both paediatricians and child and adolescent psychiatrists. The diagnosis of suicide behaviour included suicide attempts and suicide crisis, as defined by the International Classification of Diseases, 10th revision. Patients were identified based on discharge codes.We defined two periods: Period 1: before and after the lockdown, and period 2: during the French COVID-19 lockdown (ie, between 16 March 2020 and 10 May 2020). All procedures were in accordance with the ethical principles of the Declaration of Helsinki.

The characteristics of patients admitted for suicidal behaviour were compared between period 1 and Period 2 using standard univariate tests. Then, we used Poisson regression to model the count of patients admitted for suicidal behaviour per week. Independent variables included the lockdown period and summer breaks (ie, July and August weeks). Associations were expressed as incident rate ratios (IRR). Statistical analysis was performed using Stata V.15/SE.

During the study period, 234 children were admitted for suicide behaviour (28% male; mean 13.4 years (SD 1.8)). There was no significant What is already known? ► During the current COVID-19 pandemic, the lockdown may have influenced mental well-being. ► Few studies have explored children and adolescent suicide behaviour during the COVID-19 pandemic.

► This study is the first exploring hospital admission for suicide behaviour in child and adolescent during COVID-19 lockdown. ► We found a 50% decrease in the incidence of suicide behaviours in children and adolescents during the COVID-19 lockdown. ► This association might result from reduced helpseeking and decreased hospital admission rates during the lockdown, as well as cognitive and environmental factors. 

This study is the first exploring hospital admission for suicide behaviour in child and adolescent during COVID-19 lockdown. The only study that investigated suicide rates among children and adolescents during the COVID-19 pandemic explored only the school closure period. 4 We found a 50% decrease in the incidence of suicide behaviour in children and adolescents during the COVID-19 lockdown. This association might result from a combination of several factors. First, the observed decrease in suicidal behaviours may reflect reduced help-seeking and a global decrease in hospital admission rates during the lockdown. Moreover, some environnemental and cognitive factors could also be involved, such as buffering-copying mechanisms and changes in familial and lifestyle dynamics during the lockdown. Suicide behaviour in children and adolescents is traditionnaly associated with perceived burdensomeness, thwarted belongingness and feeling of hopelessness and also school harassment and social withdrawal. 5 The lockdown may have disrupted these dimensions, thus increasing the feeling of belonging and social connectedness. Our study was conducted in a single hospital on a short period, which may limit the generalisability of the findings. Further studies are needed to investigate whether change in hospital admissions may have impacted the number of suicide behaviours, whether a compensatory rise in admissions will occur in the postlockdown period and whether suicide behaviour in children and adolescents could change during a second lockdown period. Further studies should evaluate the influence of copying factors in children and adolescents, and the mechanisms underlying the effects of globalised health threat and pandemic lockdown on suicidal behaviour. In our world with recurrence of epidemic risk, this could help to develop preventive interventions. 6 

Suicidal attempts and ideation among children and adolescents in US emergency departments

Suicide mortality and coronavirus disease 2019-A perfect storm?

Suicidality in children and adolescents: lessons to be learned from the COVID-19 crisis

Do suicide rates in children and adolescents change during school closure in Japan? the acute effect of the first wave of COVID-19 pandemic on child and adolescent mental health

Psychosocial risk factors for suicidality in children and adolescents

Suicide risk and prevention during the COVID-19 pandemic

Competing interests None declared.

Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data concern number of patients admitted for suicidal behavior without any identified participant.

Maymouna Mourouvaye http:// orcid. org/ 0000-0002-5266-9836 Hugo Bottemanne http:// orcid. org/ 0000-0003-2958-0849 Jérémie F Cohen http:// orcid. org/ 0000-0003-3572-8985