Pandemic-Related Emergency Psychiatric Presentations for Self-Harm of Children and Adolescents in 10 Countries (PREP-Kids): A Retrospective International Cohort Study

Background: Suicide is the second leading cause on death in young people and self-harm is one of the strongest predictors of death by suicide. Little is known about the impact of covid-19 lockdown on hospital presentations with self-harm. Method: We used electronic patient records from 23 hospital emergency departments in 10 countries to examine differences in hospital emergency psychiatric presentations for self-harm of youths through age 18 in March and April 2020 compared with the same period in 2019. To compare the number of hospital presentations a negative binomial model was used. For other variables, individual participant data (IPD) meta-analyses were carried out. Findings: The total number of emergency psychiatric hospital presentations decreased from 1,239 in 2019 to 834 in 2020, IRR 0·67, 95% CI 0·62-0·73. The proportion of youths presenting with self-harm increased from 50% in 2019 to 57% in 2020, OR 1·33, 95% CI 1·07-1·64, but there was no difference in the proportion presenting with severe self-harm. Within self-harm presentations, the proportion of youths with emotional disorders increased from 58% to 66%, OR 1·58, 95% CI 1·06-2·36. The proportion of youths admitted to an observation ward also decreased from 13% to 9% in 2020, OR 0·52, 95% CI 0·28 to 0·96. There were no differences in other outcomes and no evidence that youths from deprived areas or from ethnic minorities were disproportionally affected. Interpretation: During lockdowns, there are likely to be fewer hospital emergency psychiatric presentations. Many children and adolescents with psychiatric emergencies might not receive any service. Developing intensive community care services with outreach capabilities should be prioritised. Funding Statement: None. Declaration of Interests: In the last three years Dr. Carucci had collaborations within projects from the European Union (7th Framework Program) and as sub-investigator in sponsored clinical trials by Shire Pharmaceutical Company, Lundbeck, Otsuka, Janssen Cilag and Angelini. Travel support from Fidia Farmaceutici. PLP has received research funding from the German Federal Ministry of Education and Research (BMBF), the German Federal Institute for Drugs and Medical devices (BfARM), the Baden Wuerttemberg state foundation, eh Volkswagen foundation, Lundbeck and Servier. He received a speaker´s honorarium from Shire. All remaining authors have no competing interests to declare. Ethics Approval Statement: This study is based on the data from the NCDR obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The study was approved by the King’s College London/South London and Maudsley NHS Foundation Trust service evaluation and clinical audit committee Ref no: AP1312/05/2020.