Tufan, Ali EvrenWong, Ben Hoi-ChingCross, SamanthaRamirez, Patricia ZavaletaBauda, InesHoffman, Pamela2024-05-062024-05-062023Wong, B. H. C., Cross, S., Zavaleta-Ramírez, P., Bauda, I., Hoffman, P., Ibeziako, P., ... & Ougrin, D. (2023). Self-harm in children and adolescents who presented at emergency units during the COVID-19 pandemic: An international retrospective cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 62(9), 998-1009.0890-85671527-5418http://dx.doi.org/10.1016/j.jaac.2022.11.016https://hdl.handle.net/20.500.12491/12119Dr. Bauda has reported support by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and the NIHR Applied Research Centre at King's College Hospital NHS Foundation Trust, King's College London. Dr. Ibeziako has received grant funding from the National Heart Lung and Blood Institute (NHLBI) for research unrelated to the current study, over the past 24 months. Dr. Romaniuk has reported support by NHS Education for Scotland. Dr. Davico has received consultant fees from Roche and Lundbeck. Dr. Carucci had collaborations within projects from the European Union (7th Framework Program) and in sponsored clinical trials by Shire Pharmaceutical Company, Lundbeck, Otsuka, Janssen-Cilag, and Angelini. Dr. Elvins has received grant funding from the NIHR. Dr. Girela Serrano has reported support by a fellowship funded by the Koplowitz Foundation. Dr. Lamberti has provided a paid expert testimony for Janssen. Drs. Zavaleta-Ramirez, Hoffman, Nussbaum, Berger, Hassanian-Moghaddam, Kapornai, Mehdi, Tolmac, Barrett, Moghraby, Ostrauskaite, Chakrabarti, Sofi, Hussain, Lloyd, McNicholas, Meadowcroft, Rao, Csabi, Gatica-Bahamonde, Ogutlu, Skouta, Boege, Dahanayake, Anderluh, Chandradasa, Uccella, Stevanovic, Nagy, Mehta, Rohanachandra, Li, Tufan, Mirza, Rozali, Baig, Noor, Fujita, Gholami, Hangul, Vasileva, Salucci, Bilac, Yektas, Cans & imath;z, Aksu, Babatunde, Youssef, Al-Huseini, Kilicaslan, Kutuk, Pilecka, and Bakolis, Prof. Ougrin, Mr. Wong, and Mss. Cross and Piercey have reported no biomedical financial interests or potential conflicts of interest that could influence or be perceived to influence their work.Objective: To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre pandemic, and to examine the changes in the characteristics of self-harm presentations.Method: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed.Results: Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58).Conclusion: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs.Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.eninfo:eu-repo/semantics/openAccessSelf-Injurious BehaviorEmergency Psychiatric ServicesCOVID-19 PandemicYouth Mental HealthEpidemiologySuicide AttemptsArticle10.1016/j.jaac.2022.11.0166299981009368067282-s2.0-85150844412Q1WOS:001084726700001Q1