Suicide-Related Emergency Department Visits Before and During the COVID-19 Pandemic in the United States

Background and aim  The impact of COVID-19 on suicide rates is a significant concern, given the widely recognized psychological effects that the pandemic has had on mental health. Overall, suicide trends remained relatively stable. Yet, specific age groups, races, and genders experienced an increase in suicide rates. A better understanding of suicide trends over time is critical to identifying and addressing mental health crises exacerbated by the pandemic. This study aimed to study whether the years preceding and during the pandemic were associated with an increase in emergency department (ED) visits in the United States for suicide or intentional injury.  Methodology Secondary analyses of data from the National Hospital and Ambulatory Medical Care Survey (2018-2021) were conducted. The frequency of ED visits due to intentional injury or suicide was compared in 2018-2019 (pre-COVID-19 pandemic onset) to those of 2020-2021 (during-COVID-19 onset). Logistic regression was used to estimate odd ratios (ORs) and corresponding 95% confidence intervals. Patient's race, sex, age, and regional differences were assessed as covariates. Results There were 27,516 and 22,247 visits assessed in the pre- and during-COVID-19 periods, respectively. In total, 1,375 visits were due to intentional injury/suicide. No differences were found comparing the proportion of visits due to intentional injuries/suicide pre- and during-COVID-19 periods (2.6% in both) The adjusted OR (aOR) comparing pre- versus during-COVID-19 for emergency room visits due to intentional injury/suicide was not significantly different from 1 (aOR = 0.98, 95% CI 0.84-1.15). The odds of suicide/intentional injury were 53% higher in males (aOR = 1.53, 95%CI 1.30-1.81), in those with ages 18-44 years (aOR = 7.24, 95% CI 4.92-10.67) and 45-64 years (aOR = 3.55, 95% CI 2.31-5.47) compared to those 65 years or older, and in non-Hispanic Black individuals compared to non-Hispanic White individuals (aOR = 1.29, 95% CI 1.05-1.58).  Conclusions Using a national sample of ED visits, we found no association between the pre- and COVID-19 pandemic periods and the proportion of visits due to intentional injury/suicide. However, the study's proportional prevalence design limits its ability to estimate actual risk, requiring a cautious interpretation of the findings. Despite these limitations, the observed increased odds of suicide or intentional injury in specific subgroups underscore the need for targeted interventions. Further research is crucial to assess the long-term impacts of COVID-19.