Trends in Presentations for Suicidal Ideation in an Emergency Department During COVID-19

Friday, November 12, 2021

4:00 PM - 5:00 PM US Eastern Time

Trends in Presentations for Suicidal Ideation in an Emergency Department During COVID-19

Objective: This study aims to detail changes in presentations at a United States Emergency Department for suicidality before and after the outbreak of COVID-19.

Methods: A retrospective chart review was conducted of all adult patients who presented to an ED with suicidality and underwent psychiatric consultation during the study period. The cohorts consisted of patients who presented between December 2018 – May 2019 and December 2019 – May 2020. Information was collected on demographics, characteristics of suicidality, reasons for suicidality and disposition. The first wave from March – May 2020 was examined, using a difference-in-differences design to control for factors other than COVID-19 that may have influenced the outcomes’ trend.

Results: Immediately following the pandemic outbreak there was a statistically significant increase in the proportion of undomiciled patients represented in visits for suicidality (40.7% vs. 57.4%; p-value < 0.001). In addition, the proportion of patient visits attributed to social (18.0% vs. 29.2%; p-value 0.003) and structural (14.2% vs. 26.4%; p value < 0.001) reasons for suicidality increased. Conversely, the proportion of visits due to psychiatric symptoms (70.5% vs 50.0%; p-value < 0.001) decreased. Furthermore, patient visits were more likely to result in a medical admission (2.1% vs. 8.3%; p-value 0.002) and less likely to result in a psychiatric admission (68.4% vs 48.6%; p-value < 0.001) during the initial phase of the pandemic.

Conclusions: COVID-19 was associated with increased ED presentations for suicidality among undomiciled patients, as well as greater likelihood of social and structural reasons driving suicidality among all visits.

Learning Objectives:

To better understand the effects of COVID-19 on emergency department presentations for suicidal ideation

Presenting Author(s)

Mila Grossman, MD

Resident Physician
Massachusetts General Hospital
Cambridge, Massachusetts, United States

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Co-Author(s)

RM

Rachel MacLean, MD

Resident Physician
Massachusetts General Hosptail
Boston, MA, United States
Michal McDowell, MD

Resident Physician
Massachusetts General Hospital
Boston, Massachusetts, United States
MN

Mladen Nisavic, MD

Consultation-Liaison Psychiatry
MGH
Boston, MA, United States
Emily Sorg, MD

Psychiatrist
Massachusetts General Hospital
Boston, MA, United States
Charles Masaki, MD,PhD

Fellow, Consultation Liaison Psychiatry
Massachusetts General Hospital
Boston, Massachusetts, United States
CF

Carrie Fry, PhD

Assistant Professor of Health Policy
Vanderbilt School of Medicine
Nashville, Tennessee, United States
SB

Suzanne Bird, MD, DFAPA

Director, Acute Psychiatry Service
Massachusetts General Hospital
Boston, Massachusetts, United States
Felicia Smith, MD

Associate Chief of Psychiatry, MGH
MGH
Boston, MA, United States
Scott Beach, MD, FACLP

Program Director
Massachusetts General Hospital
Boston, Massachusetts, United States