Reductions in suicidal and self-harm presentations to emergency departments (EDs) since COVID-19 indicate changes in help-seeking behaviours, but it is unknown if hospital avoidance equally affects all population groups.
Method:
Socio-demographic and clinical information relating to suicidal and self-harm presentations to EDs in Queensland, Australia, were compared for the period before (March–August 2019) and since the COVID-19 outbreak (March–August 2020).
Results:
Since COVID, Indigenous Australians and persons with less severe suicidal and self-harm presentations had significantly reduced presentations, while persons younger than 18 years had more presentations. Less suicidal presentations resulted in an admission to inpatient care.
Conclusions:
Patterns of reduced attendance to ED in some groups suggest the need for innovative and community-based models of care to help prevent suicides during the pandemic.
BrownSSchumanDL. Suicide in the time of COVID-19: a perfect storm. J Rural Health2020. Doi:10.1111/jrh.12458.
2.
PfefferbaumBNorthCS. Mental health and the Covid-19 pandemic. N Engl J Med2020; 383: 510–512.
3.
DragovicMPascuVHallT, et al. Emergency department mental health presentations before and during the COVID-19 outbreak in Western Australia. Australas Psychiatry2020. Doi:10.1177/1039856220960673.
4.
SmalleyCMMaloneDAMeldonSW, et al. The impact of COVID-19 on suicidal ideation and alcohol presentations to emergency departments in a large healthcare system. Am J Emerg Med2020. Doi:10.1016/j.ajem.2020.05.093.
5.
HoyerCEbertASzaboK, et al. Decreased utilization of mental health emergency service during the COVID-19 pandemic. Eur Arch Psychiatry Clin Neurosci2020. Doi:10.1007/s00406-020-01151-w.
6.
MitchellRDO'ReillyGMMitraB, et al. Impact of COVID-19 state of emergency restrictions on presentations to two Victorian emergency departments. Emerg Med Australas2020. Doi:10.1111/1742-6723.13606.
7.
WongLHawkinsJLangnessS, et al. Where are all the patients? Addressing COVID-19 fear to encourage sick patients to seek emergency care. NEJM Catalyst2020. Doi:10.1056/cat.20.0193.
8.
COVID-19 National Incident Room Surveillance Team. COVID-19 Australia: epidemiology report 24. Commun Dis Intell2020. Doi:10.33321/cdi.2020.44.75.
9.
SveticicJStapelbergNJTurnerK. Reduced suicidal presentations to emergency department during COVID-19 outbreak in Queensland, Australia. Med J Aust. accepted.
10.
Queensland Health. The Health of Queenslanders 2018: report of the Chief Health Officer Queensland. Brisbane: Queensland Government, 2018.
11.
StapelbergNJSveticicJHughesI, et al. Suicidal presentations to emergency departments in a large Australian public health service over 10 years. J Environ Res Public Health2020; 17: 5920.
12.
YashadhanaAPollard-WhartonNZwiAB, et al. Indigenous Australians at increased risk of COVID-19 due to existing health and socioeconomic inequities. Lancet Regional Health-Western Pacific2020. Doi:10.1016/j.lanwpc.2020.100007.
13.
De LeoDSveticicJMilnerA. Suicide in Indigenous people in Queensland, Australia: trends and methods, 1994–2007. Aust N Z J Psychiatry2011; 45: 532–538.
14.
SveticicJMilnerADe LeoD. Contacts with mental health services before suicide: a comparison of Indigenous with non-Indigenous Australians. Gen Hosp Psychiatry2012; 34: 185–191.
15.
HunterETraversHGibsonJ, et al. Bridging the triple divide: performance and innovative multimedia in the service of behavioural health change in remote Indigenous settings. Australas Psychiatry2007; 15: 44–48.
16.
LiHWangSZhongF, et al. Age-dependent risks of incidence and mortality of COVID-19 in Hubei Province and other parts of China. Front Med2020. Doi:10.3389/fmed.2020.00190.
17.
PowerEHughesSCotterD, et al. Youth mental health in the time of COVID-19. Ir J Psychol Med2020. Doi:10.1017/ipm.2020.84.
18.
MilnerAKõlvesKKõlvesK, et al. Treatment priority for suicide ideation and behaviours at an Australian emergency department. World J Psychiatr2013; 3: 34–38.
19.
Al-KhafajiKLoyJKellyA-M. Characteristics and outcome of patients brought to an emergency department by police under the provisions (Section 10) of the Mental Health Act in Victoria, Australia. Int J Law Psychiatry2014; 37: 415–419.
20.
OseranASNashDKimC, et al. Changes in hospital admissions for urgent conditions during COVID-19 pandemic. Am J Manag Care2020; 26: 327–328.
21.
MitchellRDO'ReillyGMMitraB, et al. Impact of COVID-19 state of emergency restrictions on presentations to two Victorian emergency departments. Emerg Med Australas2020. Doi:10.1111/1742-6723.13606.
22.
PatonFWrightKAyreN, et al. Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care. J Health Technol Assess2016. Doi:10.3310/hta2030.
23.
XiangY-TZhaoY-JLiuZ-H, et al. The COVID-19 outbreak and psychiatric hospitals in China: managing challenges through mental health service reform. Int J Biol Sci2020; 16: 1741–1743.
24.
MaguireARossEO’HaganD, et al. Suicide ideation and mortality risk: population wide data linkage study. J Epidemiol Commun Health2019; 73: A60.
25.
SveticicJStapelbergNCTurnerK. Suicidal and self-harm presentations to emergency departments: the challenges of identification through diagnostic codes and presenting complaints. Health Inf Manag J2020; 49: 38–46.
26.
LeskeSAdamGSchraderI, et al. Suicide in Queensland: Annual Report 2020. Brisbane: AISRAP, Griffith University, 2020.
27.
LazzeriniMBarbiEApicellaA, et al. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health2020; 4: e10–e11.
28.
ZulficZLiuDLloydC, et al. Is telepsychiatry care a realistic option for community mental health services during the COVID-19 pandemic?Aust N Z J Psychiatry2020. Doi:10.1177/0004867420937788.
