Publication date: Feb 01, 2025

Evidence suggests that the coronavirus disease 2019 pandemic negatively affected children’s mental health (MH). The emergency department (ED) is often the first point of contact with a physician for youth who are experiencing suicidal thoughts and behaviors. Population-level reports of ED utilization in South Carolina for suicidal ideation (SI) and suicide attempts (SAs) during the pandemic are lacking. This study compares trends in ED visits for SI and SAs among youth in South Carolina ages 5 to 24 years, before (ie, March-December 2019) and during (ie, March-December 2020) the coronavirus disease 2019 pandemic. We examined 16,906 deidentified patient records from the South Carolina Revenue and Fiscal Affairs Office. Dispositional outcomes, type of insurance, ED utilization, and mortality also were reviewed. The total number of ED visits for SI or an SA decreased during the pandemic, but the percentage of MH-related and total ED visits attributed to SI and SAs relative to other conditions increased. The pandemic negatively affected youth with preexisting utilization of EDs for MH reasons, SI, and SAs, but also those without prior ED visits for these reasons. Many youths who presented to an ED during the pandemic for SI or SAs had subsequent ED visits for MH concerns, SI, or an SA. The percentage of MH- and SI/SA-related visits increased during the pandemic. These data underscore the need for adequate MH services in EDs and increased access to outpatient MH resources to reduce the strain on EDs during public health emergencies.

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