Factors associated with gender specific adolescent presentations to the emergency department for suicide risk behaviors during the COVID-19 pandemic

Abstract

Background

Adolescent presentations to the emergency department (ED) for suicide-related thoughts and behaviors (SRTBs) increased during the COVID-19 pandemic. Gender expansive youth were particularly impacted by the loss of gender-specific services, however, data examining ED pandemic presentations of gender expansive youth for SRTBs are scarce.

Methods

Data were collected at a tertiary care center in Canada. Adolescents aged 12 to 17 presenting with SRTBs were recruited during two periods: March 2018 - March 2020 (pre-pandemic) and March 2021 - May 2023 (during pandemic). Patient demographics, mental health symptoms, and pre-ED visit healthcare utilization were examined.

Results

We identified 202 adolescents (70 pre-pandemic; 132 during pandemic), with a mean age of 14.3 years. Compared with pre-pandemic, during pandemic adolescents were more likely to identify as gender expansive [pre: 5.7% versus during: 24.2%; p = .01] and were of European descent [pre: 28.6% versus during: 59.1%; p < .01]. During the pandemic, gender expansive adolescents, on average, exhibited higher suicidal ideation, measured by Suicide Ideation Questionnaire Junior scores, compared with cisgender adolescents [gender expansive: mean = 64.3 (standard deviation = 12.1) versus cisgender participants: mean = 58.0 (standard deviation = 14.5); p = .03]. There were no differences in demographics, healthcare utilization, depression or anxiety symptom severity between gender expansive and cisgender adolescents.

Conclusions

Adolescents presenting to the ED with SRTBs during the pandemic were more likely to identify as gender expansive than those presenting pre-pandemic. Gender expansive adolescents exhibited increased suicidal ideation compared to cisgender adolescents during the pandemic.

Plain language summary

During the COVID-19 pandemic, emergency departments experienced an increase in suicide-related visits by adolescents. Gender expansive youth, i.e., youth whose gender identity does not align with their assigned sex at birth, were particularly impacted due to the loss of gender-specific services. In this study, we investigated possible factors to better understand the differences in suicide-related emergency department visits before and during the pandemic between cisgender and gender expansive adolescents. Our study comprised of 70 adolescents before the pandemic and 132 during the pandemic. We saw an increase in gender expansive youth and adolescents of European descent that visited the emergency department due to suicide-related concerns during the pandemic. We also found higher suicidal ideation among gender expansive adolescents compared to cisgender youth during the pandemic. However, gender expansive and cisgender adolescents did not differ in demographic characteristics, healthcare utilization, depression or anxiety symptoms. The pandemic appears to have changed the profile of adolescents seeking emergency department care for suicide-related concerns, emphasizing the importance of addressing gender diversity and shifts in outpatient mental health care utilization during societally stressful times.

Keywords

Adolescent gender expansive suicide related thoughts and behaviors COVID-19

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